2019年冠状病毒病疫情及封锁对基层医疗中会诊数量、会诊原因及所提供服务的影响：一项纵向观察性研究的结果
The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study.
作者信息
Schäfer Ingmar, Hansen Heike, Menzel Agata, Eisele Marion, Tajdar Daniel, Lühmann Dagmar, Scherer Martin
机构信息
Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
出版信息
BMC Fam Pract. 2021 Jun 23;22(1):125. doi: 10.1186/s12875-021-01471-3.
OBJECTIVES
The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP.
METHODS
We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices.
RESULTS
One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001).
CONCLUSIONS
We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.
目的
我们研究的目的是描述新冠疫情及封锁措施对德国初级医疗保健的影响，包括就诊次数、患者就诊的具体原因以及全科医生提供的特定服务的频率。
方法
我们采用配额抽样设计，基于标准化的全科医生访谈进行了一项纵向观察性研究，比较了新冠疫情之前（2015年6月12日至2017年4月27日）和封锁期间（2020年4月21日至7月14日）的情况。样本包括德国汉堡周边120公里范围内城乡地区的全科医生，并按地区类型和行政区进行分层。通过混合模型中的多变量线性回归分析就诊次数的差异，并对行政区和全科医生诊所层面的随机效应进行调整。
结果
110名全科医生参与了随访，占基线的52.1%。在37个选定行政区中的32个（86.5%）的初级医疗保健诊所在两次评估中均有代表。基线时，全科医生报告每周有199.6±96.9次就诊，在新冠疫情封锁期间显著减少了49.0%，降至每周101.8±67.6次就诊（p<0.001）。在封锁期间，五种就诊原因（-43.0%至-31.5%）和十一项服务（-56.6%至-33.5%）的频率显著下降。多层次多变量分析显示每周平均减少94.6次就诊（p<0.001）。
结论
我们观察到初级医疗保健中的就诊次数大幅减少。这种影响与全科医生的年龄、性别和专业无关，也与诊所位于城市还是农村地区无关。腰痛、胃肠道不适、眩晕或疲劳等病症的就诊以及上门出诊/疗养院出诊、伤口治疗、疼痛治疗或慢性病早期检测筛查等服务受到的影响尤为明显。
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