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Study finds patients defer routine health care during pandemic

Jul. 29, 2020, 3:32 PM


by Paul Govern

During February and March at two large academic medical centers in Nashville and Boston, screening for high cholesterol and high blood sugar dropped 81-90% and initiation of drug therapy for these conditions dropped 52-60%.

These figures are from a brief paper in General Internal Medicine by Adam Wright, PhD, professor of Biomedical Informatics at Vanderbilt University Medical Center, and colleagues from Brigham and Women’s Hospital and Partners Healthcare in Boston.

Adam Wright, PhD

According to the authors, rates of testing and therapy initiation for high cholesterol and type 2 diabetes rebounded only modestly in April at the two medical centers, not enough to make up for the previous sharp drop-off.

“During COVID-19, especially in the early going, it made perfect sense that patients and primary care providers would delay routine preventive screenings and move more visits to telehealth,” Wright said.

“It’s nonetheless concerning that detection, prevention and treatment of diabetes and cardiac risks from hyperlipidemia have been deferred during the pandemic. The worry is that significant public health consequences could follow.”

The authors offer recommendations to health care providers to mitigate these consequences: resume primary care visits as soon as it’s safe and practical; identify patients with gaps in care and insurance coverage; and give patients more options for lab testing, such as specimen collection at neighborhood pharmacies. “In the longer term, such strategies could be used to expand the capacity for screening or prevention to levels greater than during the pre-COVID-19 baseline,” they write.

Shriji Patel, MD

In a survey of VUMC patients and family members, respondents said their biggest fear in seeking routine care during the pandemic was the risk of getting sick from other patients. This finding is included in a paper in NEJM Catalyst, by Shriji Patel, MD, and colleagues, reporting attitudes about seeking health care at VUMC under COVID-19.

In preparation for reopening, the Medical Center sent a survey to the approximately 5,000 folks who comprise its patient and family member online advisory panel, Advise Vanderbilt. There were 1,331 completed survey responses.

Some 55% of respondents admitted to having delayed routine care during the pandemic. Among the reasons cited were anxiousness about catching COVID (48%), following government stay-at-home orders (47%) and following the advice of a doctor (43%).

Asked to rate their concerns about eventually returning to normal care, 59% of respondents rated the risk of getting sick from other patients as a severe concern (8-10 on a scale to 10); approximately one-third of respondents also registered severe levels of concern about cleanliness of facilities, getting sick from hospital staff and availability of proper protective equipment.

“The survey tells us that many patients are ready to resume entering our facilities provided certain safety measures are in place. If they are to return for routine on-site services, patients need certain assurances,” said Patel, assistant professor of Ophthalmology and Visual Sciences. The measures that respondents indicated would most influence their feelings of safety included proper infection control, waiting room precautions, provision of face masks for patients and screening of clinicians, staff, patients and visitors for COVID-19 symptoms.

VUMC has these measures and much more in place to prevent the spread of COVID in its facilities, the authors note.

Joining Patel in the study were Nancy Lorenzi, PhD, Terrell Smith, MSN, RN, Brian Carlson, MHSA, MBA, and Paul Sternberg Jr., MD.

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