Davin-Casalena B, Jardin M, Guerrera H, Tréhard H, Lapalus D, Ménager C, Nauleau S, Cassaro V, Verger P, Guagliardo V
Observatoire régional de la santé (ORS) Provence-Alpes-Côte d'Azur, 27, boulevard Jean-Moulin, 13005 Marseille, France.
Observatoire régional de la santé (ORS) Provence-Alpes-Côte d'Azur, 27, boulevard Jean-Moulin, 13005 Marseille, France.
Rev Epidemiol Sante Publique. 2021 Jun;69(3):105-115. doi: 10.1016/j.respe.2021.04.135. Epub 2021 Apr 27.
Starting in spring 2020, the COVID-19 pandemic markedly impacted the French healthcare system. Lockdown and risks of exposure to the coronavirus induced patients to modify their ways of use. The objective of this article was to share feedback on the implementation of a real-time monitoring system concerning (a) the activity of private practitioners in southeastern France, and (b) the evolution of reimbursements for drugs prescribed to persons with diabetes, for treatment of mental health disorders, and for performance of some vaccines.
Data regarding 2019 and 2020 were extracted from regional health insurance databases. They were used to elaborate several indicators relative to the general health insurance scheme, which were calculated and updated each week, starting with week 2.
We observed a drop in private physician activity during the lockdown (-23% for general practitioners; -46% for specialist doctors), followed by a return to a semblance of normalcy. Concomitantly, a boom in teleconsultations occurred: at the height of the crisis they represented 30% of medical acts. The initial stage of the lockdown was characterized by peak provisioning for drugs, whereas vaccination strongly declined (-39% regarding measles, mumps and rubella vaccine among children aged less than 5 years; -54% regarding human papillomavirus vaccine among girls aged 10 to 14 years).
The COVID-19 pandemic could lead to health effects other than those directly attributable to the coronavirus itself. Renouncing care may result in healthcare delays highly deleterious for people and society. Public authorities are preoccupied with these questions; they have set up action plans aimed at encouraging patients to seek treatment without delay. That said, the COVID-19 pandemic crisis has also created opportunities, such as the expansion of telemedicine. Although partial, these indicators can provide useful information enabling public decision makers to be reactive and to implement specific actions to meet the health needs of the population.
自2020年春季起，新冠疫情对法国医疗体系产生了显著影响。封锁措施以及接触冠状病毒的风险促使患者改变了就医方式。本文的目的是分享关于实施实时监测系统的反馈，该系统涉及（a）法国东南部私人执业医生的活动，以及（b）糖尿病患者、精神健康障碍患者所开药物的报销情况演变，以及部分疫苗接种情况。
从地区健康保险数据库中提取2019年和2020年的数据。这些数据用于制定与一般健康保险计划相关的若干指标，从第2周开始每周进行计算和更新。
我们观察到封锁期间私人医生的活动有所下降（全科医生下降23%；专科医生下降46%），随后恢复到接近正常的水平。与此同时，远程会诊出现了激增：在危机高峰期，远程会诊占医疗行为的30%。封锁初期的特点是药品储备达到峰值，而疫苗接种则大幅下降（5岁以下儿童的麻疹、腮腺炎和风疹疫苗接种下降39%；10至14岁女孩的人乳头瘤病毒疫苗接种下降54%）。
新冠疫情可能导致除直接归因于冠状病毒本身之外的其他健康影响。放弃治疗可能会导致对个人和社会极为有害的医疗延误。公共当局关注这些问题；他们制定了行动计划，旨在鼓励患者及时寻求治疗。也就是说，新冠疫情危机也创造了一些机会，比如远程医疗的扩展。尽管这些指标并不全面，但它们可以提供有用信息，使公共决策者能够做出反应并采取具体行动来满足民众的健康需求。
