Restricted access to the NHS during the COVID-19 pandemic: Is it time to move away from the rationed clinical response?

Goyal, Daniel; Mansab, Fatma; Naasan, Adeeb P; Iqbal, Amir; Millar, Colin; Franklin, Grant; Thomas, Stephen R.; McFadden, John; Burke, D. C.; Lasserson, Daniel

doi:10.1016/j.lanepe.2021.100201

Cited by 13 publications

(13 citation statements)

References 27 publications

(64 reference statements)

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“…However, the symptoms commonly include also chest pain or tightness, problems with memory and concentration ("brain fog"), difficulty sleeping (insomnia), dizziness, pins and needles, joint pain, depression and anxiety, tinnitus, earaches, nausea, diarrhoea, stomach aches, loss of appetite, a high temperature, headaches, sore throat, changes to sense of smell or taste and rashes [1]. This is a new condition and due to the lack of validated tools to effectively assess and manage, primary care and hospital outpatient clinics are being overwhelmed due to the sheer numbers of patients seeking support [1,2].…”

Section: Introductionmentioning

confidence: 99%

Post-COVID-19 syndrome risk factors and further use of health services in East England

Dębski

Tsampasian

Haney³

et al. 2022

PLOS Glob Public Health

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Post-COVID syndrome, defined as symptoms persisting for more than twelve weeks after the diagnosis of COVID-19, has been recognised as a new clinical entity in the context of SARS-CoV-2 infection. This study was conducted to characterise the burden and predictors for post-COVID-19 syndrome in the local population. It was a community-based web-survey study conducted in Norfolk, East England, UK. We sent the survey to patients with confirmed COVID-19 infection by real-time polymerase chain reaction by December 6th, 2020. Questions related to the pre-COVID and post-COVID level of symptoms and further healthcare use. Baseline characteristics were collected from the primary care records. Logistic regression analysis was conducted to establish predictors for post-COVID-19 syndrome and further healthcare utilisation. Of 6,318 patients, survey responses were obtained from 1,487 participants (23.5%). Post-COVID-19 syndrome symptoms were experienced by 774 (52.1%) respondents. Male sex compared to female sex was a factor protective of post-COVID symptoms; relative risk (RR) 0.748, 95% confidence interval (CI), 0.605–0.924. Body mass index was associated with a greater risk of developing post-COVID-19 symptoms (RR 1.031, 95% CI, 1.016–1.047, for 1 kg/m2). A total of 378 (25.4%) people used further health services after their index COVID-19 infection, of whom 277 (73.2%) had post-COVID symptoms. Male sex was negatively associated with the use of further health services (RR 0.618, 95% CI, 0.464–0.818) whereas BMI was positively associated (RR 1.027, 95% CI, 1.009–1.046). Overall, post-COVID-19 symptoms increased the probability of using health services with RR 3.280, 95% CI, 2.540–4.262. This survey of a large number of people previously diagnosed with COVID-19 across East England shows a high prevalence of self-reported post-COVID-19 syndrome. Female sex and BMI were associated with an increased risk of post-COVID-19 syndrome and further utilisation of healthcare.

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Section: Introductionmentioning

confidence: 99%

Post-COVID-19 syndrome risk factors and further use of health services in East England

Dębski

Tsampasian

Haney³

et al. 2022

PLOS Glob Public Health

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“…This allowed continuity of care but meant that only selected patients received face-to-face consultations, and most were unsatisfied with this approach. A study on restricted healthcare access during the COVID-19 pandemic also expressed concern about this healthcare approach [ 48 ]. The paper highlighted that older adults and vulnerable patients were held to the same national COVID-19 clinical pathway despite the higher risk and mortality rate among those groups; hence, patients often deteriorated before being provided care, which was sometimes neither effective nor efficient [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…A study on restricted healthcare access during the COVID-19 pandemic also expressed concern about this healthcare approach [ 48 ]. The paper highlighted that older adults and vulnerable patients were held to the same national COVID-19 clinical pathway despite the higher risk and mortality rate among those groups; hence, patients often deteriorated before being provided care, which was sometimes neither effective nor efficient [ 48 ]. From the perspective of participants in this study, this care pathway was insufficient, and many felt that face-to-face was preferable to video and pictures for patients.…”

