How did the first covid-19 lockdown affect general practitioner contacts with children and young people?

AimsTo examine the impact of the covid-19 pandemic on total, face to face and remote general practitioner (GP) contacts with children and young people aged under 25 years in England before and after the first lockdown in the United Kingdom (March to June 2020).MethodsLongitudinal trends analysis using electronic health records from the nationally representative Clinical Practice Research Datalink Aurum database. We included all children and young people aged <25 years registered with a GP anytime during the study period (January 2015 to October 2020). We assigned their GP contacts according to their age (years) on the date of the contact: <1, 1-4, 5-9, 10-14, 15-19, 20-24.Our main outcomes were total, face-to-face and remote weekly contacts with a GP. Secondary outcomes were weekly contacts with GPs for respiratory illnesses (upper respiratory tract infections, lower respiratory tract infections and asthma) and common non-transmissible conditions (urinary tract infections, diabetes, epilepsy and appendicitis). For all outcomes, we compared the number of contacts during the first UK lockdown (March to June 2020) with the mean number of contacts for comparable weeks from 2015 to 2019.ResultsOur study population included 4 307 120 million children and young people who had 47 607 765 GP contacts. Total GP contacts fell by 40.7% (95% CI: 40.7, 40.8) during the first lockdown compared with previous years. Children aged 1-14 years had greater falls in total contacts (>50%) compared with infants and those aged 15-24 years. Face-to-face contacts fell by 88.3% (95% CI: 88.2, 88.4) for all ages. The greatest falls in face-to-face contacts occurred among children aged 1-14 (> 90%), whereas face-to-face contacts with infants fell by 76.8% (95% CI: 76.6, 77.0). Remote contacts more than doubled, increasing most in infants (over 2.5 fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote and fell by 31%.ConclusionChildren and young people’s contact with GPs fell, particularly for face-to-face assessment during the first pandemic lockdown, with notably fewer contacts for respiratory illnesses. This change reflects a combination of altered healthcare seeking behaviour, lower prevalence of some conditions (notably fewer respiratory illnesses due to fewer social contacts), and changes in service provision. A major shift from face-to-face to remote contacts for common non-transmissible conditions mitigated overall falls.

Access to and use of contraceptive care during the first COVID-19 lockdown in the UK: a web-based survey.

BACKGROUND: The first wave of lockdown measures to control the COVID-19 pandemic in the UK resulted in suspension of 'non-essential' services, including contraceptive care. AIM: To examine women's perceptions and experiences of contraceptive care in the UK during the first lockdown. DESIGN & SETTING: A cross-sectional survey during the lockdown period from March-June 2020. METHOD: An online questionnaire was designed asking women aged 16-54 years their experiences of contraceptive care during lockdown. Questions were based on Maxwell's evaluation framework on access, acceptability, relevance or appropriateness, and equity. It was promoted on social media from 27 May-9 June 2020. A descriptive analysis was conducted of quantitative data and thematic analysis of free-text data. RESULTS: In total, 214 responses were analysed. General practice was the source of contraception for 43.4% (n = 49) and 52.3% (n = 34) of responders before and during the lockdown, respectively. The study found 55.1% (n = 118) of responders, including regular and new users, were uncertain where or how to get contraception during the pandemic. Responders reported reduced access to contraception during lockdown, and some thought sexual health clinics and general practices were closed. Remote consultations and electronic prescriptions facilitated contraceptive access for some responders. Long-acting reversible contraception (LARC) was unavailable in some areas owing to restrictions, and alternatives were not acceptable to those who used methods for non-contraceptive benefits to treat medical conditions; for example, menorrhagia. CONCLUSION: The study highlighted the need for better information and signposting for contraception during lockdown. Contraception, including LARC, should be reframed as an essential service with robust signposting for pandemic planning and beyond.

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study.

OBJECTIVES: To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING: All National Health Service (public) hospitals in England. PARTICIPANTS: All people in England aged <25 years. OUTCOME MEASURES: Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS: Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS: COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.

Impact of COVID-19 on primary care contacts with children and young people in England: longitudinal trends study 2015-2020.

BACKGROUND: The NHS response to COVID-19 altered provision and access to primary care. AIM: To examine the impact of COVID-19 on GP contacts with children and young people (CYP) in England. DESIGN AND SETTING: A longitudinal trends analysis was undertaken using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum database. METHOD: All CYP aged <25 years registered with a GP in the CPRD Aurum database were included. The number of total, remote, and face-to-face contacts during the first UK lockdown (March to June 2020) were compared with the mean contacts for comparable weeks from 2015 to 2019. RESULTS: In total, 47 607 765 GP contacts with 4 307 120 CYP were included. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 years had greater falls in total contacts (≥50%) compared with infants and those aged 15-24 years. Face-to-face contacts fell by 88%, with the greatest falls occurring among children aged 1-14 years (>90%). Remote contacts more than doubled, increasing most in infants (over 2.5-fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote contacts, mitigating the total fall (31%). CONCLUSION: During the COVID-19 pandemic, CYP's contact with GPs fell, particularly for face-to-face assessments. This may be explained by a lower incidence of respiratory illnesses because of fewer social contacts and changing health-seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.