The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Beacon Medical Group, Plymouth.
Br J Gen Pract. 2023 Apr 27;73(730):e318-e331. doi: 10.3399/BJGP.2022.0301. Print 2023 May.
The COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible.
To describe changes in the volume and variation of coded clinical activity in general practice across six clinical areas: cardiovascular disease, diabetes, mental health, female and reproductive health, screening and related procedures, and processes related to medication.
With the approval of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY.
Common primary care activities were analysed using Clinical Terms Version 3 codes and keyword searches from January 2019 to December 2020, presenting median and deciles of code usage across practices per month.
Substantial and widespread changes in clinical activity in primary care were identified since the onset of the COVID-19 pandemic, with generally good recovery by December 2020. A few exceptions showed poor recovery and warrant further investigation, such as mental health (for example, for 'Depression interim review' the median occurrences across practices in December 2020 was down by 41.6% compared with December 2019).
Granular NHS general practice data at population-scale can be used to monitor disruptions to healthcare services and guide the development of mitigation strategies. The authors are now developing real-time monitoring dashboards for the key measures identified in this study, as well as further studies using primary care data to monitor and mitigate the indirect health impacts of COVID-19 on the NHS.
COVID-19 大流行扰乱了广泛的临床服务中的医疗保健活动。NHS 于 2020 年 3 月停止了非紧急工作，后来建议尽可能在冬季前将服务恢复到接近正常水平。
描述一般实践中六个临床领域（心血管疾病、糖尿病、心理健康、女性和生殖健康、筛查和相关程序以及与药物相关的过程）中编码临床活动的数量和变化。
在获得 NHS England 的批准后，使用 OpenSAFELY 在原位对 2380 万患者的一般实践记录进行了队列研究。
使用临床术语版本 3 代码和关键字搜索分析常见的初级保健活动，每月展示每个实践的代码使用中位数和十分位数。
自 COVID-19 大流行开始以来，初级保健中的临床活动发生了巨大而广泛的变化，到 2020 年 12 月，情况普遍有所改善。一些例外情况表明恢复不佳，需要进一步调查，例如心理健康（例如，对于“抑郁症临时审查”，与 2019 年 12 月相比，实践中中位数的发生次数下降了 41.6%）。
可以使用 NHS 一般实践的细粒度人群规模数据来监测医疗服务的中断，并指导缓解策略的制定。作者现在正在为这项研究中确定的关键措施开发实时监测仪表板，并使用初级保健数据进行进一步研究，以监测和减轻 COVID-19 对 NHS 的间接健康影响。
