Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue #804, Los Angeles, CA, 90024, USA.
Departments of Psychology and Psychiatry/Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
J Gen Intern Med. 2022 May;37(6):1450-1456. doi: 10.1007/s11606-021-07254-x. Epub 2022 Jan 10.
COVID-19 restrictions and fear dramatically changed the use of medical care. Understanding the magnitude of cancelled and postponed appointments and associated factors can help identify approaches to mitigate unmet need.
To determine the proportion of medical visits cancelled or postponed and for whom. We hypothesized that adults with serious medical conditions and those with higher anxiety, depressive symptoms, and avoidance-oriented coping would have more cancellations/postponements.
Four nationally representative cross-sectional surveys conducted online in May, July, October, and December 2020.
59,747 US adults who completed 15-min online surveys. 69% cooperation rate.
Physical and mental health visits and cancer screening cancelled or postponed over prior 2 months. Plan to cancel or postpone visits over the next 2 months. Relationship with demographics, medical conditions, local COVID-19 death rate, anxiety, depressive symptoms, coping, intolerance of uncertainty, and perceived COVID-19 risk.
Of the 58% (N = 34,868) with a medical appointment during the 2 months before the survey, 64% had an appointment cancelled or postponed in May, decreasing to 37% in December. Of the 41% of respondents with scheduled cancer screening, 20% cancelled/postponed, which was stable May to December. People with more medical conditions were more likely to cancel or postpone medical visits (OR 1.19 per condition, 95% CI 1.16, 1.22) and cancer screening (OR 1.20, 95% CI 1.15, 1.24). Race, ethnicity, and income had weak associations with cancelled/postponed visits, local death rate was unrelated, but anxiety and depressive symptoms were strongly related to cancellations, and this grew between May and December.
Cancelled medical care and cancer screening were more common among persons with medical conditions, anxiety and depression, even after accounting for COVID-19 deaths. Outreach and support to ensure that patients are not avoiding needed care due to anxiety, depression and inaccurate perceptions of risk will be important.
COVID-19 限制措施和恐惧极大地改变了医疗服务的使用方式。了解取消和推迟预约的规模以及相关因素，有助于确定减轻未满足需求的方法。
确定取消或推迟医疗就诊的比例和对象。我们假设患有严重疾病以及焦虑、抑郁症状和回避应对的成年人会有更多的取消/推迟。
2020 年 5 月、7 月、10 月和 12 月进行的四项全国代表性横断面在线调查。
59747 名完成 15 分钟在线调查的美国成年人。合作率为 69%。
过去 2 个月取消或推迟的身体和心理健康就诊和癌症筛查。计划在未来 2 个月取消或推迟就诊。与人口统计学、医疗状况、当地 COVID-19 死亡率、焦虑、抑郁症状、应对方式、无法容忍不确定性以及感知 COVID-19 风险的关系。
在调查前 2 个月有医疗预约的 58%（N=34868）中，64%的人在 5 月取消或推迟了预约，到 12 月减少到 37%。在计划进行癌症筛查的 41%的受访者中，20%取消/推迟，5 月至 12 月保持稳定。有更多医疗状况的人更有可能取消或推迟医疗就诊（每增加一种疾病的 OR 为 1.19，95%CI 为 1.16，1.22）和癌症筛查（OR 为 1.20，95%CI 为 1.15，1.24）。种族、民族和收入与取消/推迟就诊的关系较弱，当地死亡率与就诊无关，但焦虑和抑郁症状与取消就诊密切相关，且在 5 月至 12 月之间有所增加。
在患有疾病、焦虑和抑郁的人群中，取消的医疗保健和癌症筛查更为常见，即使考虑到 COVID-19 死亡人数也是如此。提供帮助和支持，以确保患者不会因焦虑、抑郁和对风险的不准确看法而避免接受所需的护理，这将非常重要。