Section: Discussionmentioning

confidence: 99%

Health Communication and Inequalities in Primary Care Access during the COVID-19 Pandemic among Ethnic Minorities in the United Kingdom: Lived Experiences and Recommendations

Ekezie

Maxwell

Byron

et al. 2022

IJERPH

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Health Communication is critical in the context of public health and this was highlighted during the COVID-19 pandemic. Ethnic minority groups were significantly impacted during the pandemic; however, communication and information available to them were reported to be insufficient. This study explored the health information communication amongst ethnic communities in relation to their experiences with primary health care services during the COVID-19 pandemic. The research used qualitative methodology using focus groups and semi-structured interviews with community members and leaders from three ethnic minority communities (African-Caribbean, Somali and South Asian) in Leicester, United Kingdom. The interviews were audio recorded, transcribed, and open-coded. Rigour was determined through methodological coherence, appropriate and sufficient sampling, and iterative data collection and analysis. Six focus groups and interviews were conducted with 42 participants. Four overarching themes were identified related to health communication, experiences, services and community recommendations to improve primary care communication. To address primary care inequalities effectively and improve future health communication strategies, experiences from the pandemic should be reflected upon, and positive initiatives infused into the healthcare strategies, especially for ethnic minority communities.

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“…Strategic priority 1: strengthen system resilience Prepare for the impactful improbable Our findings align with a recent paper by Goyal et al, who describe how rationing access to healthcare in the early stages of the pandemic had a detrimental influence in the acute phase of COVID-19 in the UK due to the NHS already having insufficient resources, capacity or resilience. 21 Assessment of the deteriorating patient appears to have been driven by infection control logic (which avoided face-to-face encounters) and demand management (so as not to overwhelm secondary care services) rather than by protocols and pathways designed to provide patient-centred, compassionate care, or optimise outcomes in the individual sick patient.…”

Section: Lessons For Safer Carementioning

confidence: 99%

Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care

et al. 2022

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BackgroundThe introduction of remote triage and assessment early in the pandemic raised questions about patient safety. We sought to capture patients and clinicians’ experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care.Setting and sampleUK primary healthcare. A subset of relevant data was drawn from five linked in-pandemic qualitative studies. The data set, on a total of 87 participants recruited via social media, patient groups and snowballing, comprised free text excerpts from narrative interviews (10 survivors of acute COVID-19), online focus groups (20 patients and 30 clinicians), contributions to a Delphi panel (12 clinicians) and fieldnotes from an online workshop (15 patients, clinicians and stakeholders).MethodsData were uploaded onto NVivo. Coding was initially deductive and informed by WHO and Institute of Medicine frameworks of quality and safety. Further inductive analysis refined our theorisation using a wider range of theories—including those of risk, resilience, crisis management and social justice.ResultsIn the early weeks of the pandemic, patient safety was compromised by the driving logic of ‘stay home’ and ‘protect the NHS’, in which both patients and clinicians were encouraged to act in a way that helped reduce pressure on an overloaded system facing a novel pathogen with insufficient staff, tools, processes and systems. Furthermore, patients and clinicians observed a shift to a more transactional approach characterised by overuse of algorithms and decision support tools, limited empathy and lack of holistic assessment.ConclusionLessons from the pandemic suggest three key strategies are needed to prevent avoidable deaths and inequalities in the next crisis: (1) strengthen system resilience (including improved resourcing and staffing; support of new tools and processes; and recognising primary care’s role as the ‘risk sink’ of the healthcare system); (2) develop evidence-based triage and scoring systems; and (3) address social vulnerability.

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Restricted access to the NHS during the COVID-19 pandemic: Is it time to move away from the rationed clinical response?

Cited by 13 publications

References 27 publications

Post-COVID-19 syndrome risk factors and further use of health services in East England

Post-COVID-19 syndrome risk factors and further use of health services in East England

Health Communication and Inequalities in Primary Care Access during the COVID-19 Pandemic among Ethnic Minorities in the United Kingdom: Lived Experiences and Recommendations

Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care

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