The COVID-19 pandemic has resulted in dramatic changes in the delivery of routine health care in the UK. This is as a consequence of a reallocation of resources in order to prioritise COVID-19 patients, to minimise the risk of infection in non-COVID-19 patients and also as a result of behavioural changes in the population. For example, it has been shown that accident and emergency attendance and hospital admissions for non-COVID-19 related acute conditions have declined since the first UK lockdown in March 2020. Less is known about the consequence of this disruption on the provision of health care in primary care settings, though an increase in remote consultations has been documented. Overall however, reports indicate a decrease in consultations in these settings at both a regional and national level. Reduced or altered access to general practice is likely to have reduced the rate of first-diagnoses and referrals for a range of health conditions, both physical and mental. It is also likely to have adversely affected the continuation of care and risk factor management in those with pre-existing conditions, which is likely to lead to poor outcomes in the medium- to longer-term. We aim to investigate how COVID-19 and the introduction of the three national lockdowns has affected temporal trends in primary care contacts and the subsequent diagnoses and management of selected physical and mental health conditions.
This study aims to describe temporal trends in the provision of primary care in the UK before, during and after the introduction of COVID-19 national lockdowns. Studies have reported a reduction in A&E attendance and admissions at secondary care settings but less is known about the disruptions to care delivered in primary care settings. In this study, our exposure(s) will be the introduction of the national lockdowns. We will utilise an interrupted time series (ITS) framework (with time divided into before, during and between the introduction of national lockdowns and also a longer-term post-lockdown period representing the next phase of the COVID-19 pandemic) and use negative binomial regression models to estimate weekly events (e.g., primary care consultations, referrals to outpatients). We will also assess trends in risk factor control pre and post the start of the pandemic (March 2020); and determine the association between both risk factor control and medium to long-term outcomes, primarily cardiovascular events, mortality, and hospital admission.
We will also assess whether the disruption in the provision of primary care has been equitable across different population subgroups, e.g., across different age, ethnic and deprivation groups.
Weekly consultation counts; consultation type; consultation duration; referrals to outpatient services; incidence of first diagnoses of cardio-metabolic conditions; indicators of risk factor control (e.g. blood pressure, lipids, HbA1c, BMI, medication adherence (medication possession rate) and smoking status); medium to long-term outcomes (cardiovascular events, mortality, and hospital admission).
Kamlesh Khunti - Chief Investigator - University of Leicester
Tom Norris - Corresponding Applicant - University of Leicester
Claire Lawson - Collaborator - University of Leicester
Clare Gillies - Collaborator - University of Leicester
Francesco Zaccardi - Collaborator - University of Leicester
Samuel Seidu - Collaborator - University of Leicester
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation