The impact of the COVID-19 pandemic on professional practice and patient volume in medical practices: A survey among German physicians and psychotherapists

Bruch, Dunja; Muehlensiepen, Felix; Alexandrov, A.; Konstantinova, Yana; Voß, Karl; Ronckers, Cécile M.; Neugebauer, E.; May, Susann

doi:10.1016/j.zefq.2021.08.001

Cited by 17 publications

(22 citation statements)

References 17 publications

(19 reference statements)

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“…All data reported in this study were collected shortly before the COVID-19 outbreak. The pandemic, infection control measures, and changes in traditional health care delivery, however, have impacted patient and professional stakeholder perspectives on telemedicine globally [ 45 ], locally [ 25 ], and specifically in rheumatology care as well [ 26 , 46 ], resulting in massive uptake of telemedicine and digital health care. The necessity of using telemedicine to reduce contacts and infection transmission may have led many to their first experiences with telemedicine and might have contributed to the increased acceptance of telemedicine.…”

Section: Discussionmentioning

confidence: 99%

“…Shortly after its release, COVID-19 hit health care systems worldwide, leading to dramatic changes in health care delivery. Telemedicine thus became a necessity to reduce the number of contacts and control transmission, leading to an upturn in the use [ 25 ] and acceptance of telemedicine services in Germany [ 21 , 26 ]. This was initially reflected in a massive increase in the volume of telemedicine services billed by medical practices in Germany [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study

Muehlensiepen

Knitza

Marquardt³

et al. 2021

IJERPH

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Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study

Muehlensiepen

Knitza

Marquardt³

et al. 2021

IJERPH

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“…Additionally, entrance barriers to the intervention were lowered with the start of the pandemic, and a slightly different subgroup took advantage of the programme. However, a previous study indicated that doctor visits perceived as non-essential were postponed during the lockdown [ 98 ].…”

Section: Discussionmentioning

confidence: 99%

Association between chronic low back pain and regular exercise, sedentary behaviour and mental health before and during COVID-19 pandemic: insights from a large-scale cross-sectional study in Germany

Hochheim

Ramm

Wunderlich

et al. 2022

BMC Musculoskelet Disord

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Background Nonspecific chronic low back pain (CLBP) is a complex symptom with numerous possible causes and influencing factors. Understanding how modifiable factors affect the course of CLBP is important for preventing progression. As the COVID-19 pandemic has changed the lifestyle of many people, this study paper assessed whether it also changed the influence of modifiable lifestyle factors (regular exercise and sedentary behaviour) and mental health factors (anxiety and depression) on CLBP pain intensity and disability by comparing the strength of these associations before and during the pandemic. We hypothesised that the importance of regular physical activity and good mental health for CLBP patients would increase during the pandemic. Methods These questions were investigated in a cross-sectional study of insurance claims data and self-reported data from various questionnaires from 3,478 participants in a German CLBP health intervention (2014–2021) by calculating pre- and intra-pandemic odds ratios (OR) and 95% confidence intervals (CI) for each variable of interest and outcome. Potential confounders were also considered. Pandemic status was treated as an effect modifier. Based on the date of enrolment, participants were classified as “pre-pandemic” or “pandemic”. Results Regularly exercising ≥ 4 h/week significantly reduced the odds of high disability for men (OR 0.49, 95% CI 0.31 – 0.79, p = 0.003) and women (OR 0.30, 95% CI 0.14 – 0.563, p = 0.002) and reduced the probability of severe pain in women (OR 0.37, 95% CI 0.21 – 0.65, p < 0.001). Each one-point increase in PHQ-4 score for anxiety and depression increased the OR of high pain intensity by 1.25 points (95% CI 1.18 – 1.34, p < 0.001). A clear impact of COVID-19 lockdowns was observed. In individuals who exercised ≥ 4 h/week the OR of high disability was 0.57 (95% CI 0.36 – 0.92, p = 0.021) in the pre-pandemic group compared to 0.29 (95% CI 0.12 – 0.56, p = 0.002) in the pandemic group. The probability of high disability increased from an OR of 1.42 (95% CI 1.33 – 1.52, p < 0.001) per marginal increase in the PHQ-4 scale before the pandemic, to an OR of 1.73 (95% CI 1.58 – 1.89, p < 0.001) during the pandemic. Conclusions The magnitude of association of the factors that influenced high pain intensity and disability increased during the pandemic. On the one hand, the protective effect of regular exercising was greater in participants surveyed during lockdown. On the other hand, a higher risk through anxiety or depression during the lockdown was identified. An additional study with objective measures of sedentary behaviour and physical activity is needed to validate these results. More in-depth investigation of lockdown-induced associations between reduced daily physical activity, increased levels of anxiety and depression, and their effects on CLPB could also be worthwhile. Trial registration This study used routinely collected data from a CLBP intervention that was previously evaluated and registered in the German Registry of Clinical Trials under DRKS00015463 (04/09/2018). The original ethics approval, informed consent and self-reported questionnaire have remained unchanged and are still valid.

