Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study

Bottle, Alex; Neale, Francesca K; Foley, Kimberley; Viner, Russell; Kenny, Simon E.; Aylin, Paul; Saxena, Sonia; Hargreaves, Dougal

doi:10.1136/bmjopen-2022-060961

Cited by 13 publications

(14 citation statements)

References 38 publications

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“…As of November 2022, more than 632 million infections and 6.6 million deaths have been reported globally ( 2 ), an underestimate of the true burden of disease due to limited access to testing and surveillance in many countries. The pandemic has challenged public health systems worldwide, revealing that even seemingly robust health systems can be rapidly overwhelmed and compromised ( 3 – 6 ). Health seeking behavior for routine care also declined during the COVID-19 pandemic ( 7 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

The provision and utilization of essential health services in Afghanistan during COVID-19 pandemic

Neyazi

Lindan

Perdes³

et al. 2023

Front. Public Health

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IntroductionThe COVID-19 pandemic has disrupted provision of essential health services and overwhelmed even robust health systems worldwide. The Afghanistan health system has suffered both from the pandemic, as well as from political upheaval and regime change.MethodsWe evaluated essential service delivery using data collected from a cross-sectional survey of health care facilities in Afghanistan based on administration of a World Health Organization standardized assessment of frontline service readiness. A multi-stage sampling scheme was used to identify a representative sample of 92 health facilities (68 clinics and 24 hospitals) providing essential health services in five provinces. Facility managers were asked to report on changes in health service delivery in late 2021 and early 2022 (corresponding to the end of a significant national COVID-19 surge in infections) compared to the same period one year earlier.ResultsAmong health facilities evaluated; 29 were in urban and 63 were in rural settings. Most facilities reported an increase in the provision of outpatient care particularly in maternal and child health services as well as for tuberculosis, chronic respiratory diseases, mental health, and substance abuse; the number of in-patients also increased. In contrast, provision of services for malaria, neglected tropical diseases, and community outreach programs decreased. Nearly all facilities used strategies to maintain services, including targeting high-risk patients, promoting self-care, and redirecting patients to alternative health care sites. Nearly three fourth (70.6%) of facilities provided no training about COVID-19 to staff; only 65.2% referred COVID-19 patients to designated hospitals and 44.6% had safe transportation for these patients.DiscussionIncreased demand for services during this period was likely due to a backlog in need generated during the preceding COVID-19 surge and the political changes happened a few months earlier to this survey. Facilities used various methods to maintain services, although the decrease in provision of community outreach was concerning. Facilities appeared to be able to maintain essential health services, despite an increase in demand. However, awareness and training of COVID-19 protocols and appropriate and safe referrals need to be improved. In general, these series of surveys are informative and helpful to identify any changes in provision of essential health services and can facilitate recovery of health systems during and after pandemics.

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Section: Introductionmentioning

confidence: 99%

The provision and utilization of essential health services in Afghanistan during COVID-19 pandemic

Neyazi

Lindan

Perdes³

et al. 2023

Front. Public Health

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“…In addition, the running of the trial was impacted by the coronavirus pandemic. The pandemic resulted in decreased population A&E attendance ( 63 ), and decreased outpatient services ( 64 ), therefore caution must be taken when interpreting results. Number of missing data for healthcare resource use measures were similar to other outcomes obtained within the trial.…”

Section: Discussionmentioning

confidence: 99%

Economic and health impacts of the Change4Life Food Scanner app: Findings from a randomized pilot and feasibility study

2023

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IntroductionThe UK Government developed the Change4Life Food Scanner app to provide families with engaging feedback on the nutritional content of packaged foods. There is a lack of research exploring the cost-effectiveness of dietary health promotion apps.MethodsThrough stakeholder engagement, a conceptual model was developed, outlining the pathway by which the Food Scanner app leads to proximal and distal outcomes. The conceptual model informed the development of a pilot randomized controlled trial which investigated the feasibility and acceptability of evaluating clinical outcomes in children and economic effectiveness of the Food Scanner app through a cost-consequence analysis. Parents of 4–11 years-olds (n = 126) were randomized into an app exposure condition (n = 62), or no intervention control (n = 64). Parent-reported Child Health Utility 9 Dimension (CHU9D) outcomes were collected alongside child healthcare resource use and associated costs, school absenteeism and parent productivity losses at baseline and 3 months follow up. Results for the CHU9D were converted into utility scores based on UK adult preference weights. Sensitivity analysis accounted for outliers and multiple imputation methods were adopted for the handling of missing data.Results64 participants (51%) completed the study (intervention: n = 29; control: n = 35). There was a mean reduction in quality adjusted life years between groups over the trial period of –0.004 (SD = 0.024, 95% CI: –0.005; 0.012). There was a mean reduction in healthcare costs of –£30.77 (SD = 230.97; 95% CI: –£113.80; £52.26) and a mean reduction in workplace productivity losses of –£64.24 (SD = 241.66, 95% CI: –£147.54; £19.07) within the intervention arm, compared to the control arm, over the data collection period. Similar findings were apparent after multiple imputation.DiscussionModest mean differences between study arms may have been due to the exploration of distal outcomes over a short follow-up period. The study was also disrupted due to the coronavirus pandemic, which may have confounded healthcare resource data. Although measures adopted were deemed feasible, the study highlighted difficulties in obtaining data on app development and maintenance costs, as well as the importance of economic modeling to predict long-term outcomes that may not be reliably captured over the short-term.Clinical trial registrationhttps://osf.io/, identifier 62hzt.

