The covid-19 pandemic has had a strong impact on the health of the population, not only due to positive cases, but also indirectly through disruption to and the constant strain on healthcare services, which have affected the diagnosis and treatment of other diseases during this time. Also, the pandemic has turned the healthcare model of healthcare systems around the world upside-down, causing the sudden cancellation of face-to-face visits and steering the model towards telemedicine.

These two issues, focusing on the public health system of primary care in Catalonia, have been analysed in two scientific studies, with the participation of a total of three researchers linked to the UPF Centre for Research in Health and Economics (CRES): Francesc López Seguí, Héctor Pifarré i Arolas and Guillem Hernández Guillamet. Researchers linked to the Catalan Health Institute, the University Institute for Research in Primary Health Care Jordi Gol i Gurina, Sant Joan de Déu Hospital and other universities and research centres in Catalonia and Great Britain have also taken part.

“The observed decrease in new diagnoses in all disease groups suggests a large number of untreated and undetected cases”

One of the articles, published in International Journal of Environmental Research and Public Health, is led by Héctor Pifarré i Arolas and enjoys the participation of Francesc López Seguí. After comparing the ratio of new diagnoses between 2019 (without the pandemic) and 2020 (when the first wave of covid-19 hit), it found a 31.1% average decrease in new diagnoses, with substantial falls in the months of April (61.1%), May (55.6%) and November (52%) 2020.

The disease undergoing the biggest decline in diagnoses is cancer (down 49.4%). In musculoskeletal, nervous system and circulatory system diseases, less than 6 out of 10 diagnoses were reached compared to the previous year. According to the CRES researchers, “the observed decrease in new diagnoses in all disease groups suggests a large number of untreated and undetected cases”. Thus, “while we find evidence of temporal variation in new diagnoses, reductions in diagnoses early in the year are not recouped by the year end”, they say.

According to the study, the changes that have taken place in daily health practices, through the reduction of hospital admissions and visits to emergency services for reasons other than covid-19, reflect that health systems have capacity restraints and that some patients postpone or avoid healthcare for fear of contracting the disease, with serious health consequences. However, when it comes to being able to extrapolate the results to other countries, it must be borne in mind that “the Catalan healthcare system is public and free, which are two factors that reduce barriers for access to healthcare and may vary, depending on the contexts”, they reflect.

Fewer face-to-face visits to primary care and an increase in virtual visits

The second study, published in Journal of Medical Internet Research, analyses the characteristics and variation in the type of visits to primary care between 2019 and 2020 (approximately before and during covid-19). It distinguishes between those with larger and smaller variations, in order to identify the clinical profiles that may have been most affected by the pandemic.

The study, led by Francesc López Seguí (first author) involving Guillem Hernández Guillamet and Héctor Pifarré i Arolas, all linked to CRES-UPF, concludes that there was a sharp increase in non-face-to-face visits (via email and telephone), with an increase of 267%, which did not offset the decrease in face-to-face visits (which fell by 47%). Thus, there was an overall reduction in the total number of visits of 1.36%, despite the significant increase in nursing visits (10.54%).

Francesc López Seguí: “Primary care puts a lot of effort into social prescribing, which grew significantly in 2020”

By type, the largest decreases in visits in 2020, compared to 2019, were related to chronic diseases, such as high blood pressure (down 32.7%), diabetes (21.13%), obesity (48.58%), bodily injuries (33.70%) and respiratory infections (41%). Visits related to mental health also decreased (around 10%). This figure is far lower than the average and, according to the researchers, suggests an increase in demand.

As for diagnoses that increased, they were related to covid-19, along with consultations for diagnoses related to economic and housing problems (with an increase of 44.4%). This last figure, according to Francesc López Seguí, who, in addition to his links to the CRES is a researcher in Health Economics at the Germans Trias i Pujol Hospital, emphasizes the importance of social determinants of health in the context of this pandemic: “Primary care puts a lot of effort into social prescribing, which grew significantly in 2020".

Two research studies that focused on Central Catalonia that will help the health authorities

The two research studies are based on the analysis of data from the Primary Care Services Information Technologies System of the Health Region of Central Catalonia, with 400,000 patients and nearly three million visits, according to the International Statistical Classification of Diseases. Subsequent unpublished analyses have compared these figures with the Northern Metropolitan Health Region (an area that covers approximately two million users) and the results are similar.

According to the researchers, the findings of these two studies may help health authorities and planners make decisions over the next few years and in view of future pandemic waves, in areas such as underdiagnosis conditions, the potential effect of catching up with diagnoses during the months when the incidence of covid-19 decreases, information on the least treated diseases during the pandemic, and the identification of diagnostic groups that have been particularly affected by the disruptions caused by the pandemic.

Reference works:

Pifarré i Arolas, H., Vidal-Alaball, J., Gil, J., López Seguí, F., Nicodemo, C. and Saez, M. (May 2021). “Missing Diagnoses during the COVID-19 Pandemic: A Year in Review”. International Journal of Environmental Research and Public Health https://doi.org/10.3390/ijerph18105335

López Seguí, F., Hernández, G., Pifarré i Arolas, H., Martín, F.X., Ruiz, A., Rodríguez, A.M., Adrhoer, C., Vidal-Alaball, J. (September 21). “Characterization and Identification of Variations in Types of Primary Care Visits Before and During the COVID-19 Pandemic in Catalonia: Big Data Analysis Study”.  Journal of Medical Internet Research doi: 10.2196/29622