ABSTRACT
Einleitung Die COVID-19-Pandemie wirkt sich auch auf die medizinische Versorgung anderer Erkrankungen aus. Differenziert zwischen patient:innen- und anbieter:innenseitigen Gründen wurde untersucht, inwieweit Personen mit chronischen Erkrankungen vom Aussetzen medizinischer Versorgungsleistungen betroffen sind. Methoden Es wurde eine Querschnittstudie auf Datenbasis der Kohortenstudie Hamburg City Health Study (HCHS) durchgeführt. Die Studienpopulation bestand aus allen HCHS-Teilnehmer:innen (Stichprobe der Bevölkerung Hamburgs, 45–74 Jahre) zwischen April 2020 und November 2021. Über das „COVID-19-Modul" der HCHS wurde die Inanspruchnahme von Versorgungsleistungen erhoben. Als Grunderkrankungen wurden u. a. Herz-Kreislauf‑, Nieren- und Lungenerkrankungen, Krebs und Diabetes mellitus betrachtet. Die Daten wurden deskriptiv und multivariat in logistischen Regressionen ausgewertet. Ergebnisse Von 2047 Teilnehmer:innen hatten 47,9 % mindestens eine Vorerkrankung. 21,4 % der Personen mit Vorerkrankungen hatten mindestens eine Versorgungsleistung ausgesetzt oder eine Terminabsage erhalten. 15,4 % gaben an, von sich aus auf einen Arztbesuch verzichtet zu haben. Fachärztliche Leistungen (Anteil 43,8 %) entfielen häufiger als hausärztliche (16,6 %). Nach Adjustierung für Alter, Geschlecht und Bildung erwiesen sich Lungen- (OR 1,80;p < 0,008) und Krebserkrankungen (OR 2,33;p < 0,001) als unabhängige Risikofaktoren für ärztliche Terminabsagen. 42,2 % der patient:innenseitigen Absagen erfolgten aus Angst vor einer Ansteckung mit SARS-CoV‑2. Diskussion Gesundheitspolitik und Medien stehen vor der Herausforderung, mit Ängsten in der Bevölkerung vor einer Infektion so umzugehen, dass notwendige Versorgungsleistungen dadurch nicht vermieden werden. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-023-03665-9) enthalten.
ABSTRACT
AIMS: Long-term sequelae may occur after SARS-CoV-2 infection. We comprehensively assessed organ-specific functions in individuals after mild to moderate SARS-CoV-2 infection compared with controls from the general population. METHODS AND RESULTS: Four hundred and forty-three mainly non-hospitalized individuals were examined in median 9.6 months after the first positive SARS-CoV-2 test and matched for age, sex, and education with 1328 controls from a population-based German cohort. We assessed pulmonary, cardiac, vascular, renal, and neurological status, as well as patient-related outcomes. Bodyplethysmography documented mildly lower total lung volume (regression coefficient -3.24, adjusted P = 0.014) and higher specific airway resistance (regression coefficient 8.11, adjusted P = 0.001) after SARS-CoV-2 infection. Cardiac assessment revealed slightly lower measures of left (regression coefficient for left ventricular ejection fraction on transthoracic echocardiography -0.93, adjusted P = 0.015) and right ventricular function and higher concentrations of cardiac biomarkers (factor 1.14 for high-sensitivity troponin, 1.41 for N-terminal pro-B-type natriuretic peptide, adjusted P ≤ 0.01) in post-SARS-CoV-2 patients compared with matched controls, but no significant differences in cardiac magnetic resonance imaging findings. Sonographically non-compressible femoral veins, suggesting deep vein thrombosis, were substantially more frequent after SARS-CoV-2 infection (odds ratio 2.68, adjusted P < 0.001). Glomerular filtration rate (regression coefficient -2.35, adjusted P = 0.019) was lower in post-SARS-CoV-2 cases. Relative brain volume, prevalence of cerebral microbleeds, and infarct residuals were similar, while the mean cortical thickness was higher in post-SARS-CoV-2 cases. Cognitive function was not impaired. Similarly, patient-related outcomes did not differ. CONCLUSION: Subjects who apparently recovered from mild to moderate SARS-CoV-2 infection show signs of subclinical multi-organ affection related to pulmonary, cardiac, thrombotic, and renal function without signs of structural brain damage, neurocognitive, or quality-of-life impairment. Respective screening may guide further patient management.
Subject(s)
COVID-19 , COVID-19/diagnosis , COVID-19/epidemiology , Cohort Studies , Humans , SARS-CoV-2 , Stroke Volume , Ventricular Function, LeftABSTRACT
OBJECTIVES: The study investigates the impact of the COVID-19 pandemic on health services with and without specific health care of COVID-19 patients through the eyes of leading physicians at the University Medical Center Hamburg-Eppendorf (UKE). METHODS: From April 30 to May 12, 2020, four interviewers conducted 38 expert interviews via telephone, video or face-to-face by using a semi-standardized questionnaire. The standardized answers were analysed descriptively. The free text-answers were subject to a qualitative content analysis. The categories were analysed via quantitative frequency distributions. RESULTS: All chief physicians with responsibility for inpatient and outpatient health care at the UKE took part in this study (N=38). The leading physicians reported numerous changes regarding occupancy in the hospital, patient composition, work flows and diagnostic as well as therapeutic measures. Additionally, various arrangements were necessary to cover the needs of prevention, treatment and follow-up care as well as protection of staff. Measures showed, on the one hand, a strong reduction in occupancy and workload in most inpatient and outpatient clinics. On the other hand, the amount of work also increased by fundamental transitions of work flows, communication, staff structure and hygiene measures. Many respondents commented positively on the rapid and efficient setup of a digital communication structure. Partially, staff was strained by the pandemic itself and by the associated measures. CONCLUSION: The results of the study help to understand and assess the effects of the pandemic on health care, work flows and staff. The findings may support the specification and adaptation of prospective measures and processes for pandemic crisis situations. Future studies should investigate how staff beneath the highest executive level experienced and evaluated this crisis and consequences.