Lopez Segui Francesc, Hernandez Guillamet Guillem, Pifarré Arolas Héctor, Marin-Gomez Francesc X, Ruiz Comellas Anna, Ramirez Morros Anna Maria, Adroher Mas Cristina, Vidal-Alaball Josep
Centre de Recerca en Economia i Salut, Pompeu Fabra University, Barcelona, Spain.
Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.
J Med Internet Res. 2021 Sep 14;23(9):e29622. doi: 10.2196/29622.
The COVID-19 pandemic has turned the care model of health systems around the world upside down, causing the abrupt cancellation of face-to-face visits and redirection of the model toward telemedicine. Digital transformation boosts information systems-the more robust they are, the easier it is to monitor the health care system in a highly complex state and allow for more agile and reliable analysis.
The purpose of this study was to analyze diagnoses from primary care visits and distinguish between those that had higher and lower variations, relative to the 2019 and 2020 periods (roughly before and during COVID-19), to identify clinical profiles that may have been most impaired from the least-used diagnostic codes for visits during the pandemic.
We used a database from the Primary Care Services Information Technologies Information System of Catalonia. We analyzed the register of visits (n=2,824,185) and their International Classification of Diseases (ICD-10) diagnostic codes (n=3,921,974; mean 1.38 per visit), as approximations of the reasons for consultations, at 3 different grouping levels. The data were represented by a term frequency matrix and analyzed recursively in different partitions aggregated according to date.
The increase in non-face-to-face visits (+267%) did not counterbalance the decrease in face-to-face visits (-47%), with an overall reduction in the total number of visits of 1.36%, despite the notable increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial hypertension (ICD-10 codes I10-I16: -32.73%) or diabetes (ICD-10 codes E08-E13: -21.13%), but also obesity (E65-E68: -48.58%) and bodily injuries (ICD-10 code T14: -33.70%). Visits with mental health-related diagnostic codes decreased, but the decrease was less than the average decrease. There was a decrease in consultations-for children, adolescents, and adults-for respiratory infections (ICD-10 codes J00-J06: -40.96%). The results show large year-on-year variations (in absolute terms, an average of 12%), which is representative of the strong shock to the health system.
The disruption in the primary care model in Catalonia has led to an explosive increase in the number of non-face-to-face visits. There has been a reduction in the number of visits for diagnoses related to chronic pathologies, respiratory infections, obesity, and bodily injuries. Instead, visits for diagnoses related to socioeconomic and housing problems have increased, which emphasizes the importance of social determinants of health in the context of this pandemic. Big data analytics with routine care data yield findings that are consistent with those derived from intuition in everyday clinical practice and can help inform decision making by health planners in order to use the next few years to focus on the least-treated diseases during the COVID-19 pandemic.
新冠疫情使全球卫生系统的护理模式发生了翻天覆地的变化，导致面对面就诊突然取消，护理模式转向远程医疗。数字转型推动了信息系统的发展——信息系统越强大，就越容易在高度复杂的状态下监测医疗保健系统，并进行更灵活可靠的分析。
本研究旨在分析初级保健就诊的诊断情况，并区分2019年和2020年期间（大致在新冠疫情之前和期间）变化较大和较小的诊断，以确定在疫情期间就诊时使用最少的诊断代码中可能受影响最大的临床特征。
我们使用了加泰罗尼亚初级保健服务信息技术信息系统的数据库。我们分析了就诊记录（n = 2,824,185）及其国际疾病分类（ICD - 10）诊断代码（n = 3,921,974；每次就诊平均1.38个），作为咨询原因的近似值，在3个不同的分组级别上进行分析。数据由词频矩阵表示，并在按日期聚合的不同分区中进行递归分析。
非面对面就诊的增加（+267%）并未抵消面对面就诊的减少（-47%），尽管护理就诊显著增加（10.54%），但就诊总数仍总体减少了1.36%。2020年增加最多的是与新冠疫情相关诊断的就诊（ICD - 10代码Z20 - Z29: 2,540%），以及与经济和住房问题相关的代码（ICD - 10代码Z55 - Z65: 44.40%）。与2019年相比，2020年大多数其他诊断代码的就诊有所减少。减少最多的是慢性疾病，如动脉高血压（ICD - 10代码I10 - I16: -32.73%）或糖尿病（ICD - 10代码E08 - E13: -21.13%），但肥胖（E65 - E68: -48.58%）和身体损伤（ICD - 10代码T14: -33.70%）也有所减少。与心理健康相关诊断代码的就诊减少了，但减少幅度小于平均降幅。儿童、青少年和成人因呼吸道感染的就诊减少（ICD - 10代码J00 - J06: -40.96%）。结果显示同比变化很大（绝对值平均为12%），这代表了对卫生系统的强烈冲击。
加泰罗尼亚初级保健模式的中断导致非面对面就诊数量急剧增加。与慢性疾病、呼吸道感染、肥胖和身体损伤相关诊断的就诊数量减少。相反，与社会经济和住房问题相关诊断的就诊增加，这凸显了在此次疫情背景下健康的社会决定因素的重要性。利用常规护理数据进行大数据分析得出的结果与日常临床实践中的直觉结果一致，并有助于为卫生规划者的决策提供信息，以便在未来几年专注于新冠疫情期间治疗最少的疾病。
