The impact of the Covid-19 pandemic on the continuity of care for at-risk patients in Swiss primary care settings

A mixed-methods study

Bibliographic Data

ID4879680
AuthorsMichael J Deml (0000-0003-2224-8173, University of Geneva), Julia Minnema (0000-0003-0407-822X, University of Bern), J Dubois (0000-0001-9241-0231, University of Fribourg), Oliver Senn (0000-0003-4422-7250, University Hospital of Zurich), Sven Streit (0000-0002-3813-4616, University of Bern), Yael Rachamin (0000-0002-1484-6934, University Hospital of Zurich), Katharina Tabea Jungo (0000-0002-1782-1345, University of Bern, corresponding author)
Year2022
Volume298
Pages114858
Publication date2022-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2022.114858
PMID35247784
OpenAlexW4213426061
LanguageEN
Citations received5
References cited29

Continuity of care is important for the health of aging individuals with comorbidities. When initial coronavirus mitigation campaigns involved messaging such as "Stay at home-stay safe," and banned provision of non-urgent care, at-risk patients depending upon regular consultations with general practitioners (GPs) faced confusion about the possibility of seeking non-COVID-19 related healthcare. We employed a sequential explanatory mixed-methods design, consisting of a quantitative component followed by a qualitative component, to understand at-risk patients' health services use during the COVID-19 pandemic in Switzerland. Quantitatively, we used electronic medical records data from 272 GPs and 266,796 patients. Based on pre-pandemic data, we predicted weekly consultation counts as well as weekly measurement counts (blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol) per 100 patients that would be expected in 2020 in absence of a pandemic and compared those to actual observed values. Qualitatively, we conducted 23 semi-structured interviews with 24 GPs (∼45 min) and 37 interviews with at-risk patients (∼35 min). Quantitative results demonstrate a significant decrease in consultation and measurement counts during the first shutdown period, with consultation counts quickly returning to normal and moving within expected values for the rest of 2020. Qualitative data contextualize these findings with GPs describing constantly implementing material, administrative, and communication changes. GPs reported communication gaps with the authorities and noted a lack of clear guidelines delineating how to define "at-risk patients" and what cases were "urgent" to treat during shutdowns. Patient interviews show that patient-level factors, such as fear of contracting coronavirus, perceptions that GPs were overburdened, and a sense of solidarity, influenced patients' decisions to consult less at the beginning of the pandemic. Findings demonstrate communication gaps during pandemic periods and provide valuable lessons for future pandemic preparedness, particularly the need for contingency plans for the overall healthcare system instead of plans focusing only on the infectious agent itself

Coronavirus disease 2019 (COVID-19 · Disease · Family medicine · Health care · Medical emergency · Pandemic · Public health · Qualitative research · Chronic Disease Management Strategies · COVID-19 and healthcare impacts · Medicine · Nursing · Palliative Care and End-of-Life Issues · Emergency Medicine · Internal Medicine