Consumer Reported Care Deferrals Due to the COVID-19 Pandemic, and the Role and Potential of Telemedicine: Cross-Sectional Analysis

Abstract

Background The COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge in hospitalizations. There have been concerns that care deferral may have negative health effects, but it is hoped that telemedicine can provide a viable alternative. Objective This study aimed to understand what type of health care services were being deferred during the COVID-19 pandemic lockdown, the role played by telemedicine to fill in care gaps, and changes in attitudes toward telemedicine. Methods We conducted a cross-sectional analysis of survey responses from 1694 primary care patients in a mid-sized northeastern city. Our main outcomes were use of telemedicine and reports of care deferral during the shutdown. Results Deferred care was widespread—48% (n=812) of respondents deferred care—but it was largely for preventive services, particularly dental and primary care, and did not cause concerns about negative health effects. In total, 30.2% (n=242) of those who delayed care were concerned about health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic; it was seen as a viable option to deliver deferred care, particularly by respondents who were over 65 years of age, female, and college educated. Mental health services stood out for having high levels of deferred care. Conclusions Temporary health system shutdowns will give rise to deferred care. However, much of the deferrals will be for preventive services. The effect of this on patient health can be moderated by prioritizing surgical and orthopedic services and delivering other services through telemedicine. Having telemedicine as an option is particularly crucial for mental health services.

COVID‐19 did not delay time from referral to definitive management for head and neck cancer patients in a regional Victorian centre

“…Although time to definitive management was not significantly affected by the pandemic, employing telemedicine did reduce the total number of clinical attendances. Furthermore, patients now view telemedicine more favourably since the pandemic 18 . This is an important finding in the context of the pandemic, which may instigate improvements to the future delivery of cancer care in non‐pandemic circumstances by reducing patient travel and clinic waiting room times.…”

A Review of Patient Satisfaction and Experience with Telemedicine: A Virtual Solution During and Beyond COVID-19 Pandemic

“…27 Age did not hinder attending virtual consultations, rather elderly patients who faced logistical difficulties benefitted through virtual visits 46 as not many alternatives were available during pandemic. 53 The older patients, however, usually required assistance for electronic communication. 24 Whatsapp, 39 facebook, 30 facetime, 7,32 and various software packages were used to provide a wider reach.…”

“…11,42,43,[65][66][67] Other major concerns regarding the usage of telemedicine involve legal, privacy, and security risks. 43,65,68 To incentivize the usage of telemedicine and for its long-term implementation, reimbursement for virtual 22,53 and telephonic visits 11 should be considered in health care financing. The Australian government has introduced funding for all patients without geographic restrictions for all telehealth consultations and also extended the funding to telephonic consultations.…”

COVID-19 and Sexual and Reproductive Health Care: Findings From Primary Care Providers Who Serve Adolescents

“…However, concerns have been raised about limited availability of in-person SRH care owing to clinic closures, cancellation of services deemed nonessential, and diversion of staff and other resources [ [3] , [4] , [5] ]. Even when services are available, reductions in walk-in and evening or weekend hours, which are considered youth-friendly practices [ 6 ], may limit adolescent access, or adolescents may forgo in-person care they deem nonessential to minimize coronavirus exposure [ 7 , 8 ]. Although the rapid expansion of telehealth has partially compensated for disruptions to in-person services [ 9 ], confidentiality concerns associated with this approach may be a particular barrier for adolescent patients [ 4 , [9] , [10] , [11] ].…”