Israeli COVID lockdowns mildly reduced overall use of preventive health services, but exacerbated some disparities

Abstract

Background During 2020, Israel experienced two COVID-19-related lockdowns that impacted the provision of primary and secondary preventive care. Methods We examined the month-by-month performance of selected preventive care services using data from Israel’s national Quality Indicators in Community Healthcare (QICH) program. Process of care measures included Hemoglobin A1c (HbA1c) testing, cholesterol testing, colon cancer screening, and mammography. Intermediate outcome measures included low-density lipoprotein (LDL) control and HbA1c control. Measures were stratified by sex and by area-level socioeconomic position (SEP). Diabetes and mammography are presented in this abstract due to space limitations. Results Annual HbA1c testing among persons with diabetes decreased from 90.9% in 2019 to 88.0% in 2020. Performance of HbA1c tests during lockdown months was as low as half the usual amount. There were compensatory increases in testing during post-lockdown months that did not quite make up for the missed tests. In 2019, 9.0% of Israelis with diabetes had poor glycemic control (HbA1c ≥ 9.0); in 2020, it was 8.8%. In total, 4.5% fewer mammograms were performed in 2020 compared with 2019. Women in the lowest SEP level performed 10.4% fewer mammograms in 2020 than in 2019, while women in the highest SEP level performed 3.1% more mammograms. Conclusions Prolonged COVID lockdowns in 2020 were associated with marked decreases in the performance of preventive health services during those months. Compensatory spikes following the end of lockdowns partly, but did not completely, make up for the missed care. COVID lockdowns may have exacerbated socioeconomic disparities in some preventive health services.

The Effect of the COVID-19 Pandemic on HbA1c Testing: Prioritization of High-Risk Cases and Impact of Social Deprivation

“…We showed that, across all ten centres, monthly HbA1c requests dropped by 81.9–92.1% in April 2020 compared with the mean monthly 2019 request numbers. This replicates our previous findings [ 8 ], those from the US (a reduction of 66% in HbA1c testing during the first 8 weeks of the pandemic) [ 18 ], Israel (a reduction in HbA1c of ~ 55% during April 2020 [ 19 ] and Spain (a reduction of 52% during March–June 2020 in people with a HbA1c of < 48 mmol/mol) [ 20 ]. It is also consistent with other UK findings by Carr et al [ 9 ], which showed a similar magnitude of reduction in HbA1c testing in April 2020.…”

Impact of the COVID-19 pandemic on the quality of diabetes care: Insights from longitudinal data in Switzerland

“…Globally, the COVID-19 pandemic has resulted in a heterogeneous disruption of outpatient care, which can stem from differences in the resilience of national health systems and variable government responses to face the spread of SARS-CoV-2 [1] , [15] , [16] . This could explain the absence of apparent decline in the quality of diabetes care in our setting, while a significant drop in quality was found in other countries [5] , [7] . This hypothesis is corroborated by the results of a recent international survey, which showed that 66.6% of Swiss primary care providers considered that the overall quality of medical care had not been affected by the COVID-19 pandemic, whereas this share ranged from 16.6% to 40.1% in the nine other high-income countries included in the study [17] .…”

“…In the field of diabetes care, evidence is equivocal. Some research found that quality indicators like glycaemic control slightly improved during lockdown [4] , while other works reported a decline in the quality of diabetes care [5] , [6] , [7] . Taking advantage of longitudinal data collected in the setting of a Swiss population-based cohort study, this research aimed at comparing the quality of diabetes care before and during the COVID-19 pandemic, as measured by self-reported indicators.…”

The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa

“…The clinical impact of such a contracted mammography service is reflected in the 44% reduction (247 vs. 139) in new breast cancers diagnosed at a large WCP anatomical pathology laboratory in the first three months of lockdown (1 April to 30 June 2020), compared to the corresponding period in 2019 [31]. Substantial decreases in mammographic investigations are common in all reports on the impact of COVID-19 on radiological departments [32][33][34]. The American Mammography Database recorded a 42% reduction in diagnostic studies during peak COVID lockdown, compared to pre-COVID levels, with a corresponding 52% reduction in breast cancer diagnoses.…”