Dataset Information

Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review.

ABSTRACT:

Background

The COVID-19 pandemic and global efforts to contain its spread, such as stay-at-home orders and transportation shutdowns, have created new barriers to accessing healthcare, resulting in changes in service delivery and utilization globally. The purpose of this study is to provide an overview of the literature published thus far on the indirect health effects of COVID-19 and to explore the data sources and methodologies being used to assess indirect health effects.

Methods

A scoping review of peer-reviewed literature using three search engines was performed.

Results

One hundred and seventy studies were included in the final analysis. Nearly half (46.5%) of included studies focused on cardiovascular health outcomes. The main methodologies used were observational analytic and surveys. Data were drawn from individual health facilities, multicentre networks, regional registries, and national health information systems. Most studies were conducted in high-income countries with only 35.4% of studies representing low- and middle-income countries (LMICs).

Conclusion

Healthcare utilization for non-COVID-19 conditions has decreased almost universally, across both high- and lower-income countries. The pandemic's impact on non-COVID-19 health outcomes, particularly for chronic diseases, may take years to fully manifest and should be a topic of ongoing study. Future research should be tied to system improvement and the promotion of health equity, with researchers identifying potentially actionable findings for national, regional and local health leadership. Public health professionals must also seek to address the disparity in published data from LMICs as compared with high-income countries.

SUBMITTER: Roy CM

PROVIDER: S-EPMC8083627 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review.

Roy Charlotte M CM Bollman E Brennan EB Carson Laura M LM Northrop Alexander J AJ Jackson Elizabeth F EF Moresky Rachel T RT

European journal of public health 20210701 3

<h4>Background</h4>The COVID-19 pandemic and global efforts to contain its spread, such as stay-at-home orders and transportation shutdowns, have created new barriers to accessing healthcare, resulting in changes in service delivery and utilization globally. The purpose of this study is to provide an overview of the literature published thus far on the indirect health effects of COVID-19 and to explore the data sources and methodologies being used to assess indirect health effects.<h4>Methods</h ...[more]

PMID: 33755130

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Project description:BackgroundIndividuals with spinal cord injuries or disease (SCI/D) require frequent healthcare services. The COVID-19 pandemic may have impacted healthcare. Furthermore, due to secondary health conditions and comorbidities persons with SCI/D are at increased risk of experiencing severe symptoms or outcomes if infected with the COVID-19 virus. It is unclear to what extent research has investigated the pandemic and virus impacts on the SCI/D population.ObjectiveTo identify and summarize what is reported in the literature on the impact the COVID-19 virus and pandemic had on healthcare, health outcomes, and experiences in the adult SCI/D population.MethodsElectronic databases and grey literature were searched for articles that included an adult population with a SCI/D and investigated the impact the COVID-19 virus and pandemic had on healthcare-related outcomes and experiences. Articles were double screened, and data were extracted, and synthesized to provide a descriptive summary of the findings.ResultsTwenty-four studies were included in this review with eight qualitative, fifteen quantitative, and one mixed methods study. Sixteen studies investigated healthcare utilization/access; nine investigated care delivery, nine investigated patient outcomes, and eight investigated patient experiences, with multiple studies spanning different categories of investigation. The pandemic was detrimental to healthcare utilization, access, and outcomes, but no studies quantified these changes. Virtual care was well-received by the SCI/D population to maintain continuity of care. The SCI/D population had issues with maintaining caregiving support. It was unclear if the COVID-19 virus infection impacted individuals with SCI/D differently than the general population.ConclusionsThis scoping review found the pandemic negatively impacted multiple aspects of healthcare in individuals with SCI/D, however further investigation on health outcomes is required. More research, particularly large-scale quantitative studies, investigating healthcare access, utilization, and delivery, as well as patient outcomes and experiences is needed to improve care in the SCI/D population post-pandemic onset.