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Section: Introductionmentioning

confidence: 99%

“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID 19) virus upended health care around the world and forever changed how patients converse with and receive care from providers (1,2). Bruch et al (2) reported that physicians and psychologists in Germany had a shift to more positive attitudes toward telehealth because of the COVID 19 pandemic. Many clinicians quickly learned to use novel platforms to virtually examine and treat their patients with vestibular disorders and modify how they conducted their physical examination (3).…”

Section: Introductionmentioning

confidence: 99%

Vestibular Rehabilitation Telehealth During the SAEA-CoV-2 (COVID-19) Pandemic

Harrell

Schubert

Oxborough³

et al. 2022

Front. Neurol.

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During the COVID-19 pandemic, physical therapists transitioned to provide telehealth in the United States. We sought to determine the experiences of physical therapists delivering telerehabilitation for vestibular disorders including barriers, preferences, and concerns. A survey was created using the results of a focus group and previously published studies. The survey was distributed across social media sites and through email- the link was sent to the orthopedic, neurologic, and geriatric academies of the American Physical Therapy Association list serves. The email was also shared with each of the 50 state chapters of the American Physical Therapy Association. The survey was broken down into five sections: demographic information, physical therapists' general impressions of telehealth, physical therapists' comfort level treating various vestibular diagnoses, and common barriers physical therapists experienced during telehealth sessions. There were 159 completed surveys. More than 80% of physical therapists surveyed agreed that telehealth was an effective platform for vestibular physical therapy. When asked whether physical therapists felt the patient had similar health outcomes with telehealth versus clinic care 68% of physical therapists agreed. For the physical therapists who treated posterior or horizontal canal benign paroxysmal positional vertigo via telehealth, more than 50% were comfortable treating these conditions via telehealth. In analyzing common peripheral vestibular diagnoses treated via telehealth including bilateral vestibular loss, Meniere's disease, and vestibular neuritis more than 75% of the physical therapists reported comfort treating these diagnoses. Similarly, more than 75% of physical therapists who treated central vestibular diagnoses- including mild traumatic brain injury and vestibular migraine- via telehealth reported being comfortable treating these diagnoses. Physical therapists reported several barriers to tele healthcare ranging from concerns about testing balance with no caregiver present (94%) to challenges with providing a written home exercise program (33%). Physical therapists report that telehealth is a viable mechanism for providing rehabilitation for persons with balance and vestibular disorders. For common diagnoses, most physical therapists were comfortable treating vestibular disorders via telehealth. While barriers remain including maintaining patient safety and being able to complete a thorough vestibular exam, telehealth for vestibular physical therapy services holds promise for the delivery of virtual care.

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The impact of the COVID-19 pandemic on professional practice and patient volume in medical practices: A survey among German physicians and psychotherapists

Cited by 17 publications

References 17 publications

Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study

Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study

Association between chronic low back pain and regular exercise, sedentary behaviour and mental health before and during COVID-19 pandemic: insights from a large-scale cross-sectional study in Germany

Vestibular Rehabilitation Telehealth During the SAEA-CoV-2 (COVID-19) Pandemic

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