Underuse of primary healthcare in France during the COVID-19 epidemic in 2020 according to individual characteristics: a national observational study.
Ambulatory healthcare use
COVID-19
Chronic diseases
Deaths
Epidemic trends
France
Lockdown
Observational study
Journal
BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676
Informations de publication
Date de publication:
09 08 2022
09 08 2022
Historique:
received:
11
01
2022
accepted:
12
07
2022
entrez:
9
8
2022
pubmed:
10
8
2022
medline:
12
8
2022
Statut:
epublish
Résumé
The organization of healthcare systems changed significantly during the COVID-19 pandemic. The impact on the use of primary care during various key periods in 2020 has been little studied. Using individual data from the national health database, we compared the numbers of people with at least one consultation, deaths, the total number of consultations for the population of mainland France (64.3 million) and the mean number of consultations per person (differentiating between teleconsultations and consultations in person) between 2019 and 2020. We performed analyses by week, by lockdown period (March 17 to May 10, and October 30 to December 14 [less strict]), and for the entire year. Analyses were stratified for age, sex, deprivation index, epidemic level, and disease. During the first lockdown, 26% of the population consulted a general practitioner (GP) at least once (-34% relative to 2019), 7.4% consulted a nurse (-28%), 1.6% a physiotherapist (-80%), and 5% a dentist (-95%). For specialists, consultations were down 82% for ophthalmologists and 37% for psychiatrists. The deficit was smaller for specialties making significant use of teleconsultations. During the second lockdown, the number of consultations was close to that in 2019, except for GPs (-7%), pediatricians (-8%), and nurses (+ 39%). Nurses had already seen a smaller increase in weekly consultations during the summer, following their authorization to perform COVID-19 screening tests. The decrease in the annual number of consultations was largest for dentists (-17%), physiotherapists (-14%), and many specialists (approximately 10%). The mean number of consultations per person was slightly lower for the various specialties, particularly for nurses (15.1 vs. 18.6). The decrease in the number of consultations was largest for children and adolescents (GPs: -10%, dentists: -13%). A smaller decrease was observed for patients with chronic diseases and with increasing age. There were 9% excess deaths, mostly in individuals over 60 years of age. There was a marked decrease in primary care consultations in France, especially during the first lockdown, despite strong teleconsultation activity, with differences according to age and healthcare profession. The impact of this decrease in care on morbidity and mortality merits further investigation.
Sections du résumé
BACKGROUND
The organization of healthcare systems changed significantly during the COVID-19 pandemic. The impact on the use of primary care during various key periods in 2020 has been little studied.
METHODS
Using individual data from the national health database, we compared the numbers of people with at least one consultation, deaths, the total number of consultations for the population of mainland France (64.3 million) and the mean number of consultations per person (differentiating between teleconsultations and consultations in person) between 2019 and 2020. We performed analyses by week, by lockdown period (March 17 to May 10, and October 30 to December 14 [less strict]), and for the entire year. Analyses were stratified for age, sex, deprivation index, epidemic level, and disease.
RESULTS
During the first lockdown, 26% of the population consulted a general practitioner (GP) at least once (-34% relative to 2019), 7.4% consulted a nurse (-28%), 1.6% a physiotherapist (-80%), and 5% a dentist (-95%). For specialists, consultations were down 82% for ophthalmologists and 37% for psychiatrists. The deficit was smaller for specialties making significant use of teleconsultations. During the second lockdown, the number of consultations was close to that in 2019, except for GPs (-7%), pediatricians (-8%), and nurses (+ 39%). Nurses had already seen a smaller increase in weekly consultations during the summer, following their authorization to perform COVID-19 screening tests. The decrease in the annual number of consultations was largest for dentists (-17%), physiotherapists (-14%), and many specialists (approximately 10%). The mean number of consultations per person was slightly lower for the various specialties, particularly for nurses (15.1 vs. 18.6). The decrease in the number of consultations was largest for children and adolescents (GPs: -10%, dentists: -13%). A smaller decrease was observed for patients with chronic diseases and with increasing age. There were 9% excess deaths, mostly in individuals over 60 years of age.