Project description:BackgroundThe demands for healthcare resources following a COVID-19 diagnosis are substantial, but not currently quantified.ObjectiveTo describe trends in healthcare utilization within 180 days for patients diagnosed with COVID-19 and identify patient factors associated with increased healthcare use.DesignObservational cohort study.PatientsA total of 64,011 patients with a test-confirmed COVID-19 diagnosis from March to September 2020 in a large integrated healthcare system in Southern California.Main measuresOverall healthcare utilization during the 180 days following COVID-19 diagnosis, as well as encounter types and reasons for visits during the first 30 days. Poisson regression was used to identify patient factors associated with higher utilization. Analyses were performed separately for patients who were and were not hospitalized for COVID-19.Key resultsHealthcare utilization was about twice as high for hospitalized patients compared to non-hospitalized patients in all time periods. The average number of visits was highest in the first 30 days (hospitalized: 12.3 visits/30 person-days; non-hospitalized: 6.6) and gradually decreased over time. In the first 30 days, the majority of healthcare visits were telehealth encounters (hospitalized: 9.0 visits; non-hospitalized: 5.6 visits), and the most prevalent reasons for visits were COVID-related diagnoses, COVID-related symptoms, and respiratory-related conditions. For hospitalized patients, older age (≥65: RR 1.27, 95% CI 1.15-1.41), female gender (RR 1.07, 95% CI 1.05-1.09), and higher BMI (≥40: RR 1.07, 95% CI 1.03-1.10) were associated with higher total utilization. For non-hospitalized patients, older age, female gender, higher BMI, non-white race/ethnicity, former smoking, and greater number of pre-existing comorbidities were all associated with increased utilization.ConclusionsPatients with COVID-19 seek healthcare frequently within 30 days of diagnosis, placing high demands on health systems. Identifying ways to support patients diagnosed with COVID-19 while adequately providing the usual recommended care to our communities will be important as we recover from the pandemic.

Project description:ObjectivesThere is limited evidence on how clinical outcomes differ by socioeconomic conditions among patients with coronavirus disease 2019 (COVID-19). Most studies focused on COVID-19 patients from a single hospital. Results based on patients from multiple health systems have not been reported. The objective of this study is to examine variation in patient characteristics, outcomes, and healthcare utilization by neighborhood social conditions among COVID-19 patients.MethodsWe extracted electronic health record data for 23,300 community dwelling COVID-19 patients in New York City between March 1st and June 11th, 2020 from all care settings, including hospitalized patients, patients who presented to the emergency department without hospitalization, and patients with ambulatory visits only. Zip Code Tabulation Area-level social conditions were measured by the Social Deprivation Index (SDI). Using logistic regressions and Cox proportional-hazards models, we examined the association between SDI quintiles and hospitalization and death, controlling for race, ethnicity, and other patient characteristics.ResultsAmong 23,300 community dwelling COVID-19 patients, 60.7% were from neighborhoods with disadvantaged social conditions (top SDI quintile), although these neighborhoods only account for 34% of overall population. Compared to socially advantaged patients (bottom SDI quintile), socially disadvantaged patients (top SDI quintile) were older (median age 55 vs. 53, P<0.001), more likely to be black (23.1% vs. 6.4%, P<0.001) or Hispanic (25.4% vs. 8.5%, P<0.001), and more likely to have chronic conditions (e.g., diabetes: 21.9% vs. 10.5%, P<0.001). Logistic and Cox regressions showed that patients with disadvantaged social conditions had higher risk for hospitalization (odds ratio: 1.68; 95% confidence interval [CI]: [1.46, 1.94]; P<0.001) and mortality (hazard ratio: 1.91; 95% CI: [1.35, 2.70]; P<0.001), adjusting for other patient characteristics.ConclusionSubstantial socioeconomic disparities in health outcomes exist among COVID-19 patients in NYC. Disadvantaged neighborhood social conditions were associated with higher risk for hospitalization, severity of disease, and death.

Dataset Information

Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review.

Background

Methods

Results

Conclusion

Publications

Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review.

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