The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada.
Front Public Health. 2023 Dec 18;11:1251020. doi: 10.3389/fpubh.2023.1251020. eCollection 2023.
The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs).
We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy. We used time series auto-regressive integrated moving-average models to compare observed versus projected rates.
Following an initial reduction (March-May 2020) in all types of visits, primary care outpatient visits (combined in-person and virtual) returned to pre-pandemic levels for asthma, angina, hypertension, and diabetes, remained below pre-pandemic levels for COPD, and rose above pre-pandemic levels for CHF (104.8 vs. 96.4, 95% CI: 89.4-104.0) and epilepsy (29.6 vs. 24.7, 95% CI: 22.1-27.5) by the end of the first pandemic year. Specialty visits returned to pre-pandemic levels for COPD, angina, CHF, hypertension, and diabetes, but remained above pre-pandemic levels for asthma (95.4 vs. 79.5, 95% CI: 70.7-89.5) and epilepsy (53.3 vs. 45.6, 95% CI: 41.2-50.5), by the end of the year. Virtual visit rates increased for all ACSCs. Among ACSCs, reductions in hospitalizations were most pronounced for COPD and asthma. CHF-related hospitalizations also decreased, albeit to a lesser extent. For angina, hypertension, diabetes, and epilepsy, hospitalization rates reduced initially, but returned to pre-pandemic levels by the end of the year.
This study demonstrated variation in outpatient visit trends for different ACSCs in the first pandemic year. No outpatient visit trends resulted in increased hospitalizations for any ACSC; however, reductions in rates of asthma, COPD, and CHF hospitalizations persisted.
COVID-19 大流行导致非紧急卫生服务在全球范围内中断，影响了具有门诊医疗敏感条件（ACSCs）个体的健康结果。
我们使用安大略省卫生行政数据（加拿大）进行了一项基于省的研究，以确定在大流行第一年（2020 年 3 月至 2021 年 3 月）与前几年（2016-2019 年）相比，普通成年人群中七种 ACSC 的门诊就诊和住院率（每 10 万人）的趋势，以及门诊就诊的中断与急性护理使用的关系。考虑的 ACSC 包括慢性阻塞性肺疾病（COPD）、哮喘、心绞痛、充血性心力衰竭（CHF）、高血压、糖尿病和癫痫。我们使用时间序列自回归综合移动平均模型来比较观察到的和预测到的比率。
在所有类型的就诊最初减少（2020 年 3 月至 5 月）之后，哮喘、心绞痛、高血压和糖尿病的初级保健门诊就诊（包括面对面和虚拟就诊）恢复到大流行前的水平，COPD 的就诊仍低于大流行前的水平，CHF（104.8 比 96.4，95%CI：89.4-104.0）和癫痫（29.6 比 24.7，95%CI：22.1-27.5）在大流行第一年结束时高于大流行前的水平。COPD、心绞痛、CHF、高血压和糖尿病的专科就诊恢复到大流行前的水平，但哮喘（95.4 比 79.5，95%CI：70.7-89.5）和癫痫（53.3 比 45.6，95%CI：41.2-50.5）的就诊仍高于大流行前的水平，到年底。所有 ACSC 的虚拟就诊率均有所上升。在 ACSC 中，COPD 和哮喘的住院率下降最为明显。CHF 相关住院率也有所下降，但幅度较小。心绞痛、高血压、糖尿病和癫痫的住院率最初有所下降，但到年底已恢复到大流行前的水平。
本研究表明，在大流行的第一年，不同 ACSC 的门诊就诊趋势存在差异。没有任何 ACSC 的门诊就诊趋势导致住院率增加；然而，哮喘、COPD 和 CHF 住院率的下降仍在持续。
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