Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study.
Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study.
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DOI：
10.1016/s2468-2667(20)30201-2
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Peek N
中科院分区：
文献类型：
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作者：
Williams R;Jenkins DA;Ashcroft DM;Brown B;Campbell S;Carr MJ;Cheraghi-Sohi S;Kapur N;Thomas O;Webb RT;Peek N
迄今为止，有关COVID-19疫情对人口健康和医疗保健系统的间接影响的研究很少。我们旨在调查COVID-19大流行对全科医疗保健使用的间接影响，以及英国贫困人口常见身心健康状况的后续诊断。我们使用2010年1月1日至2020年5月31日期间记录在索尔福德综合记录中的常规收集的初级保健数据进行了回顾性队列研究。我们提取了每周进入患者记录的临床代码数量，以及六个高级别类别：症状和观察，诊断，处方，操作和程序，实验室检查和其他诊断程序。将负二项回归模型应用于每月常见疾病（常见精神健康问题、心脑血管疾病、2型糖尿病和癌症）的首次诊断计数，以及指示这些疾病的相应首次药物处方。我们使用这些模型来预测2020年3月1日至5月31日期间首次诊断和首次处方的预期数量，然后将其与同一时期的观察数字进行比较。在2020年3月1日至5月31日期间，报告了1073例常见心理健康问题的首次诊断，与前几年的2147例预期病例（95%CI 1821至2489）相比，减少了50.0%（95%CI 41.1至56.9）。与预期数字相比，观察到循环系统疾病诊断减少456例（减少43.3%，95%CI 29.6至53.5），2型糖尿病诊断减少135例（减少49.0%，23.8至63.1）。相关药物的首次处方数量也低于同期的预期。然而，在这段时间内，观察到的癌症诊断与预期癌症诊断之间的差距（减少31例;减少16.0%，-18.1至36.6）在统计学上并不显著。在这些贫困的城市人口中，2020年3月至5月期间，常见病的诊断大幅下降，这表明大量患者患有未诊断的疾病。随着COVID-19限制措施的放松，以及患有未确诊疾病或延迟诊断的患者出现在初级和二级医疗服务中，未来工作量的反弹可能迫在眉睫。这些服务应优先诊断和治疗这些患者，以减轻潜在的间接危害，保护公众健康。国立卫生研究院。
To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population. We did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period. Between March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, −18·1 to 36·6) during this time period was not statistically significant. In this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health. National Institute of Health Research.