Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

Abstract

ObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic review.EligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery.PROSPERO registration numberCRD42020203729.

Post-acute COVID-19 sequelae in cases managed in the community or hospital in the UK: a population based study

“…This increase since pre-pandemic levels also suggests that lack of access to healthcare following the second wave is less of a problem than in wave one; however, evidence indicates this can nevertheless still be difficult. 16,19 Contrary to our findings however, a Norwegian study suggested that mild COVID-19 does not persist to cause a need for healthcare beyond two months following a positive test. 22 It is unclear if symptoms or diseases post-COVID-19 are due to the infection itself, anxiety caused by diagnosis and isolation or due to complications.…”

“…This was important as changes in healthcare utilisation during the pandemic have been recognised and may influence outcome events. 19 Baseline characteristics included the most recent measurement of body mass index (BMI) within five years of index date. Smoking status and the Charlson Comorbidity Index (CCI) were identified at any time point before COVID-19 diagnosis.…”

The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

“…During Ebola, weekly admissions decreased by 51%(16), compared to decreases of 14.7% (Q1-Q2) and 13.2% (Q1-Q3) in this study. The decreases are also lower than the median decrease in admissions of 28.4% (17.4-40.4) from 43 studies in a recent worldwide systematic review(4). We observed similar patterns of change in healthcare utilisation to those found during Ebola.…”

“…Thus far, there has been limited research on the impact of COVID-19 on essential health services in sSA, including Sierra Leone. A systematic review published in 2021, of the impact of COVID-19 on healthcare utilisation worldwide, found no eligible studies from sSA and only four studies from non-African Low and Middle Income countries (LMICs)(4). In rural South Africa, a single centre interrupted time series analysis, found no significant change in total admissions during 2020, but did find significant changes between subgroups of admissions(5).…”

“…Outside of sSA, evidence has shown the impact of the pandemic on all aspects of care(4). For example, Pakistan reported a 52.5% decline in the daily average total number of vaccinations administered during their lockdown compared to baseline(10).…”