People in England whose access to healthcare was disrupted during the COVID-19 pandemic were more likely to have potentially preventable hospital admissions, researchers report today.
A study, published in today’s edition of The BMJ, is the first to use individual level longitudinal data to examine the impact of disruption on health outcomes.
Researchers, led by a team at the University of Liverpool, UK, accessed data from seven longitudinal studies in the UK Longitudinal Linkage Collaboration (UK LLC) with linked data for 29,276 people in England to their NHS electronic health records from 1 March 2020 to 25 August 2022.
The main measure was avoidable emergency hospital admissions, defined as admissions for ambulatory care sensitive conditions and emergency urgent care sensitive conditions.
Out of the cohort, 9,742 participants (35%) reported some disrupted access to healthcare during the pandemic and after the data were adjusted for other potentially influential factors, individuals who reported any form of disruption in accessing healthcare were found to be at increased risk of hospital admission. For any condition and for ambulatory sensitive care conditions, they had 80% increased odds, while those with acute conditions had doubled odds.
When they investigated outcomes according to the type of healthcare disruption, people who experienced disrupted access to procedures had 77% higher odds of being admitted to hospital for any ambulatory care sensitive condition; 88% higher odds of being admitted for a chronic ambulatory care sensitive condition; 45% higher odds of an emergency urgent care sensitive admission; and 57% higher odds of any hospital admission.
People who experienced disruption in accessing appointments had 52% higher odds of hospital admission for any ambulatory care sensitive condition and 46% higher odds of any hospital admission.
These are observational findings and the team acknowledge that not all avoidable hospital admissions would have been caused by disruption of care. The team did not have data on them having problems accessing healthcare before the pandemic and say the disruption was self-reported.
Nevertheless, they believe that by combining individual level data from longitudinal studies with electronic health records they had a detailed picture of hospital admissions across a national healthcare system during the period studied.
“The external shock to the health system caused by the COVID-19 pandemic seriously disrupted access to healthcare and this impact is having negative impacts on hospital admissions that could potentially be preventable,” they said.
They add their findings “highlight the need to increase healthcare investment to tackle the short- and long-term implications of the pandemic, and to protect treatments and procedures during future pandemics”.
Green MA, McKee M, Hamilton OKL et al. Associations between self-reported healthcare disruption due to covid-19 and avoidable hospital admission: evidence from seven linked longitudinal studies for England. BMJ 20 July 2023; doi: 10.1136/bmj-2023-075133
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