Impact of the COVID-19 Pandemic on the Intensity of Health Services Use in General Practice: A Retrospective Cohort Study

Background: The COVID-19 pandemic affects non-COVID-19-related health services use due to shutdown measures and fears of coronavirus infection or overwhelmed health systems. We aimed to explore the impact of the Swiss shutdown in spring 2020 on the intensity of health services use (consultation counts, chronic disease measurement counts) in Swiss general practice. Methods: Based on electronic medical records from 278 general practitioners in Switzerland, we built two patient cohorts from January to June in 2019 (173,523 patients) and 2020 (179,086 patients). We used linear regression to model weekly consultation counts and weekly blood pressure (BP) and glycated haemoglobin (HbA1c) measurement counts per 100 patients. We also calculated expected values (in absence of a shutdown) and compared them to observed values. The analyses were repeated for selected at-risk groups (i.e. patients with hypertension, diabetes, and cardiovascular disease) and different age groups (i.e. 80 years). Results: During the shutdown period, weekly consultation counts were lower than non-shutdown prediction models estimated by -17.2% for the total population, -16.5% for patients with hypertension, -17.5% for patients with diabetics, and -17.6% for patients with cardiovascular disease. Between different age groups, the decrease in consultations was -15.7% for patients aged 80 years. Weekly BP counts were reduced by -35.3% in the total population and by -35.0% for patients with hypertension. Weekly HbA1c counts were reduced by -33.2% in the total population and by -29.8% for patients with diabetes. P-values were <0.001 for all reported estimates. Conclusions: Our results document and analyse consequential decreases in consultation counts and chronic disease monitoring during the shutdown in Switzerland. It is crucial that health systems remain able to meet the non-COVID-19-related health care needs of patients during subsequent waves of the pandemic. This requires a careful balance between protecting GPs and patients against COVID-19 infections and preventing rapid deteriorations in patients with chronic conditions in need of regular care.