Department of Health Ministry of Public Health, Health Intervention and Technology Assessment Program (HITAP), 6Th Floor, 6Th Building, Nonthaburi, Thailand.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
BMC Health Serv Res. 2023 Feb 3;23(1):116. doi: 10.1186/s12913-023-09121-3.
Out-patient department (OPD) is a crucial component of the healthcare systems in low- and middle-income countries including Thailand. A considerable impact of coronavirus disease 2019 (COVID-19) pandemic and its control measures, especially the lockdown, on utilisation of OPD services was expected. This study thus aims to estimate the pattern of OPD utilisation during the COVID-19 pandemic in Thailand including overall utilisation and within each sub-groups including diagnostic group, age group, and health region.
This study was a secondary data analysis of aggregated outpatient data from patients covered under the Universal Coverage Scheme (UCS) in Thailand over a 4-year period (2017-2020). Interrupted time series analyses and segmented Quasi-Poisson regression were used to examine the impact of COVID-19 on the overall OPD utilisation including the impact on each diagnostic group, age groups, health regions, and provinces.
Analysis of 845,344,946 OPD visits in this study showed a seasonal pattern and increasing trend in monthly OPD visits before the COVID-19 pandemic. A 28% (rate ratio (RR) 0.718, 95% confidence interval (CI): 0.631-0.819) and 11% (RR 0.890, 95% CI: 0.811-0.977) reduction in OPD visits was observed during the lockdown and post-lockdown periods, respectively, when compared to the pre-lockdown period. Diseases of respiratory system were most affected with a RR of 0.411 (95% CI: 0.320-0.527), while the number of visits for non-communicable diseases (ICD-10: E00-E90, I00-I99) and elderly (> 60 years) dropped slightly. The post-lockdown trend in monthly OPD visits gradually increased to the pre-pandemic levels in most groups.
Thailand's OPD utilisation rate during the COVID-19 lockdown decreased in some diseases, but the service for certain group of patients appeared to remain available. After the COVID-19 lockdown, the rate returned to the pre-pandemic level in a timely manner. Equipped with a knowledge of OPD utilisation pattern during COVID-19 based on a national real-world database could aid with a better preparation of healthcare system for future pandemics.
门诊部门（OPD）是包括泰国在内的低收入和中等收入国家医疗体系的重要组成部分。预计 2019 年冠状病毒病（COVID-19）大流行及其控制措施，特别是封锁措施，将对 OPD 服务的利用产生相当大的影响。因此，本研究旨在估计 COVID-19 大流行期间泰国 OPD 利用模式，包括总体利用情况以及每个亚组，包括诊断组、年龄组和卫生区。
本研究是对泰国全民医疗保险计划（UCS）覆盖的患者在四年期间（2017-2020 年）汇总的门诊数据进行的二次数据分析。使用中断时间序列分析和分段准泊松回归来检查 COVID-19 对 OPD 整体利用的影响，包括对每个诊断组、年龄组、卫生区和省份的影响。
本研究分析了 845,344,946 次 OPD 就诊，结果显示在 COVID-19 大流行之前，OPD 就诊有季节性模式和逐月就诊呈上升趋势。与封锁前相比，封锁期间和封锁后分别观察到 OPD 就诊减少了 28%（比率比（RR）0.718，95%置信区间（CI）：0.631-0.819）和 11%（RR 0.890，95% CI：0.811-0.977）。呼吸系统疾病受影响最大，RR 为 0.411（95% CI：0.320-0.527），而非传染性疾病（ICD-10：E00-E90，I00-I99）和老年人（>60 岁）就诊人数略有下降。大多数群体的月度 OPD 就诊在封锁后逐渐增加到大流行前水平。
泰国 COVID-19 封锁期间 OPD 利用率在某些疾病中下降，但某些患者群体的服务似乎仍然可用。COVID-19 封锁后，该比率及时恢复到大流行前水平。基于国家真实世界数据库的 COVID-19 期间 OPD 利用模式的知识可以帮助更好地为未来的大流行做好医疗体系的准备。
