September 29, 2020, 3:19 pm Michael Devitt -- More than 40% of American adults have avoided or delayed receiving medical care because of concerns about COVID-19, and people with multiple underlying medical conditions, such as diabetes or hypertension, are significantly more likely to avoid urgent or emergency care compared to people without these conditions.
Those are among the more notable findings from a study published Sept. 11 in the CDC Morbidity and Mortality Weekly Report. The study, "Delay or Avoidance of Medical Care Because of COVID-19-Related Concerns," presented the results of a web-based survey taken by more than 5,400 adults in the last week of June.
The survey's findings illustrate the widespread chaos caused by the COVID-19 pandemic on the delivery of health care in the United States. The Academy has responded to the challenge by developing numerous resources to help family physicians stay connected with patients and ensure they are providing the best possible care.
To understand the effects of the pandemic on medical care, researchers with the COVID-19 Outbreak Public Evaluation Initiative developed a web-based survey that asked respondents if they had delayed or avoided medical care due to concerns related to COVID-19, with additional questions on gender, age, race/ethnicity, presence of underlying medical conditions and other factors. The survey was administered to a representative sample of U.S. adults 18 and older. Of 5,412 participants, 4,975 completed data for all of the survey variables.
Results showed that overall, 40.9% of U.S. adults reported having delayed or avoided medical care because of concerns about COVID-19. This included 12% of adults who chose not to seek or avoided getting urgent or emergency care.
More than half of the respondents in some specific populations avoided getting any medical care, including
Although the survey did not ask participants why they delayed or avoided getting care, the authors suggested several reasons.
For example, 31.5% of respondents reported that they avoided or delayed routine medical care. The authors speculated that this result "might reflect adherence to community mitigation efforts such as stay-at-home orders, temporary closures of health facilities or other factors."
At the same time, the authors warned of the negative effects associated with avoidance of routine care. Over time, patients could miss appointments for vaccinations or management of chronic conditions, and there would be fewer opportunities to discuss new conditions or health concerns, all of which could worsen long-term outcomes.
Similarly, people with underlying medical conditions and caregivers of adults at increased risk for COVID-19 may have avoided or delayed care out of concern for contracting the disease themselves or passing it on to others. However, delaying or avoiding care could also increase the risk of medical emergency, and people with underlying medical conditions would be more likely to require care to manage and treat those underlying conditions regardless of whether they contracted COVID-19.
"Given … widespread reporting of medical care avoidance because of COVID-19 concerns, especially among persons at increased risk for severe COVID-19, urgent efforts are warranted to ensure delivery of services that, if deferred, could result in patient harm," the study's authors wrote, adding, "Even during the COVID-19 pandemic, persons experiencing a medical emergency should seek and be provided care without delay."
Scott Hartman, M.D., chair of the AAFP's Commission on Health of the Public and Science and an associate professor of clinical family medicine and maternity care coordinator for the primary care network at the University of Rochester Medical Center in Rochester, N.Y., told AAFP News about the pandemic's effects on his practice and the adjustments he has made to continue caring for patients.
"My own practice initially saw patients expressing a lot of hesitancy to come in," said Hartman. "During March, we were mostly focusing on third-trimester prenatal visits and early (younger than 1 year) well-child visits, then slowly expanding that as we gained a better understanding of SARS-CoV-2 transmission. We were able to send patients under investigation for COVID-19 to a centralized network site, but I realize not all clinicians had this luxury.
"I would also say, in my own experience, that separating 'sick' and well days or sessions is very helpful," Hartman continued. "If this isn't practical in your office or health center, then at least have separate hallways and rooms for sick and well care -- or febrile/respiratory illness vs. non-febrile/respiratory illness. In my practice, we've found that if patients need to come for preventive care or chronic disease (management), they are much more likely to come if they know they are being 'separated' from patients with respiratory or febrile illness.
"Also, moving patients quickly through the waiting room and keeping the waiting room fairly empty can really be a game-changer."
Academy Offers More Solutions
Long before anyone had heard of COVID-19, the negative effects associated with delaying or avoiding medical care were well known. The pandemic has made these effects more evident -- but it has also shown that there are solutions to these problems.
The AAFP has for the past several months embarked on a concentrated effort to help family physicians get through the pandemic by giving them tools to sustain their practices while providing the best patient care possible. The Academy's Respond to Coronavirus page, for example, has been active since March and is continuously being updated with new resources and links to additional content.
Hartman recommended that members also visit the Academy's COVID-19 Rapid Response Member Exchange, which gives FPs a place to share ideas and discuss best practices based on personal experiences.
The Academy has also emphasized the importance of telehealth, a service the MMWR authors acknowledged could address some patient needs and help prevent delays in care. Among the resources available to members, in September the Academy published a toolkit that provides tips on building and growing a sustainable telehealth program. Additional resources include a telehealth and COVID-19 FAQ page, and members are welcome to join the Telehealth Member Interest Group to troubleshoot issues and discuss topics of interest.
Hartman related the benefits of offering expanded telehealth services in his own practice.
"Patients seemed to really utilize this option well," he said. "I think telehealth is a key to access and will continue to be for the foreseeable future and probably long term -- but we also need to constantly check the updates from AAFP, the CDC and the World Health Organization in terms of how to maintain sanitization and safety for patients needing in-person care."
And on a personal level, Hartman noted the role FPs can play in making sure patients understand the importance of getting the care they need, in-person or otherwise.
"I think this is really all in the messaging," said Hartman. "Public statements and advertisements -- patient-facing messaging -- regarding the risks of delaying preventive and chronic care can have a huge impact. And again, making telehealth as accessible as possible is so critical."