Delayed medical care and underlying health in the United States during the COVID-19 pandemic: A cross-sectional study

Gertz, Autumn; Pollack, Catherine C.; Schultheiss, Marinanicole D.; Brownstein, John S.

doi:10.1016/j.pmedr.2022.101882

Cited by 39 publications

(38 citation statements)

References 15 publications

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“…One potential explanation for the discrepancy in results is that our study consisted of data collected from patients as part of routine clinical care and included only patients who had the self-agency to access specialty orthopaedic services at our institution, whereas the previously cited studies were not patient-specific and consisted of data collected from the general population for research purposes only. Additionally, a recent study found that patients with poorer overall health and lower household income were more likely to avoid medical care during the pandemic in 2021 [12], and therefore, our results might have underestimated the true change in the health status of orthopaedic patients from communities with high levels of social deprivation by not capturing those who avoided orthopaedic care. Efforts to identify patients who avoided orthopaedic care during the pandemic and ensure they are now receiving proper care may be warranted.…”

Section: Discussionmentioning

confidence: 86%

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Hollenberg

Yanik

Hannon

et al. 2023

Clin Orthop Relat Res

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Background The 2019 novel coronavirus (COVID-19) pandemic has been associated with poor mental health outcomes and widened health disparities in the United States. Given the inter-relationship between psychosocial factors and functional outcomes in orthopaedic surgery, it is important that we understand whether patients presenting for musculoskeletal care during the pandemic were associated with worse physical and mental health than before the pandemic's onset. Questions/purposes (1) Did patients seen for an initial visit by an orthopaedic provider during the COVID-19 pandemic demonstrate worse physical function, pain interference, depression, and/or anxiety than patients seen before the pandemic, as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) instrument?(2) During the COVID-19 pandemic, did patients living in areas with high levels of social deprivation demonstrate worse patterns of physical function, pain interference, depression, or anxiety on initial presentation to an orthopaedic provider than patients living in areas with low levels of social deprivation, compared with prepandemic PROMIS scores? Methods This was a retrospective, comparative study of new patient evaluations that occurred in the orthopaedic department at a large, urban tertiary care academic medical center. During the study period, PROMIS computer adaptive tests were routinely administered to patients at clinical visits. Between January 1, 2019, and December 31, 2019, we identified 26,989 new patients; we excluded 4% (1038 of 26,989) for being duplicates, 4% (1034 of 26,989) for having incomplete demographic data, 44% (11,925 of 26,989) for not having a nine-digit home ZIP Code recorded, and 5% (1332 of 26,989) for not completing all four PROMIS computer adaptive tests of interest. This left us with 11,660 patients in the "before COVID-19" cohort. Between January 1, 2021 and December 31, 2021, we identified 30,414 new patients; we excluded 5% (1554 of 30,414) for being duplicates, 4% (1142 of 30,414) for having incomplete demographic data, 41% (12,347 of 30,414) for not having a nine-digit home ZIP Code recorded, and 7% (2219 of 30,414) for not completing all four PROMIS computer adaptive tests of interest. This left us with 13,152 patients in the "during COVID-19" cohort. Nine-digit home ZIP Codes were used to determine patients' Area Deprivation Indexes, a neighborhood-level composite measure of social deprivation. To ensure that patients included in the study represented our overall patient population, we performed univariate analyses on available demographic and PROMIS data between patients included in the study and those excluded from the study, This work was supported by the National Institutes of Health, United States P50 MH122351 (RPC). Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the autho...

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Section: Discussionmentioning

confidence: 86%

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Hollenberg

Yanik

Hannon

et al. 2023

Clin Orthop Relat Res

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“…While trends in high ED use may have changed since 2015, the factors leading to high ED use continue are likely to continue to be of interest, particularly that of the role of primary care settings who may see greater numbers of these patients. The COVID‐19 pandemic may have led to delayed outpatient care and increased morbidity leading to higher likelihood of ED visits 50 . Emerging research suggests ED visits have rebounded but have not returned to pre‐pandemic levels, and those that frequently receive their care at the ED may not return to the ED until they feel it is safe to do so 51 .…”

Section: Discussionmentioning

confidence: 99%

“…The COVID-19 pandemic may have led to delayed outpatient care and increased morbidity leading to higher likelihood of ED visits. 50 Emerging research suggests ED visits have rebounded but have not returned to pre-pandemic levels, and those that frequently receive their care at the ED may not return to the ED until they feel it is safe to do so. 51 Understanding the role of the factors examined in our study may be integral with increased populations that would shift to primary and alternative care settings for their care.…”

