Davin-Casalena B, Jardin M, Guerrera H, Mabille J, 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.
Observatoire Régional de la Santé (ORS) Provence-Alpes-Côte d'Azur, 27 boulevard Jean Moulin, 13005 Marseille.
Rev Epidemiol Sante Publique. 2021 Oct;69(5):255-264. doi: 10.1016/j.respe.2021.07.006. Epub 2021 Aug 10.
The spring 2020 COVID-19 epidemic severely impacted France's healthcare system. The associated lockdown (17 March- 11 May 2020) and the risk of exposure to SARS-CoV-2 led patients to change their use of healthcare. This article presents the development and implementation of a real-time system to monitor i) private doctors' activity in South-eastern France, and ii) changes in prescription of drugs for people with diabetes, mental health disorders and for certain vaccines from Mars 2020 to October 2020.
Data extracted from the regional healthcare insurance databases for 2019 and 2020 were used to construct indicators of healthcare use. They were calculated on a weekly basis, starting from week 2 2020 and compared for the same period between 2019 and 2020.
Private doctors' activity decreased during the spring 2020 lockdown (by 23 % for general practitioners and 46 % for specialists), followed by an almost complete return to normal after it ended until week 41. Over the same period, a huge increase in teleconsultations was observed, accounting for 30 % of private doctors' consultations at the height of the crisis. The start of the lockdown was marked by a peak in drug prescriptions, while vaccinations declined sharply (by 39 % for the measles, mumps and rubella (MMR) vaccine in children under 5 years old, and by 54 % for human papillomavirus vaccine in girls aged 10-14 years old).
The ongoing COVID-19 epidemic may lead to health consequences other than those directly attributable to the disease itself. Specifically, lockdowns and foregoing healthcare could be very harmful at the individual and population levels. The latter issue is a concern for French public authorities, which have implemented actions aimed at encouraging patients to immediately seek treatment. However, the COVID-19 crisis has also created opportunities, such as the roll-out of teleconsultation and tele-expertise. The indicators described here as part of the monitoring system can help public decision-makers to become more responsive and to implement tailored actions to better meet the general population's healthcare needs.
2020年春季的新冠疫情严重冲击了法国的医疗体系。相关的封锁措施（2020年3月17日至5月11日）以及接触严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的风险导致患者改变了其医疗使用方式。本文介绍了一个实时系统的开发与实施情况，该系统用于监测：i）法国东南部私人医生的诊疗活动；ii）2020年3月至10月糖尿病患者、精神疾病患者以及某些疫苗的处方变化。
利用从2019年和2020年区域医疗保险数据库中提取的数据构建医疗使用指标。这些指标从2020年第2周开始按周计算，并对2019年和2020年同期进行比较。
2020年春季封锁期间，私人医生的诊疗活动减少（全科医生减少23%，专科医生减少46%），封锁结束后直至第41周几乎完全恢复正常。同期，远程会诊大幅增加，在危机高峰期占私人医生会诊的30%。封锁开始时，药品处方量达到峰值，而疫苗接种量急剧下降（5岁以下儿童麻疹、腮腺炎和风疹（MMR）疫苗下降39%，10 - 14岁女孩人乳头瘤病毒疫苗下降54%）。
持续的新冠疫情可能导致除疾病本身直接造成的后果之外的其他健康影响。具体而言，封锁措施和放弃医疗保健在个人和人群层面可能非常有害。后一个问题是法国公共当局所关注的，他们已采取行动鼓励患者立即寻求治疗。然而，新冠危机也创造了一些机遇，比如远程会诊和远程专业咨询的推广。作为监测系统一部分在此描述的指标有助于公共决策者更迅速地做出反应，并采取针对性行动以更好地满足普通民众的医疗需求。
