• COVID-19 Continues to Cause Some People to Put Off Care

    October 6, 2021, 11:00 a.m. Michael Devitt — Even though vaccines to protect against disease caused by SARS-CoV-2 have been available for many people in the United States since December, concerns about the ongoing pandemic continue to cause adults and children to either delay or miss out on much-needed care.  

    young physician staring at computer

    That’s the main finding from a pair of reports recently issued by the Urban Institute and funded by the Robert Wood Johnson Foundation, and based on data from the institute’s April 2021 Health Reform Monitoring Survey. The reports found that as recently as this spring, more than one in 10 adults chose to delay or not seek at least one type of care in the previous 30 days due to concerns about coronavirus exposure, and nearly the same percentage of parents delayed or forwent care for their children for the same reason.

    “The survey results confirm what I’ve been hearing from other physicians and experiencing in my own life. If anything, I was surprised that more people didn’t report delayed care because it’s been a common side effect of the pandemic,” said family physician Lisa Doggett, M.D., M.P.H., senior medical director for HGS-AxisPoint Health and a 2021-2022 AAFP Vaccine Science Fellow.

    “We have been focused for the last year and a half on the people who have gotten sick and died from COVID-19 (and) rightfully so,” Doggett continued. “But at the same time, many people of all ages have been jeopardizing their health by delaying or forgoing other kinds of medical care, including screening and diagnostic tests, well care, routine immunizations and followup for chronic conditions. We need to remind our patients now to catch up on missed care and help ensure they can receive that care safely.”

    Methods and Findings

    The Health Reform Monitoring Survey was conducted between April 2, 2021, and April 20, 2021. It had a sample size of 9,067 adults ages 18 to 64 from across the United States, who were randomly selected from a national probability-based online panel. Eighty-two percent of individuals who took the survey completed it in the first week.

    Story Highlights

    Survey participants answered a variety of questions about their personal health and health care experiences. Researchers then used the survey data to generate two reports. The first report examined the pandemic’s effects on whether and how adults chose to delay or forgo care; the second focused on how the pandemic affected parents’ decisions to delay or forgo care for their children.

    Among the reports’ most relevant findings:

    • Eleven percent of adults reported that worries about the coronavirus had caused them to delay or forgo at least one type of care in the previous 30 days.
    • Similarly, 9.2% of parents reported that worries about the coronavirus had caused them to delay or forgo at least one type of care for their children in the previous 30 days.
    • Adults with two or more chronic health conditions were more than twice as likely as adults with no chronic conditions to report that their care needs were not met (16.7% vs. 7.6%).
    • For adults, dental care was the most commonly delayed or forgone type of care, followed by general doctor/specialist visits, preventive health screenings or medical tests, and hospital visits.
    • For parents, dental care was the most common type of care delayed or forgone for their children, followed by checkups, well-child visits or other preventive health screenings, general doctor/specialist visits, and immunizations.
    • Adults with family incomes below 250% of the federal poverty level were more likely than those with higher incomes to avoid care (14.9% vs. 8.2%).
    • Parents with family incomes below 250% of the federal poverty level were more likely than those with higher incomes to delay or forgo care for their children (12.3% vs. 6.5%).
    • Hispanic/Latinx and Black adults delayed or missed out on care at rates considerably higher than those of white adults (16.2% and 13.3%, respectively, vs. 8.7%).

    It is important to note that at the time the Health Reform Monitoring Survey took place, rollout of COVID-19 vaccines in the United States had yet to reach its current level. The FDA issued an emergency use authorization for the Pfizer-BioNTech vaccine on Dec. 11, 2020, and an EUA for the Moderna vaccine one week later. The Janssen/Johnson & Johnson vaccine received an EUA on Feb. 27, 2021.

