Effects of COVID-19 Infection Control Measures on Appointment Cancelation in an Italian Outpatient Memory Clinic

Abstract

Background: In the first wave of the COVID-19 pandemic in 2020, many countries made changes to the routine management of patients with non-communicable diseases, including neurocognitive disorders. Therefore, many “so-called” non-urgent elective procedures and outpatient appointments have been canceled or postponed, possibly impacting negatively on health and well-being of patients in the short- and long-term.Aim: Here, we aimed at describing numbers and types of outpatient appointments canceled as a result of government's restrictive measures in our memory clinic.Methods: The scheduled appointments at the memory clinic of the Santa Lucia Foundation IRCCS, Rome, Italy, are recorded in a comprehensive dataset under strict administrative control. Here, we compared appointments (first-time and follow-up) that were canceled from January to April 2020 with those of the corresponding months in 2019.Results: We observed a substantial decrease in appointments during 2020. The majority of scheduled appointments were follow-up, and about a quarter were first-time appointments. We estimated that 66.7% and 77.4% of patients missed out respectively their first and follow-up appointments in our memory clinic due to government's restrictive measures in March–April 2020.Conclusions: A large number of patients with neurocognitive disorders missed crucial appointments due to government's restrictive measures, and many experienced a delay in initial diagnosis and initiation of treatment. This has relevant impact on their treatment and consequently has (is still having and potentially will have) an increase on the healthcare service burden of clinics. Furthermore, as a second wave of COVID-19 affects Europe, and with winter approaching, it is a compelling priority to ensure easy and rapid access to appropriate assessment, care and treatment in the event of a new outbreak and potential subsequent lockdowns, with particular attention to the development of specific healthcare technologies customized to older persons with cognitive impairment.

Perceptions, Experiences, and Challenges of Physicians Involved in Dementia Care During the COVID-19 Lockdown in India: A Qualitative Study

“…The physicians in our study reported difficulty in maintaining in-person appointments with significantly reduced compliance even when the out-patient services were running. Similar findings have been reported from Italy by Spalletta et al (33) where 66.7 and 77.4% of patients had missed out on their first and follow-up visits, respectively, during the first wave of the pandemic, mainly due to the administrative restrictive measures imposed to curb the viral spread. The authors highlighted enhanced access of healthcare by PwD and their caregivers as a "compelling priority" to prevent burden of the gradually re-opening healthcare clinics.…”

Management of Older Outpatients during the COVID-19 Pandemic: The GeroCovid Ambulatory Study

“…The study started just after the World Health Organization declared a pandemic due to the coronavirus SARS-COV-2 in March 2020 and Italy planned a national quarantine in order to control the virus spread. In that context, nonurgent healthcare services were suspended [ 6 ], including medical visits for patients with cognitive disorders or other chronic conditions, which are the cornerstone for guaranteeing satisfactory disease control. The overall result was that quarantine induced a fast increase of Behavioral and Psychiatric Symptoms of Dementia (BPSD) in patients affected with dementia and stress-related symptoms in their caregivers [ 7 ].…”

Systematic Review on the Mental Health and Treatment Impacts of COVID-19 on Neurocognitive Disorders

“…Hence, 16% reported difficulties accessing medical care, 33% received medical phone assistance, 20% needed emergency care and 21% had changes in psychopharmacological therapies. Similarly, a registry based longitudinal study by Spalletta et al [ 51 ] comparing cancellation rates for first or follow-up appointments for memory services during the pandemic compared to previous year found that over 60% of patients with mild or major NCD missed their first and follow-up appointments to memory service during the pandemic due to restrictions. Moreover, an interrupted time series study by Chen et al [ 52 ] assessing the medium-term impact of the pandemic on referrals to secondary care mental health services revealed no post-lockdown longer-term acceleration rate for referrals of people with dementia.…”