大流行趋势下医疗保健的使用：从医院病床到 COVID-19 期间的自我护理。

Pandemic trends in health care use: From the hospital bed to self-care with COVID-19.

机构信息

Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway.

Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.

出版信息

PLoS One. 2022 Mar 23;17(3):e0265812. doi: 10.1371/journal.pone.0265812. eCollection 2022.

AIM

To explore whether the acute 30-day burden of COVID-19 on health care use has changed from February 2020 to February 2022.

METHODS

In all Norwegians (N = 493 520) who tested positive for SARS-CoV-2 in four pandemic waves (February 26th, 2020 -February 16th, 2021 (1st wave dominated by the Wuhan strain), February 17th-July 10th, 2021 (2nd wave dominated by the Alpha variant), July 11th-December 27th, 2021 (3rd wave dominated by the Delta variant), and December 28th, 2021 -January 14th, 2022 (4th wave dominated by the Omicron variant)), we studied the age- and sex-specific share of patients (by age groups 1-19, 20-67, and 68 or more) who had: 1) Relied on self-care, 2) used outpatient care (visiting general practitioners or emergency ward for COVID-19), and 3) used inpatient care (hospitalized ≥24 hours with COVID-19).

RESULTS

We find a remarkable decline in the use of health care services among COVID-19 patients for all age/sex groups throughout the pandemic. From 83% [95%CI = 83%-84%] visiting outpatient care in the first wave, to 80% [81%-81%], 69% [69%-69%], and 59% [59%-59%] in the second, third, and fourth wave. Similarly, from 4.9% [95%CI = 4.7%-5.0%] visiting inpatient care in the first wave, to 3.6% [3.4%-3.7%], 1.4% [1.3%-1.4%], and 0.5% [0.4%-0.5%]. Of persons testing positive for SARS-CoV-2, 41% [41%-41%] relied on self-care in the 30 days after testing positive in the fourth wave, compared to 16% [15%-16%] in the first wave.

CONCLUSION

From 2020 to 2022, the use of COVID-19 related outpatient care services decreased with 29%, whereas the use of COVID-19 related inpatient care services decreased with 80%.

目的

探讨自 2020 年 2 月至 2022 年 2 月期间，COVID-19 对医疗保健利用的急性 30 天负担是否发生变化。

方法

在四次大流行浪潮中检测出 SARS-CoV-2 呈阳性的所有挪威人（N=493520 人）中（2 月 26 日至 2 月 16 日，第一波以武汉株为主；2 月 17 日至 7 月 10 日，第二波以 Alpha 变异株为主；7 月 11 日至 12 月 27 日，第三波以 Delta 变异株为主；12 月 28 日至 1 月 14 日，第四波以 Omicron 变异株为主），我们研究了不同年龄和性别的患者比例（按年龄组 1-19、20-67 和 68 岁或以上）中以下三种情况的患者比例：1）依靠自我护理，2）使用门诊护理（因 COVID-19 就诊全科医生或急诊室），和 3）使用住院治疗（因 COVID-19 住院≥24 小时）。

结果

我们发现，在整个大流行期间，所有年龄/性别组的 COVID-19 患者对医疗服务的使用显著下降。从第一波的 83%[95%CI=83%-84%]门诊就诊，到第二波的 80%[81%-81%]、第三波的 69%[69%-69%]和第四波的 59%[59%-59%]。同样，从第一波的 4.9%[95%CI=4.7%-5.0%]住院治疗，到第二波的 3.6%[3.4%-3.7%]、第三波的 1.4%[1.3%-1.4%]和第四波的 0.5%[0.4%-0.5%]。在 SARS-CoV-2 检测呈阳性的人中，第四波中 41%[41%-41%]在检测呈阳性后的 30 天内依赖自我护理，而第一波中为 16%[15%-16%]。