A new report from the Urban Institute indicates more than “one third of adults aged 18-64 years in the United States delayed or went without medical care because of efforts by patients or providers to reduce the spread of COVID-19.”  It shows, “among the adults who postponed or missed care, 32.6% said the gap worsened one or more health conditions or limited their ability to work or perform daily activities.”  The findings highlight “the detrimental ripple effects of delaying or forgoing care on overall health, functioning, and well-being,” researchers concluded.  Data was collected in September 2020 and included more than 4000 respondents who reported delaying care.The team, which included Dulce Gonzalez, MPP, a research associate in the Health Policy Center at the Urban Institute, and colleagues, found “one or more chronic conditions were more likely than adults without chronic conditions to have delayed or missed care (40.7% vs. 26.4%).  Adults with a mental health condition were particularly likely to have delayed or gone without care.”  Jacqueline W. Fincher, MD, president of the American College of Physicians, explained, “Doctors are already seeing the consequences of the missed visits.”

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Two of her patients with chronic conditions missed, and when they resumed this year, after delaying their care, their labs showed a significant decrease in kidney function “Lo and behold, their kidneys were in failure…One was in the hospital for three days and the other one was in for five days,” said Fincher, who added her “office has been proactive about calling patients with chronic diseases who missed follow-up visits or laboratory testing or who may have run out of medication.  We have stayed open the whole time now.”The delay in receiving care typically has to do with patients’ own scheduling conflicts, being unable to receive in-person care with pandemic-induced at-home responsibilities.  Even though many offices, like Fincher’s, are offering telehealth and in-person, many patients are still deciding to postpone treatment.  Fincher said, “We do know that chronic problems left without appropriate follow-up can create worse problems for them in terms of stroke, heart attack, and end organ damage.”“Future studies may help researchers understand the effects of delayed and missed care during the pandemic,” added Russell S. Phillips, MD, director of the Center for Primary Care at Harvard Medical School in Boston. “Although it is still early, and more data on patient outcomes will need to be collected, I anticipate that the delays in diagnosis, in cancer screening, and in management of chronic illness will result in lost lives and will emphasize the important role that primary care plays in saving lives.  During the first several months of the pandemic, there were fewer diagnoses of hypertension, diabetes, and depression.”The researchers report in their findings, “Though some missed care may have been of low value or unnecessary, physicians report concern over unmet needs for care, particularly for people with chronic health conditions, whose health can deteriorate rapidly without careful monitoring and treatment.  Mortality data suggest the pandemic has caused a surge in excess deaths from conditions such as diabetes, dementia, hypertension, heart disease, and stroke, and a record number of drug overdose deaths occurred in the 12 months ending in May 2020.  These events underscore the importance of ensuring people with chronic physical and behavioral health conditions continue to access the care they need during the public health crisis and beyond.”In general, the survey shows that the detrimental effects of the pandemic aren’t going anywhere anytime soon.

Sources:

Missed Visits During Pandemic Cause ‘Detrimental Ripple Effects’Delayed and Forgone Health Care for Nonelderly Adults during the COVID-19 Pandemic