Effect of the COVID-19 lockdown on disease recognition and utilisation of healthcare services in the older population in Germany: a cross-sectional study

Abstract

Background There is little evidence about the utilization of healthcare services and disease recognition in the older population, which was urged to self-isolate during the COVID-19 lockdowns. Objectives We aimed to describe the utilization of physician consultations, specialist referrals, hospital admissions, and the recognition of incident diseases in Germany for this age group during the COVID-19 lockdown. Design Cross-sectional observational study. Setting 1,095 general practitioners’ (GPs) and 960 specialist practices in Germany. Subjects 2.45 million older patients aged 65 or older. Methods The number of documented physician consultations, specialist referrals, hospital admissions, and incident diagnoses during the imposed lockdown in 2020 was descriptively analyzed and compared to 2019. Results Physician consultations decrease slightly in February (−2%), increase before the imposed lockdown in March (+9%), and decline in April (−18%) and May (−14%) 2020 compared to the same periods in 2019. Volumes of hospital admissions decrease earlier and more intensely than physician consultations (−39% vs. -6% respectively). Overall, 15%, 16%, and 18% fewer incident diagnoses were documented by GPs, neurologists, and diabetologists respectively in 2020. Diabetes, dementia, depression, cancer, and stroke were diagnosed less frequently during the lockdown (−17% to −26%), meaning that the decrease in the recognition of diseases was greater than the decrease in physician consultations. Conclusion The data suggest that organizational changes were adopted quickly by practice management, but also raise concerns about the maintenance of routine care. Prospective studies should evaluate the long-term effects of lockdowns on patient-related outcomes.

Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam

“…Our results extend previous research that was done in Germany based on medical record data of older adults [11]. This previous study showed that GP consultations and referrals to hospital specialist outpatient care decreased substantially (up to -39%) during the lockdown in the first wave of the pandemic.…”

“…Very few studies were undertaken in older populations. One study from Germany used healthcare registration data of older adults, and observed a decrease in healthcare use and diagnosis of diseases during the lockdown period, compared to the same period 1 year earlier [11]. Another study among older adults > 75 years in the UK revealed no major problems with access to healthcare services during the first months of the COVID-19 pandemic [12].…”

How COVID-19 has affected general practice consultations and income: general practitioner cross-sectional population survey evidence from Ireland

“…A recent German study with 1,095 GPs and patients aged 65 or older found that there was a 14% decrease in consultations in May 2020 compared with the same time in 2019, and the rate of diabetes, dementia, depression, cancer and stroke diagnoses decreased during this period (between −17% and −26%). 28 In a survey of Australian GPs, 73% of practices had a reduction in bookings and 77% had a decrease in practice income; meanwhile, telephone calls (93%) and practice costs (81%) increased. 17 These results support our survey’s findings that these challenges have also been experienced by GPs in Ireland.…”

Impact of the COVID-19 Pandemic on Consultations and Diagnoses in Gastroenterology Practices in Germany

“…It has previously been found that the panel of practices included in the Disease Analyzer database is representative of general and specialized practices in Germany (8). Finally, this database has already been used for other studies investigating the impact of the Covid-19 pandemic on the healthcare system (9)(10)(11).…”