The COVID-19 pandemic and the associated public health emergency have affected patients and health services in non-COVID-19 pathologies. Several studies have shown its dissociation from health services, with a decrease in emergency department visits, in hospital admissions for non-COVID-19 pathologies, as well as in the reported weekly incidence of acute illnesses and new diagnoses in primary care. In parallel, the pandemic has had direct and indirect effects on people with chronic diseases; the difficulties in accessing health services, the interruption of care, the saturation of the system itself and its reorientation towards non-face-to-face formats has reduced the capacity to prevent or control chronic diseases. All this has also had an impact on the different areas of people’s lives, creating new social and economic difficulties, or aggravating those that existed before the pandemic. All these circumstances have changed with each epidemic wave. We present a review of the most relevant studies that have been analyzing this problem and incorporate as a case study the results of a retrospective observational study carried out in Primary Care in the Madrid Health Service, which provides health coverage to a population of more than 6 million people, and whose objective was to analyze the loss of new diagnoses in the most prevalent pathologies such as common mental health problems, cardiovascular and cerebrovascular diseases, type 2 diabetes, chronic obstructive pulmonary disease, and breast and colon tumors, in the first and second waves. Annual incidence rates with their confidence interval were calculated for each pathology and the monthly frequency of new codes recorded between 1/01/2020 and 12/31/2020 was compared with the monthly mean of observed counts for the same months between 2016 and 2019. The annual incidence rate for all processes studied decreased in 2020 except for anxiety disorders. Regarding the recovery of lost diagnoses, heart failure is the only diagnosis showing an above-average recovery after the first wave. To return to pre-pandemic levels of diagnosis and follow-up of non-COVID-19 pathology, the healthcare system must reorganize and contemplate specific actions for the groups at highest risk.
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The COVID-19 pandemic and the associated public health emergency have affected patients and health services with regard to pathologies not related to COVID-19. Various studies have shown their disengagement from health services, with a decrease in visits to emergency services, hospital admissions for non-COVID-19 pathologies, as well as the reported weekly incidence of acute diseases and new diagnoses in primary care. In parallel, the pandemic has had direct and indirect effects on people with chronic diseases; the difficulties of access to health services, the interruption of care, the saturation of the system itself and its reorientation towards non-face-to-face formats have reduced the ability to prevent or control chronic diseases, also impacting the different areas of life of the people, creating new social and economic difficulties, or aggravating those that existed before the pandemic. All these circumstances have been changing with each of the epidemic waves. A review of the most relevant studies that have been analyzing this problem is presented and the results of a retrospective observational study carried out in primary care in Madrid, which provides health coverage to a population of more than 6 million people, are incorporated as a case study. , and whose objective has been to analyze the loss of new diagnoses in the most prevalent pathologies, such as common mental health problems, cardiovascular and cerebrovascular diseases, type 2 diabetes, chronic obstructive pulmonary disease and breast and colon tumors, in the first and the second waves. The annual incidence rates were calculated with their confidence interval for each pathology and the monthly frequency of the new codes registered between January 1 and December 31, 2020 was compared with the monthly average of the counts observed for the same months. in 2016-2019. The annual incidence rate for all the processes studied decreased in 2020, except for anxiety disorders. Regarding the recovery of missed diagnoses, heart failure is the only diagnosis that shows an above-average recovery after the first wave. To return to pre-pandemic levels of diagnosis and monitoring of non-COVID-19 pathology, the health system must reorganize itself and contemplate specific actions for the groups at greatest risk.
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Keywords:
primary care; COVID-19; Chronic diseases; Missed diagnoses; Chronic diseases; follow-up; Health services; Missed diagnoses; primary health care; SARS-CoV-2; Follow; Health services.
