College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA.
Department of Psychology, University of Memphis, Memphis, TN, USA.
BMC Health Serv Res. 2022 Nov 23;22(1):1403. doi: 10.1186/s12913-022-08705-9.
Women undergoing treatment for breast cancer require frequent clinic visits for maintenance of therapy. With COVID-19 causing health care disruptions, it is important to learn about how this population's access to health care has changed. This study compares self-reported health care utilization and changes in factors related to health care access among women treated at a cancer center in the mid-South US before and during the pandemic.
Participants (N = 306) part of a longitudinal study to improve adjuvant endocrine therapy (AET) adherence completed pre-intervention baseline surveys about their health care utilization prior to AET initiation. Questions about the impact of COVID-19 were added after the pandemic started assessing financial loss and factors related to care. Participants were categorized into three time periods based on the survey completion date: (1) pre-COVID (December 2018 to March 2020), (2) early COVID (April 2020 - December 2020), and later COVID (January 2021 to June 2021). Negative binomial regression analyses used to compare health care utilization at different phases of the pandemic controlling for patient characteristics.
Adjusted analyses indicated office visits declined from pre-COVID, with an adjusted average of 17.7 visits, to 12.1 visits during the early COVID period (p = 0.01) and 9.9 visits during the later COVID period (p < 0.01). Hospitalizations declined from an adjusted average 0.45 admissions during early COVID to 0.21 during later COVID, after vaccines became available (p = 0.05). Among COVID period participants, the proportion reporting changes/gaps in health insurance coverage increased from 9.5% participants during early-COVID to 14.8% in the later-COVID period (p = 0.05). The proportion reporting financial loss due to the pandemic was similar during both COVID periods (34.3% early- and 37.7% later-COVID, p = 0.72). The proportion of participants reporting delaying care or refilling prescriptions decreased from 15.2% in early-COVID to 4.9% in the later-COVID period (p = 0.04).
COVID-19 caused disruptions to routine health care for women with breast cancer. Patients reported having fewer office visits at the start of the pandemic that continued to decrease even after vaccines were available. Fewer patients reported delaying in-person care as the pandemic progressed.
接受乳腺癌治疗的女性需要经常到诊所就诊以维持治疗。由于 COVID-19 导致医疗保健中断，因此了解这一人群的医疗保健获取途径发生了哪些变化非常重要。本研究比较了在美国中南部癌症中心接受治疗的女性在大流行前后自我报告的医疗保健利用情况以及与医疗保健获取相关的因素变化。
参与一项旨在改善辅助内分泌治疗（AET）依从性的纵向研究的参与者（N=306）在开始 AET 之前完成了关于他们在 AET 启动前的医疗保健利用情况的预干预基线调查。在大流行开始后，增加了关于 COVID-19 影响的问题，评估了经济损失和与护理相关的因素。参与者根据调查完成日期分为三个时间段：（1）COVID-19 前（2018 年 12 月至 2020 年 3 月），（2）早期 COVID（2020 年 4 月至 2020 年 12 月）和后期 COVID（2021 年 1 月至 2021 年 6 月）。使用负二项回归分析比较了大流行不同阶段的医疗保健利用情况，并控制了患者特征。
调整分析表明，与 COVID-19 前相比，门诊就诊次数从平均 17.7 次下降到早期 COVID 期间的 12.1 次（p=0.01），晚期 COVID 期间的 9.9 次（p<0.01）。随着疫苗的推出，住院人数从早期 COVID 期间的平均 0.45 次入院减少到晚期 COVID 期间的 0.21 次（p=0.05）。在 COVID 期间的参与者中，报告健康保险覆盖范围发生变化/差距的比例从早期 COVID 期间的 9.5%增加到晚期 COVID 期间的 14.8%（p=0.05）。由于大流行而导致经济损失的参与者比例在两个 COVID 期间相似（早期 COVID 期间为 34.3%，晚期 COVID 期间为 37.7%，p=0.72）。报告延迟护理或重新配药的参与者比例从早期 COVID 期间的 15.2%下降到晚期 COVID 期间的 4.9%（p=0.04）。
COVID-19 扰乱了乳腺癌女性的常规医疗保健。患者报告在大流行开始时就诊次数减少，并且即使在疫苗可用后仍持续减少。随着大流行的发展，报告延迟亲自就诊的患者比例下降。