Section: Limitationsmentioning

confidence: 99%

Factors associated with frequent emergency department visits among health centre patients receiving primary care

Pourat¹,

Lu²,

Chen³

et al. 2023

Evaluation Clinical Practice

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Rationale, Aims and ObjectivesWe sought to examine specific care‐seeking behaviours and experiences, access indicators, and patient care management approaches associated with frequency of emergency department (ED) visits among patients of Health Resources and Services Administration‐funded health centres that provide comprehensive primary care to low‐income and uninsured patients.MethodWe used cross‐sectional data of a most recent nationally representative sample of health centre adult patients aged 18–64 (n = 4577) conducted between October 2014 and April 2015. These data were merged with the 2014 Uniform Data System to incorporate health centre characteristics. We measured care‐seeking behaviours by whether the patient called the health centre afterhours, for an urgent appointment, or talked to a provider about a concern. Access to care indicators included health centre continuity of care and receipt of transportation or translation services. We included receipt of care coordination and specialist referral as care management indicators. We used a multilevel multinomial logistic regression model to identify the association of independent variables with number of ED visits (4 or more visits, 2–3 visits, 1 visit, vs. 0 visits), controlling for predisposing, enabling, and need characteristics.ResultsCalling the health centre after‐hours (OR = 2.41) or for urgent care (OR = 2.53), and being referred to specialists (OR = 2.36) were associated with higher odds of four or more ED visits versus none. Three or more years of continuity with the health centre (OR = 0.32) was also associated with lower odds of four or more ED visits versus none.ConclusionsFindings underscore opportunities to reduce higher frequency of ED visits in health centres, which are primary care providers to many low‐income populations. Our findings highlight the potential importance of improving patient retention, better access to providers afterhours or for urgent visits, and access to specialist as areas of care in need of improvement.

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“…Last, it has to be mentioned that the observation period included the first waves of the COVID‐19 pandemic 3,8 . This challenging global health crisis caused many changes in society and might have led to a delay in patients seek for medical help, with a possible negative impact on clinical outcomes 27 …”

Section: Limitationsmentioning

confidence: 99%

Association of preclinical blood glucose with hospitalization rate and in‐hospital mortality: A single‐center retrospective cohort study

Kloock,

Skudelny,

Kranke

et al. 2024

JACEP Open

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ObjectiveCritical illness is often accompanied by elevated blood glucose, which generally correlates with increased morbidity and mortality. Prehospital blood glucose (PBG) level might be a useful and easy‐to‐perform tool for risk assessment in emergency medicine. This retrospective single‐center cohort study was designed to analyze the association of prehospital glucose measurements with hospitalization rate and in‐hospital mortality.MethodsRecords of 970 patients admitted to a university hospital by an emergency physician were analyzed. Patients with a PBG ≥140 mg/dL (G1, n = 394, equal to 7.8 mmol/L) were compared with patients with a PBG <140 mg/dL (G2, n = 576). Multivariable logistic regression models were used to correct for age, prediagnosed diabetes, and sex.ResultsFive hundred thirty‐four patients (55%) were hospitalized. In comparison to normoglycemic patients, hyperglycemic patients were more likely to be hospitalized with an adjusted odds ratio (OR) of 1.48 (95% confidence interval [CI] 1.11–1.97), more likely to be admitted to the intensive care unit (ICU) with an adjusted OR of 1.74 (95% CI 1.31–2.31) and more likely to die in the hospital with an adjusted OR of 1.84 (95% CI 0.96–3.53). Hospitalized hyperglycemic patients had a median length of stay of 6.0 days (interquartile range [IQR] 8.0) compared to 3.0 days (IQR 6.0) in the normoglycemic group (P < 0.001). In the subgroup analysis of cases without known diabetes, patients with PBG ≥140 mg/dL were more likely to be hospitalized with an adjusted OR of 1.49 (95% CI 1.10–2.03) and more likely to be admitted to ICU/intermediate care with an adjusted OR of 1.80 (95% CI 1.32–2.45), compared to normoglycemic patients.ConclusionElevated PBG ≥140 mg/dL was associated with a higher hospitalization risk, a longer length of stay, and a higher mortality risk and may therefore be included in risk assessment scores.

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Delayed medical care and underlying health in the United States during the COVID-19 pandemic: A cross-sectional study

Cited by 39 publications

References 15 publications

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Factors associated with frequent emergency department visits among health centre patients receiving primary care

Association of preclinical blood glucose with hospitalization rate and in‐hospital mortality: A single‐center retrospective cohort study

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