Trends in outpatient and inpatient visits for separate ambulatory-care-sensitive conditions during the first year of the COVID-19 pandemic: a province-based study.

ARIMA COVID-19 pandemic ambulatory care sensitive conditions inpatient visits outpatient visits trends

Journal

Frontiers in public health
ISSN: 2296-2565
Titre abrégé: Front Public Health
Pays: Switzerland
ID NLM: 101616579

Informations de publication

Date de publication:
2023
Historique:
received: 30 06 2023
accepted: 28 11 2023
medline: 4 1 2024
pubmed: 4 1 2024
entrez: 3 1 2024
Statut: epublish

Résumé

The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs). We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy. We used time series auto-regressive integrated moving-average models to compare observed versus projected rates. Following an initial reduction (March-May 2020) in all types of visits, primary care outpatient visits (combined in-person and virtual) returned to pre-pandemic levels for asthma, angina, hypertension, and diabetes, remained below pre-pandemic levels for COPD, and rose above pre-pandemic levels for CHF (104.8 vs. 96.4, 95% CI: 89.4-104.0) and epilepsy (29.6 vs. 24.7, 95% CI: 22.1-27.5) by the end of the first pandemic year. Specialty visits returned to pre-pandemic levels for COPD, angina, CHF, hypertension, and diabetes, but remained above pre-pandemic levels for asthma (95.4 vs. 79.5, 95% CI: 70.7-89.5) and epilepsy (53.3 vs. 45.6, 95% CI: 41.2-50.5), by the end of the year. Virtual visit rates increased for all ACSCs. Among ACSCs, reductions in hospitalizations were most pronounced for COPD and asthma. CHF-related hospitalizations also decreased, albeit to a lesser extent. For angina, hypertension, diabetes, and epilepsy, hospitalization rates reduced initially, but returned to pre-pandemic levels by the end of the year. This study demonstrated variation in outpatient visit trends for different ACSCs in the first pandemic year. No outpatient visit trends resulted in increased hospitalizations for any ACSC; however, reductions in rates of asthma, COPD, and CHF hospitalizations persisted.

Sections du résumé

Background UNASSIGNED
The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs).
Methods UNASSIGNED
We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy. We used time series auto-regressive integrated moving-average models to compare observed versus projected rates.
Results UNASSIGNED
Following an initial reduction (March-May 2020) in all types of visits, primary care outpatient visits (combined in-person and virtual) returned to pre-pandemic levels for asthma, angina, hypertension, and diabetes, remained below pre-pandemic levels for COPD, and rose above pre-pandemic levels for CHF (104.8 vs. 96.4, 95% CI: 89.4-104.0) and epilepsy (29.6 vs. 24.7, 95% CI: 22.1-27.5) by the end of the first pandemic year. Specialty visits returned to pre-pandemic levels for COPD, angina, CHF, hypertension, and diabetes, but remained above pre-pandemic levels for asthma (95.4 vs. 79.5, 95% CI: 70.7-89.5) and epilepsy (53.3 vs. 45.6, 95% CI: 41.2-50.5), by the end of the year. Virtual visit rates increased for all ACSCs. Among ACSCs, reductions in hospitalizations were most pronounced for COPD and asthma. CHF-related hospitalizations also decreased, albeit to a lesser extent. For angina, hypertension, diabetes, and epilepsy, hospitalization rates reduced initially, but returned to pre-pandemic levels by the end of the year.
Conclusion UNASSIGNED
This study demonstrated variation in outpatient visit trends for different ACSCs in the first pandemic year. No outpatient visit trends resulted in increased hospitalizations for any ACSC; however, reductions in rates of asthma, COPD, and CHF hospitalizations persisted.

Identifiants

DOI: 10.3389/fpubh.2023.1251020 PMID: 38169852 PMC: PMC10759216
pubmed: 38169852
doi: 10.3389/fpubh.2023.1251020
pmc: PMC10759216
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1251020

Informations de copyright

Copyright © 2023 Kendzerska, Zhu, Pugliese, Manuel, Sadatsafavi, Povitz, Stukel, To, Aaron, Mulpuru, Chin, Kendall, Thavorn, Robillard and Gershon.

Déclaration de conflit d'intérêts

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Auteurs

Tetyana Kendzerska (T)

The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada.
ICES, Ottawa, Toronto, ON, Canada.

David T Zhu (DT)

The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.

Michael Pugliese (M)

The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
ICES, Ottawa, Toronto, ON, Canada.

Douglas Manuel (D)

The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
ICES, Ottawa, Toronto, ON, Canada.

Mohsen Sadatsafavi (M)

Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.

Marcus Povitz (M)

Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Therese A Stukel (TA)

ICES, Ottawa, Toronto, ON, Canada.
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Teresa To (T)

ICES, Ottawa, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Research Institute, The Hospital of Sick Children, Toronto, ON, Canada.

Shawn D Aaron (SD)

The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada.

Sunita Mulpuru (S)

The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada.

Melanie Chin (M)

The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada.

Claire E Kendall (CE)

ICES, Ottawa, Toronto, ON, Canada.
Bruyère Research Institute, Ottawa, ON, Canada.
The Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.

Kednapa Thavorn (K)

The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
ICES, Ottawa, Toronto, ON, Canada.
Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

Rebecca Robillard (R)

School of Psychology, University of Ottawa, Ottawa, ON, Canada.

Andrea S Gershon (AS)

ICES, Ottawa, Toronto, ON, Canada.
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Research Institute, The Hospital of Sick Children, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.

Classifications MeSH