Healthcare Utilisation in Patients With Long-Term Conditions During the Covid-19 Pandemic: A Population Based Study Across Greater Manchester, Uk

Abstract

Background: The COVID-19 pandemic has placed an unprecedented demand on global healthcare resources. Data on whole population healthcare utilisation (HCU) across both primary and secondary care during the COVID-19 pandemic are lacking. Aim: To describe primary and secondary HCU stratified by LTCs and deprivation, during the first 19 months of COVID-19 pandemic across a large urban area in the United Kingdom. Methods: Observational HCU data between 30th-December-2019 and 1st-August-2021 were extracted from the Greater Manchester Care Record. Primary care HCU (incident prescribing and recording of healthcare information) and secondary care HCU (planned and unplanned admissions) were assessed. Results: The first national lockdown was associated with reductions in all primary HCU measures, ranging from 24.7% (24.0% to 25.5%) for incident prescribing to 84.9% (84.2% to 85.5%) for cholesterol monitoring. Secondary HCU also dropped significantly for planned (47% (42.9% to 51.5%)) and unplanned admissions (35.0% (28.3% to 41.6%)). Only secondary care had significant reductions in HCU during the second national lockdown. Primary HCU measures had not recovered to pre-pandemic levels by the end of the study. The secondary admission rate ratio between multi-morbid patients and those without LTCs increased during the first lockdown by a factor of 2.4 (2.0 to 2.9;p<0.001) for planned admissions and by 1.3 (1.1 to 1.5;p=0.006) for unplanned admissions. No significant changes in this ratio were observed in primary HCU. Different patterns in secondary care HCU were observed by LTC group. Conclusion: Major changes in primary and secondary HCU have been observed during the COVID-19 pandemic. Secondary HCU reduced more in those without LTCs and the ratio of utilisation between the most and least deprived increased for the majority of HCU measures. Overall primary HCU measures and secondary care HCU for some LTC groups had not returned to pre-pandemic levels by the end of the study.