Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.
Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study.
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DOI：
10.1371/journal.pmed.1003854
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发表时间：
2021-11
期刊：
影响因子：
15.8
通讯作者：
Licher S
中科院分区：
文献类型：
--
作者：
Splinter MJ;Velek P;Ikram MK;Kieboom BCT;Peeters RP;Bindels PJE;Ikram MA;Wolters FJ;Leening MJG;de Schepper EIT;Licher S
在2019年冠状病毒病（COVID-19）大流行期间，与大流行前相比，初级保健的咨询和诊断数量以及转诊到专科护理的数量大幅下降。除了医疗保健提供者推迟选择性非covid -19护理外，目前尚不清楚社区居民避免医疗保健在多大程度上导致了常规医疗保健使用率的下降。此外，尚不确定哪些特定症状被患者忽视，以及哪些决定因素易导致一般人群回避医疗保健。在这项横断面研究中，我们从患者的角度评估了大流行期间医疗回避的流行程度，包括未被注意的症状，以及医疗回避的决定因素。2020年4月20日，一份关于医疗保健利用、社会经济因素、身心健康、药物使用和COVID-19特异性症状的COVID-19纸质调查被发送给基于人群的鹿特丹研究的8732名参与者（回复率73%）。所有问卷均于2020年7月10日前返回。随后，通过对全科医生病历的自由文本分析，手工验证了医疗回避的流行程度。使用逻辑回归模型确定避免的优势比（ORs），并根据年龄、性别和慢性病史进行调整。我们发现5,656名参与者中有1,142人（20.2%）报告避免医疗保健。其中，414名参与者（36.3%）报告了可能需要紧急评估的症状，包括肢体无力（13.6%）、心悸（10.8%）和胸痛（10.2%）。与逃避相关的决定因素为年龄较大（调整后OR为1.14[95%可信区间（CI） 1.08至1.21]）、女性（1.58[1.38至1.82]）、受教育程度低（小学教育程度与高等职业/大学教育程度之比为1.21[1.01至1.46]）、自我评价健康状况不佳（每水平下降2.00[1.80至2.22]）、失业（与就业人员之比为2.29[1.54至3.39]）、吸烟（1.34[1.08至1.65]）、对感染新冠病毒的担忧（每增加1.28[1.19至1.38]）、抑郁症状（每增加1.13[1.11至1.14]）和焦虑症状（每增加1.16[1.14至1.18]）。研究的局限性包括对所报告症状的（可感知的）严重程度的不确定性，以及考虑到研究人群的种族同质性，可能有限的通用性。在这项基于人群的横断面研究中，五分之一的人在COVID-19大流行期间避免了医疗保健，通常是为了潜在的紧急症状。医疗回避与女性性别、脆弱的自我评价健康、高水平的抑郁和焦虑密切相关。这些结果强调有必要进行有针对性的公众教育，敦促这些脆弱的患者及时寻求医疗护理，以减轻严重的健康后果。Marije J. Splinter及其同事评估了2019冠状病毒病（COVID-19）大流行期间逃避医疗保健的流行情况，并调查了相关决定因素。与大流行前相比，2019冠状病毒病（COVID-19）大流行期间，初级和专科医疗的问诊率都有所下降，部分原因是推迟或取消了选择性和非紧急医疗服务。（四）目前尚不清楚咨询率的下降在多大程度上与普通人群中患者逃避医疗保健有关。（五）为了评估COVID-19大流行对健康的附带损害，不仅要评估逃避医疗保健的流行程度，还要评估避免医疗保健的症状以及与这种行为相关的决定因素。（五）我们向以人口为基础的鹿特丹研究的8732名参与者发送了一份纸质问卷，其中包含若干与COVID-19相关的主题，如医疗保健利用、工作状态、身心健康以及对感染COVID-19的担忧。约6241名参与者（73%）返回了问卷，其中5656名参与者（90.6%）被纳入我们的分析。我们发现，其中1142人（20.2%）在COVID-19大流行期间避免了医疗保健，通常是因为可能需要紧急医疗评估的症状，如肢体无力（13.6%）、心悸（10.8%）和胸痛（10.2%）。与逃避医疗保健最密切相关的决定因素是女性、自我评价不佳的健康状况以及高度抑郁和焦虑。（五）这项以人群为基础的研究结果表明，在2019冠状病毒病大流行期间，医疗回避导致了咨询率的下降。重要的是，我们的研究结果表明，这种行为可能与人群中的某些弱势群体有关。（四）对这些发现的解释应考虑到本研究的局限性，其中包括参与者报告的症状的实际严重程度尚不清楚，因为他们在经历这些症状时未进行医学评估。（五）本研究结果可用于制定针对弱势群体的政策干预措施，这些群体可能更有可能表现出逃避医疗保健的行为。
During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance. On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19–specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population. In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences. Marije J. Splinter and colleagues assess the prevalence of healthcare avoidance during the COIVD-19 pandemic and investigate related determinants ➢ During the Coronavirus Disease 2019 (COVID-19) pandemic, consultation rates in both primary and specialist care declined compared to prepandemic levels, which can partially be attributed to the postponement or cancellation of elective and nonurgent medical care. ➢ It is unclear to what extent these declines in consultation rates could be related to healthcare avoidance by patients in the general population. ➢ To evaluate the collateral health damage of the COVID-19 pandemic, it is important to not only assess the prevalence of healthcare avoidance, but also for what symptoms healthcare was avoided and which determinants are associated with this behaviour. ➢ We sent out a paper questionnaire to 8,732 participants of the population-based Rotterdam Study containing several COVID-19–related subjects, such as healthcare utilisation, work status, mental and physical health, and concerns about contracting COVID-19. ➢ About 6,241 participants (73%) returned the questionnaire, of whom 5,656 participants (90.6%) were included in our analyses. We found that 1,142 of them (20.2%) avoided healthcare during the COVID-19 pandemic, often for symptoms that might have needed urgent medical evaluation, such as limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). ➢ Determinants that were most strongly associated with healthcare avoidance were female sex, poor self-appreciated health, and high levels of depression and anxiety. ➢ The results of this population-based study suggest that healthcare avoidance contributed to the decline in consultation rates during the COVID-19 pandemic. Importantly, our findings suggest that this behaviour may be associated with certain vulnerable groups within the population. ➢ These findings should be interpreted in light of the limitations of this study, which include that the actual severity of the symptoms that were reported by participants is unknown, since they were not medically evaluated when they experienced these symptoms. ➢ The findings of this study can be used to develop policy interventions targeted to vulnerable individuals who may be more likely to exhibit healthcare avoiding behaviours.
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