The long-term impact of the COVID-19 pandemic on primary and specialized care provision and disease recognition in Germany

Abstract

BackgroundThe COVID-19 pandemic and the imposed lockdowns severely affected routine care in general and specialized physician practices.ObjectiveTo describe the long-term impact of the COVID-19 pandemic on the physician services provision and disease recognition in German physician practices and perceived causes for the observed changes.DesignObservational study based on medical record data and survey data of general practitioners and specialists' practices.Participants996 general practitioners (GPs) and 798 specialist practices, who documented 6.1 million treatment cases for medical record data analyses and 645 physicians for survey data analyses.Main measuresWithin the medical record data, consultations, specialist referrals, hospital admissions, and documented diagnoses were extracted for the pandemic (March 2020–September 2021) and compared to corresponding pre-pandemic months in 2019. The additional online survey was used to assess changes in practice management during the COVID-19 pandemic and physicians' perceived main causes of affected primary and specialized care provision.Main resultsHospital admissions (GPs: −22% vs. specialists: −16%), specialist referrals (−6 vs. −3%) and recognized diseases (−9 vs. −8%) significantly decreased over the pandemic. GPs consultations initially decreased (2020: −7%) but compensated at the end of 2021 (+3%), while specialists' consultation did not (−2%). Physicians saw changes in patient behavior, like appointment cancellation, as the main cause of the decrease. Contrary to this, they also mentioned substantial modifications of practice management, like reduced (nursing) home visits (41%) and opening hours (40%), suspended checkups (43%), and delayed consultations for high-risk patients (71%).ConclusionThe pandemic left its mark on primary and specialized healthcare provision and its utilization. Both patient behavior and organizational changes in practice management may have caused decreased and non-compensation of services. Evaluating the long-term effect on patient outcomes and identifying potential improvements are vital to better prepare for future pandemic waves.

Demenz-Screening- und testpsychologische Untersuchungen in deutschen Haus- und Facharztpraxen unter Bedingungen der Corona Pandemie

“…fragungsstudie [5] HA im Vergleich zu FA häufiger angegeben hatten, präventive oder nicht dringende Untersuchungen während der Pandemie zurückgestellt zu haben. Folgende Ursachen können dafür verantwortlich sein.…”

Demenzdiagnosen in deutschen Hausarztpraxen – Ein Vergleich mit der Prävalenzschätzung für das Jahr 2021

“…Andererseits gibt es ebenfalls in HA-Praxen Gründe, die zu einer Unterschätzung der Demenzprävalenz führen können. Dazu gehören vor allem veränderte Patientenpräferenzen [11], regulatorische und finanzielle Abrechnungsbedingungen [12] und ärztliche Diagnosegewohnheiten [8], welche sich vor allem während der Covid-19-Pandemie [13] auf die Prävalenz ausgewirkt haben können. Zudem werden Demenzdiagnosen, wie eingangs erwähnt, dann gestellt, wenn sie für den HA handlungs-bzw.…”

COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy

“…On top of this wellrecognised issue in the NHS, the pandemic resulted in a reduction in the number of available clinic appointments 40 . Interestingly, despite the longer waiting times, there were fewer patients being added to the list, with the number of referrals to specialist spinal surgeons falling to half during the pandemic 41 . Many patients with LDP were reluctant to make a GP appointment, simply unable to access an appointment, or presented at a later stage of disease 42 due to fear of catching COVID-19 or due to other lockdown-associated.…”

“…The existing literature covering the impact of the COVID-19 pandemic on spinal surgery mainly focusses on the changing neurosurgical workload (i.e., numbers of referrals, emergency attendances, surgeries performed), infection rates, and the efficacy of COVIDrelated implementations within the service 2,3,9,[11][12][13]35,41,44,[46][47][48][49] . Spinal surgery case volume was reported to have decreased by 52-70% over the pandemic 10,35 .…”