CONCLUSIONS
There was a marked decrease in primary care consultations in France, especially during the first lockdown, despite strong teleconsultation activity, with differences according to age and healthcare profession. The impact of this decrease in care on morbidity and mortality merits further investigation.
Identifiants
pubmed: 35945511
doi: 10.1186/s12875-022-01792-x
pii: 10.1186/s12875-022-01792-x
pmc: PMC9361264
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
200Informations de copyright
© 2022. The Author(s).
Références
J Clin Epidemiol. 2018 Nov;103:60-70
pubmed: 30016643
PLoS One. 2021 Aug 12;16(8):e0255992
pubmed: 34383844
Nature. 2020 Aug;584(7820):257-261
pubmed: 32512579
CMAJ. 2021 Feb 8;193(6):E200-E210
pubmed: 33558406
BMC Med. 2020 Dec 18;18(1):408
pubmed: 33334341
Thromb Res. 2021 Sep 21;207:67-74
pubmed: 34562677
JAMA Netw Open. 2021 Sep 1;4(9):e2124650
pubmed: 34529066
PLoS One. 2021 Mar 25;16(3):e0249251
pubmed: 33765096
Lancet Reg Health Eur. 2021 Sep;8:100158
pubmed: 34308411
Oncologist. 2021 Feb;26(2):e338-e341
pubmed: 33111460
Int J Environ Res Public Health. 2021 Jun 29;18(13):
pubmed: 34209931
BMJ Open. 2020 Dec 7;10(12):e043151
pubmed: 33293329
Front Cardiovasc Med. 2022 Apr 25;9:856689
pubmed: 35548431
Rev Epidemiol Sante Publique. 2017 Oct;65 Suppl 4:S149-S167
pubmed: 28756037
JAMA Netw Open. 2020 Oct 1;3(10):e2021476
pubmed: 33006622
JAMA Netw Open. 2020 Oct 1;3(10):e2025591
pubmed: 33095252
BMC Fam Pract. 2021 Jun 23;22(1):125
pubmed: 34162343
Phys Ther. 2020 Jul 19;100(7):1058-1061
pubmed: 32302404
BMJ Open. 2021 Feb 19;11(2):e045015
pubmed: 33608406
BMC Fam Pract. 2020 Oct 10;21(1):208
pubmed: 33038926
BMC Emerg Med. 2021 May 1;21(1):56
pubmed: 33932988
MMWR Morb Mortal Wkly Rep. 2020 May 22;69(20):630-631
pubmed: 32437340
BMJ. 2020 May 13;369:m1931
pubmed: 32404318
PLoS One. 2021 Mar 22;16(3):e0248995
pubmed: 33750990
BMC Public Health. 2009 Jan 22;9:33
pubmed: 19161613
BMJ. 2020 Jul 14;370:m2752
pubmed: 32665257
Lancet Child Adolesc Health. 2020 May;4(5):e10-e11
pubmed: 32278365
Am J Obstet Gynecol. 2021 Sep;225(3):347-348
pubmed: 34022198
Arch Cardiovasc Dis. 2021 Dec;114(12):768-780
pubmed: 34840126
Eur J Neurol. 2021 Oct;28(10):3279-3288
pubmed: 33738913
JAMA Netw Open. 2021 Jan 4;4(1):e2036462
pubmed: 33512520
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720969557
pubmed: 33174495
BMJ Open. 2020 Dec 02;10(12):e042119
pubmed: 33268433
Br J Gen Pract. 2020 Jul 30;70(697):e540-e547
pubmed: 32661009
JAMA Netw Open. 2020 Nov 2;3(11):e2024984
pubmed: 33151319
JAMA Intern Med. 2020 Oct 1;180(10):1328-1333
pubmed: 32744612
Midwifery. 2021 Mar;94:102918
pubmed: 33418511
Int J Environ Res Public Health. 2020 May 12;17(10):
pubmed: 32408658
Br J Surg. 2020 Sep;107(10):1250-1261
pubmed: 32350857