安大略省 COVID-19 大流行前两波期间，居住在社区的痴呆症患者对急诊部门的就诊情况：一项重复的横断面分析。
Visits to the emergency department by community-dwelling people with dementia during the first 2 waves of the COVID-19 pandemic in Ontario: a repeated cross-sectional analysis.
机构信息
ICES Central (Maclagan, Wang, Emdin, Jones, Jaakkimainen, Schull, Swartz, Bronskill); Dalla Lana School of Public Health (Emdin, Schull, Bronskill), Department of Family and Community Medicine (Jaakkimainen) and Division of Neurology (Swartz), Department of Medicine, University of Toronto; Sunnybrook Research Institute (Jaakkimainen, Schull, Bronskill), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Swartz), McMaster University, Hamilton, Ont.; Department of Health Management, Evaluation and Policy (Sourial), School of Public Health, University of Montreal; Department of Family Medicine (Vedel), McGill University, Montréal, Que.
出版信息
CMAJ Open. 2022 Jul 5;10(3):E610-E621. doi: 10.9778/cmajo.20210301. Print 2022 Jul-Sep.
BACKGROUND
Community-dwelling people with dementia have been affected by COVID-19 pandemic health risks and control measures that resulted in worsened access to health care and service cancellation. One critical access point in health systems is the emergency department. We aimed to determine the change in weekly rates of visits to the emergency department of community-dwelling people with dementia in Ontario during the first 2 waves of the COVID-19 pandemic compared with historical patterns.
METHODS
We conducted a population-based repeated cross-sectional study and used health administrative databases to compare rates of visits to the emergency department among community-dwelling people with dementia who were aged 40 years and older in Ontario during the first 2 waves of the COVID-19 pandemic (March 2020-February 2021) with the rates of a historical period (March 2019-February 2020). Weekly rates of visits to the emergency department were evaluated overall, by urgency and by chapter from the . We used Poisson models to compare pandemic and historical rates at the week of the lowest rate during the pandemic period and the latest week.
RESULTS
We observed large immediate declines in rates of visits to the emergency department during the COVID-19 pandemic (rate ratio [RR] 0.50, 95% confidence interval [CI] 0.47-0.53), which remained below historical levels by the end of the second wave (RR 0.88, 95% CI 0.83-0.92). Rates of both nonurgent (RR 0.33, 95% CI 0.28-0.39) and urgent (RR 0.51, 95% CI 0.48-0.55) visits to the emergency department also declined and remained low (RR 0.68, 95% CI 0.59-0.79, RR 0.91, 95% CI 0.86-0.96), respectively. Visits for injuries, and circulatory, respiratory and musculoskeletal diseases declined and remained below historical levels.
INTERPRETATION
Prolonged reductions in visits to the emergency department among people with dementia during the first 2 pandemic waves raise concerns about patients who delay seeking acute care services. Understanding the long-term effects of these reductions requires further research.
背景
患有痴呆症的社区居民受到了 COVID-19 大流行健康风险和控制措施的影响，导致他们更难获得医疗保健和服务的机会。卫生系统的一个关键切入点是急诊室。我们旨在确定与历史模式相比，在 COVID-19 大流行的前两个波期间，安大略省社区居住的痴呆症患者每周到急诊室就诊的比率的变化。
方法
我们进行了一项基于人群的重复横断面研究，并使用健康管理数据库比较了 COVID-19 大流行的前两个波期间（2020 年 3 月至 2021 年 2 月）安大略省年龄在 40 岁及以上的社区居住的痴呆症患者每周到急诊室就诊的比率与历史时期（2019 年 3 月至 2020 年 2 月）的比率。整体上、按紧急情况和按章节评估了每周急诊室就诊率。我们使用泊松模型比较了大流行期间最低每周率和最新每周率的大流行和历史比率。
结果
我们观察到 COVID-19 大流行期间急诊室就诊率大幅下降（比率比 [RR] 0.50，95%置信区间 [CI] 0.47-0.53），到第二波结束时仍低于历史水平（RR 0.88，95% CI 0.83-0.92）。非紧急（RR 0.33，95% CI 0.28-0.39）和紧急（RR 0.51，95% CI 0.48-0.55）就诊的比率也有所下降且保持较低水平（RR 0.68，95% CI 0.59-0.79，RR 0.91，95% CI 0.86-0.96）。伤害、循环、呼吸和肌肉骨骼疾病的就诊率下降且保持在历史水平以下。
解释
在 COVID-19 大流行的前两个波期间，痴呆症患者到急诊室就诊的次数持续减少，这令人担忧，因为这些患者可能会延迟寻求急性护理服务。了解这些减少的长期影响需要进一步的研究。
Zotero 插件