ABSTRACT
BACKGROUND: The COVID-19 pandemic has altered the provision of health care and expanded telehealth consultations. AIM: To study the effect of the COVID-19 pandemic on contact patterns in general practice, and to identify patient groups at risk of losing care. DESIGN AND SETTING: Register-based study of Danish general practice, including daytime and out-of-hours (OOH) services. METHOD: All individuals residing in Denmark from 1 January 2017 to 31 October 2020 were included. The incidence rate for six contact types in general practice and adjusted incidence rate ratio were calculated by comparing the incidence rate in the pandemic period with the adjusted expected incidence rate based on the incidence rate in the pre-pandemic period. RESULTS: The number of face-to-face in-clinic consultations declined during the lockdown in March 2020. A subsequent increase in the number of clinic consultations was observed, rising to a level above that of the pre-pandemic period; this increase resulted mainly from the introduction of telehealth consultations (that is, video and extended telephone). The number of daytime email consultations increased, whereas the number of daytime home visits decreased. Likewise, the number of OOH telephone consultations increased, whereas the number of OOH home visits and clinic consultations decreased. Consultation rates of patients who are vulnerable, that is, those with low education, old age, and comorbidity, were most adversely affected by the pandemic. The most adverse impact in OOH clinic consultations was seen for children aged 0-9 years. CONCLUSION: New methods are called for to ensure access to general practice for patients who are vulnerable during a pandemic. The potential of telehealth consultations should be further investigated.