National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
J Clin Epidemiol. 2022 Feb;142:45-53. doi: 10.1016/j.jclinepi.2021.10.015. Epub 2021 Oct 26.
Methodological challenges for investigating the changes in healthcare utilization during COVID-19 pandemic must be considered for obtaining unbiased estimates.
A population-based study in the Lombardy region (Italy) measured the association between the level of epidemic restrictions (increasing exposure during pre-epidemic, post-lockdown, and lockdown periods) and the recommended healthcare (outcome) for patients with schizophrenia, heart failure, chronic obstructive pulmonary disease, breast cancer, and pregnancy women. Two designs are applied: the self-controlled case series (SCCS) and the usual cohort design. Adjustments for between-patients unmeasured confounders and seasonality of medical services delivering were performed.
Compared with pre-epidemic, reductions in delivering recommended healthcare during lockdown up to 73% (95% confidence interval: 63%-80%) for timeliness of breast cancer surgery, and up to 20% (16%-23%) for appropriated gynecologic visit during pregnancy were obtained from SCCS and cohort design, respectively. Healthcare provision came back to pre-epidemic levels during the post-lockdown, with the exception of schizophrenic patients for whom the SCCS showed a reduction in continuity of care of 11% (11%-12%).
Strategies for investigating the changes in healthcare utilization during pandemic must be implemented. Recommendations for taking into account sources of systematic uncertainty are discussed and illustrated by using motivating examples.
研究 COVID-19 大流行期间医疗保健利用变化的方法学挑战，必须加以考虑，以获得无偏估计。
一项基于人群的研究在伦巴第地区（意大利）测量了疫情限制水平（在流行前、封锁后和封锁期间增加暴露）与推荐的医疗保健（结果）之间的关联，适用于精神分裂症、心力衰竭、慢性阻塞性肺疾病、乳腺癌和妊娠妇女患者。应用了两种设计：自我对照病例系列（SCCS）和常规队列设计。对患者间未测量混杂因素和医疗服务季节性进行了调整。
与流行前相比，SCCS 和队列设计分别得出，在封锁期间，乳腺癌手术及时性的推荐医疗保健减少了 73%（95%置信区间：63%-80%），妊娠期适当的妇科就诊减少了 20%（16%-23%）。在封锁后，医疗保健服务恢复到流行前水平，但精神分裂症患者除外，SCCS 显示其连续性护理减少了 11%（11%-12%）。
必须实施研究大流行期间医疗保健利用变化的策略。讨论了考虑系统不确定性来源的建议，并通过使用有启发性的示例进行了说明。