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“…It was noted that there was no significant difference in outpatient visit amongst the middle aged, this was not unexpected though because they were more mobile, and their perceived risk of contracting or dying from COVID-19 was minimal 47 . In England, a study amongst under 25 to assess impact of COVID-19 on outpatient visits revealed a sharp fall in outpatient appointments as at March 2020 and had not returned to pre-pandemic levels in March 2021, this period saw a 23.5% reduction as compared to levels between 2017-2019, this fall affected all ages and sexes, though babies under 1 year had their physical appointments preserved 50 . During the pandemic in England, face to face outpatient appointments were avoided as much as possible, where it was still essential, a one patient , one room policy was adopted to minimize the risk of infection [51][52][53] , this was consistent with other national research in England that demonstrated reductions in secondary health care service, including outpatient activity for all age group 54,55 .…”

Section: Impact On Health Care Settingsmentioning

confidence: 99%

“…Across all ages it was estimated by the British Medical Association that in England between April and June, 2020 there were between 2.47 million and 2.6million fewer first outpatient attendances than expected 56 ,this was also corroborated by the Health Foundation whom reported a fall of 4.4 million in outpatient appointments in England in May, 2020 compared with May, 2019 and 4 million fewer General Practitioner referrals to outpatient between January and October , 2020 compared with same period in 2019, even though the study noted referrals for cancer had returned to pre-pandemic level by October , 2020 57 . The reason for the fall in outpatient activity reflects a reduction in health seeking behavior and changes in health system pathways, including a move towards remote consultations 50 . While many outpatient services manage chronic disease conditions, a number manage acute and severe presentations like diabetic foot disease and it is well recognized that diabetic foot syndrome is associated with high levels of morbidity and mortality 58 , therefore a 5year mortality is put at >50% which is similar to or worse than in many cancers 59 .…”

Section: Impact On Health Care Settingsmentioning

confidence: 99%

A Review Article on Impact of Coronavirus Disease on Patients in the Health Care Setting: A Tale or Reality

Ozah

Akerele

Tagar

2023

MRAJ

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Background: Coronavirus disease had a devastating effect on the World, with significant disruption in healthcare, the burgeoning impact is still unfolding. The inequities and fragilities amongst nations particularly low and medium economic countries whose patients are dependent on out of pocket expenditure to access healthcare, has occasioned varied consequence of the pandemic on patients in the health care setting and it has reshaped how health care is practiced. Aims: The aim of this review article was to assess the impact of Coronavirus disease on health care utilization by non -COVID patient during the pandemic. Methods: The review article was carried out with a search engine focused on articles related to impact of Coronavirus disease published between December 2019 till date, which were identified and reviewed. Conclusion: The review article gave an insight to the significant disruptions in health care services amongst patients witnessed across countries of the world, the disparities in the disruptions were due to heterogeneity amongst nations, national policies and health policies during the pandemic and the socioeconomic realities that ensued. Outpatient services witnessed varying reduction across the globe ranging between 30-50%. Sub-Saharan Africa witnessed disruption as much as 50% depending on load of COVID-19 infection amongst populace. The reason for the interruptions across the world was the fear of contracting the disease, access to health care setting due to lock down and shortage of health care personnel, in addition in sub-Saharan Africa, the economic down turn occasioned by the pandemic reduced household income which in turn reduced expenditure on health since most countries were dependent on out of pocket expenditure to fund health care services. In-patient care was also not spared of the disruptions witnessed even though emergency care was prioritized. Overall, there was a reported reduction in admissions for respiratory diseases due to non- pharmacological measures aimed at stemming COVID-19 infection which was equally effective for other respiratory diseases. In some countries like United States the reduction in hospital admissions was paralleled by increasing mortality particularly amongst Hispanic blacks as more acute and severe cases were deemed to have presented for admissions. Surgical priority was maintaining emergency services and prioritization of cancer care, there was a measurable reduction in surgical procedures as elective surgeries were postponed or cancelled. Most laparoscopic and endoscopic procedures were cancelled because of the perceived notion that they are aerosol generating and could increase transmission of COVID-19 infection from asymptomatic carriers, however US jettisoned cancellation of its surgical procedures after 35 days considering that it could not cope. The psychosocial impact of the pandemic and health care access spiraled into increasing anxiety and depression for both health care workers and patients, while the fear of stigmatization was rife from contracting the disease. The consensus therefore was to strengthen adaptive measures and reconfigure health care to mitigate this impact in future pandemic, while allowing telehealth to take center stage.

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Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study

Cited by 13 publications

References 38 publications

The provision and utilization of essential health services in Afghanistan during COVID-19 pandemic

The provision and utilization of essential health services in Afghanistan during COVID-19 pandemic

Economic and health impacts of the Change4Life Food Scanner app: Findings from a randomized pilot and feasibility study

A Review Article on Impact of Coronavirus Disease on Patients in the Health Care Setting: A Tale or Reality

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