Many patients in US continue to face pandemic-related delays in primary care
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Many older adults and individuals of historically underrepresented groups who experienced a delay in care due to the COVID-19 pandemic still have not received care, according to recent research.
In particular, survey results from the National Poll on Health Aging revealed that nearly one in three adults aged older than 50 years had a COVID-19-related delay in care in 2021, many of whom said they have not rescheduled their visit nor plan to.
“While we were not surprised that many older adults have experienced delayed care due to the COVID-19 pandemic, we were surprised that so many of these individuals either had not yet rescheduled disrupted care or were not planning to,” Jeffrey Kullgren, MD, MPH, MS, the associate director of the poll and an associate professor of internal medicine at Michigan Medicine, told Healio. “This group, older adults who had disrupted care but have not yet received or rescheduled it, may be at particular risk for more health problems down the line unless health systems proactively reach out to them.”
Delayed care among older adults
Kullgren and colleagues polled a nationally representative sample of 1,011 adults aged older than 50 years, who responded to a wide range of questions online or by phone in late January 2022. Among the cohort, 83% of participants were vaccinated against COVID-19 and 70% were boosted.
Overall, 29% of respondents who had a primary care visit scheduled in 2021 reported a disruption to care related to COVID-19. Among them, 15% of respondents said they postponed, rescheduled or canceled a primary care visit, while 11% said their provider postponed, reschedule or canceled their primary care visit.
Most respondents already had a makeup visit (56%) or scheduled one (20%) by January. However, 14% of respondents said they did not reschedule their appointments yet, and 8% do not intent to reschedule, according to the researchers. Unvaccinated adults were least likely to reschedule their missed appointments (53%) compared with vaccinated adults (74%) and vaccinated and boosted adults (85%).
In addition to primary care, 31% of respondents reported a canceled or delayed dental appointment and 28% reported a canceled or delayed procedure, test or operation. Accounting for all avenues of care, 64% to 85% of vaccinated or vaccinated and boosted respondents had rescheduled care as of January compared with 30% to 53% of unvaccinated respondents.
“There are many ways in which delaying needed health care can lead to more health problems down the road,” Kullgren said. “Delayed care for chronic conditions such as diabetes, hypertension or heart disease can lead to new complications that could have been prevented through monitoring and medications. Delayed elective surgeries for conditions that limit physical activity, such as knee replacements for severe osteoarthritis, can hinder mobility and increase the risk of falls. In these and many other situations, delayed care can result in missed opportunities to intervene on health issues before they lead to more serious problems.”
He advised physicians to communicate the health problems associated with delayed care to patients, particularly those at high risk.
Delayed care among historically underrepresented groups
In addition to older adults, individuals of historically underrepresented groups were also more likely to delay or not receive medical care due to the pandemic, according to separate findings published in the Journal of General Internal Medicine.
“The pandemic has been devastating, leading to unprecedented public health and economic crises,” Rishi K. Wadhera, MD, MPP, MPhil, an assistant professor of medicine at Beth Israel Deaconess Medical Center, told Healio. “Racial and ethnic minority and low-income communities have been disproportionately affected by both the direct and indirect effects of the pandemic. Moving forward, our public health and policy strategies must prioritize health equity to ensure that the long-term effects of the pandemic do not continue to disproportionately affect communities of color.”
Wadhera and colleagues conducted a serial, cross-sectional survey study of 2,470,717 adults using data from the U.S. Census Bureau Household Pulse Survey. Online survey results were collected weekly from April 2020 to July 2020 and biweekly from August 19, 2020, onward during the pandemic from the National Center for Health Statistics.
The researchers calculated the proportion of adults who experienced a delay in health care by race and ethnicity across four consecutive time periods: wave one (April 23, 2020, to June 16, 2020), post-wave one (June 18, 2020, to Sept. 14, 2020), wave two (Sept. 16, 2020, to Feb. 15, 2021) and post-wave two (Feb. 17, 2021 to May 10, 2021). They then estimated the likelihood of delaying or not getting needed medical care by race and ethnicity compared with non-Hispanic white adults.
Among the cohort, the mean age was 48.9 years and 48.4% of the adults were men. Also, 62.7% of adults were white, 16.9% were Hispanic, 11.5% were Black and 5.1% were Asian.
During the study period, the proportion of participants who delayed or did not receive care decreased from 38.7% to 19.1% (P < .001). Asian (OR = 0.74; 95% CI, 0.69-0.8), Hispanic (OR = 0.89; 95%, CI 0.84-0.93) and non-Hispanic Black (OR = 0.94; 95% CI, 0.9-0.99) adults were less likely to delay or not get medical care during wave one compared with non-Hispanic white adults. However, Wadhera and colleagues reported that during wave two, Hispanic (OR = 1.25; 95%, CI 1.2-1.29) and non-Hispanic Black (OR = 1.05; 95% CI, 1-1.1) adults were more likely to delay or not get medical care than non-Hispanic white adults. By the end of the post-wave two period, Asian (OR = 1.22; 95% CI, 1.16-1.28), Hispanic (OR = 1.39; 95% CI 1.34-1.45) and non-Hispanic Black (OR = 1.17; 95% CI, 1.12-1.22) adults were more likely to delay or not get medical care.
Overall, nearly one in five adults in the U.S. continue to delay or not receive medical care due to the pandemic, according to study author Ahmed Ahmed, MPP, MSc, a doctoral candidate at Harvard Medical School.
“These findings are alarming and suggest that many individuals may not be receiving important screening tests (eg, mammograms), care for chronic conditions like diabetes and high blood pressure and/or are avoiding the hospital when they have life-threatening symptoms (eg, chest pain),” Ahmed told Healio. “The impact of these delays or deferrals in care on health could be vast over the long term.”
References:
Ahmed A, et al. J Gen Intern Med. 2022;doi:10.1007/s11606-022-07406-7.
Pandemic disruptions mean many older adults still haven’t gotten needed care. https://www.healthyagingpoll.org/reports-more/poll-extras/pandemic-disruptions-mean-many-older-adults-still-havent-gotten-needed. Published Feb. 15, 2022. Accessed Feb. 16, 2022.