    It is also important to note, however, that the researchers found declines in the percentages of adults and parents who chose to avoid or miss out on care over time. While 11% of adults reported that they avoided getting or did not get needed care in the previous 30 days due to concerns about COVID-19, nearly 25% of adults reported delaying or forgoing care for the same reason in the previous 12 months. Similarly, while 9.2% of parents delayed or forwent care for their children in the previous 30 days over worries about the coronavirus, nearly 20% reported that they had delayed or forgone care for their children in the previous 12 months.

    In the reports’ conclusions, the authors expanded on the negative effects associated with the decision to continue avoiding or going without health care, especially in children.

    “Delaying or forgoing children’s health care can worsen their health and limit their abilities to go to school or day care, complete schoolwork or do other daily activities,” the authors wrote. They called for greater efforts from all levels of government, as well as from insurers and health care professionals, to help children catch up on overdue care.

    Family Physicians Share Experiences, Advice

    Anne Schneider, D.O., a practicing family physician with Edward Medical Group in Naperville, Ill., and also a 2021-2022 Vaccine Science Fellow, told AAFP News that she was surprised at the percentage of adults who reported delaying or forgoing care for themselves or their children. She estimated that that in her own practice, the number of delayed adult and pediatric visits in the year before the survey was administered was even higher than what the authors found.

    “I have especially noticed this when it comes to preventive care,” Schneider said. “Within the past couple of months, I have often seen adults for their annual checkup and note that they skipped their annual checkup in 2020. This delay in care is particularly noticeable in my pediatric patients who are now needing to catch up on vaccines.”

    Doggett, who was diagnosed with multiple sclerosis in 2009, has experienced the effects of COVID-19 as a health care professional, a patient and a parent. She told AAFP News that she wrestled with the issue of avoiding or delaying care herself for several months, based on her own health status.

    “I … personally delayed an MRI for several months that my neurologist had ordered to check for progression of MS,” said Doggett. “I couldn’t justify the possible exposure to coronavirus for a nonurgent test in the days before I was vaccinated, even though of course I wanted to follow my doctor’s orders and find out if my MS was getting worse.”

    Schneider and her staff have used a variety of measures to put patients at ease about coming into the office during the pandemic.

    “My office has reassured patients who are hesitant that we have established a very stringent cleaning process for our exam rooms,” Schneider said. “We continue to do mainly video visits with patients who have COVID-19-like symptoms and so we communicate this to our patients who are worried they would be sitting in our waiting room next to a patient who has COVID-19. We also reassure our patients that all of our staff members will be wearing masks in the office at all times.”

    Schneider has also stressed the importance of preventive care.

    “We take time to discuss with patients how preventive screenings can often detect disease at an early stage, at a time when treatment can be more effective,” she said. “We review with parents how well-child visits are a vital component of a child’s health because during these visits we track important indicators of health such as height, weight and developmental milestones. (And) we express how important it is to keep children up to date on their immunizations to prevent and spread disease.”

    Doggett offered similar advice, with an emphasis on physician outreach and telehealth.

    “Physicians can help patients feel more comfortable returning for office visits by ensuring their staff are vaccinated, spacing out appointments to avoid crowded waiting rooms and requiring everyone to continue wearing masks. Such safety measures should be posted in the office and shared with patients.

    “I would also encourage my fellow physicians to outreach to patients, when feasible, to remind them about the importance of preventive care, immunizationsespecially the flu shot — and chronic disease management. Continuing virtual visits, when appropriate, is another good way to connect with people who are still reluctant to risk possible coronavirus exposure by coming into the office.”

    Both FPs recommended a number of resources from the Academy and others.

    Doggett cited the Academy’s Considerations for Resuming In-Person Care webpage, along with the AAFP’s COVID-19 Vaccine Patient Education webpage, both of which provide a wealth of resources and educational materials on reopening practices, debunking myths pertaining to COVID-19 vaccines, and other topics.

    Schneider recommended the AAFP’s Telehealth Toolkit to help members develop and grow a sustainable telehealth program in practice and the CDC’s webpage on providing immunization services during the pandemic.