Impact of COVID-19 pandemic on healthcare service use for non-COVID-19 patients in Japan: retrospective cohort study

Abstract

ObjectivesWe aimed to investigate the impact of the first and second waves of the COVID-19 pandemic on healthcare service use by non-COVID-19 patients.DesignRetrospective cohort study.SettingHospital-based claims database from anonymised hospitals in Japan.ParticipantsPatients (n=785 495) who visited and/or were hospitalised in 26 anonymised hospitals in Japan between January 2017 and November 2020.Outcome measuresWe compared changes in the monthly number of hospitalisations (overall or by diagnosis), outpatient visits, endoscopic fibrescopies (EFs), rehabilitations, outpatient chemotherapy treatments, maintenance haemodialysis treatments and outpatient prescriptions between pre-COVID-19 years and the same period in 2020.ResultsThe overall number of hospitalisations and outpatient visits decreased by 27% and 22%, respectively, in May 2020, of which the most substantial decrease was observed in the paediatrics department (65% and 51%, respectively). The number of hospitalisations for respiratory diseases, circulatory diseases, malignant neoplasms and digestive diseases decreased by a maximum of 55%, 32%, 10% and 26%, respectively, in 2020. The number of hospitalisations for non-COVID-19 pneumonia in patients aged <16 years, patients aged ≥16 years and patients with asthma decreased by 93%, 43% and 80%, respectively, in May 2020. EFs and outpatient rehabilitations decreased by >30%. In contrast, outpatient chemotherapy and maintenance haemodialysis treatments decreased by <10%, if at all. Outpatient prescriptions decreased by a maximum of 20% in 2020, with the largest decrease observed in drugs for obstructive airway diseases and cough and cold preparations.ConclusionsThe use of healthcare services by non-COVID-19 patients was most affected during the first wave of the COVID-19 pandemic in May 2020. The number of hospitalisations for respiratory diseases, particularly non-COVID-19 pneumonia and asthma, drastically decreased, while the number of hospitalisations and outpatient chemotherapies for malignant neoplasms or maintenance haemodialysis was less affected.

A Review Article on Impact of Coronavirus Disease on Patients in the Health Care Setting: A Tale or Reality

“…Reasons to justify the low patient patronage was negative image of public hospitals in local media 40 . Consistent with reports across the World, a study conducted in Japan demonstrated a decrease in outpatient clinic prescriptions, with drugs for respiratory diseases most affected and antineoplastic least affected 41 , it correlates with other studies carried out in Japan that revealed a temporary decline in physician visit by patients with chronic conditions 42 . A study carried out in Korea reported a decline in outpatient visits for all cause and chronic diseases than was expected in 2020 43 , in this study there were discrepancies in clinic attendance amongst patients with different chronic diseases, the decline in outpatient visits were more pronounced in these with respiratory, neurological and liver diseases (11.5%,7.1% and 6.2%) respectively, it was less with diabetes, malignant neoplasm , heart disease, thyroid conditions and mental and behavioral disorders 43 .…”

“…The first wave signaled the most significant decrease in hospitalization in Japan, particularly in May,2020. This decrease was particularly striking in pediatric care as it persisted through till November,2020, this was mainly due to a reduction in respiratory diseases 41 , even though admissions were low, there was no observed increase in mortality in the ensuing months 41 . In Croatia a survey carried out showed that general admissions fell by 21% over the study period 85 , the greatest dip in admission was witnessed in April 2020, after WHO declared COVID-19 a pandemic 85 .…”

Comparison of the clinical characteristics and outcomes of Japanese patients with COVID-19 treated in primary, secondary, and tertiary care facilities

“…Numbers do not always add up due to missing values. Total (n = 59,707) Primary (n = 2004) Secondary (n = 41,420) Tertiary (n = 16,283) p-value Vital signs Temperature (°C) 37 [36.6, 37.8] 37 [36.6, 37.7] 37 [36.6, 37.7] 37.1 [36.6, 37.8] <0.001 Heart rate (beats/minute) 86 [76, 98] 87 [76, 98] 86 [75, 98] 87 [76, 99] <0.001 Respiratory rate (breaths/minute) 18 [ 16 , 21 ] 18 [ 16 , 20 ] 18 [ 16 , 21 ] 19 [ 16 , 23 ] <0.001 Systolic blood pressure (mmHg) 127 [114, 142] 125 [113, 138] 127 [114, 142] 127 [114, 142] <0.001 Diastolic blood pressure (mmHg) 79 [70, 88] 80 [70, 88] 79 [70, 88] 78 [69, 88] <0.001 Severity of COVID-19 Severe 19975 (33.5) 525 (26.2) 12142 (29.3) 7308 (44.9) <0.001 Non-severe 39732 (66.5) 1479 (73.8) 29278 (70.7) 8975 (55.1) Oxygen support Yes 10401 (17.4) 209 (10.4) 5541 (13.4) 4651 (28.6) <0.001 Route of oxygen support Nasal cannula 6265 (60.2) 159 (76.1) 3953 (71.3) 2153 (46.3) Face mask 1885 (18.1) …”

“…no caregiver at home) rather than medical indications. The COVID-19 pandemic has had a significant negative impact on the management of other diseases [ 21 , 22 ]. It is crucial to develop a healthcare resource allocation strategy that takes a view of the entire picture as opposed to focusing on COVID-19.…”

The estimated disease burden of COVID-19 in Japan from 2020 to 2021

“…MHLW recommended to avoid Three Cs (Closed spaces, Crowded places, and Close-contact settings) to prevent COVID-19 transmission 8 and behaviour of the general population drastically changed. The number of healthcare facility visits and the consumption of antimicrobials decreased substantially after the emergence of COVID-19 in Japan 9,10 . In short, the COVID-19 pandemic changed the Japanese way of life substantially.…”