"I have travelled along on my own"-Experiences of seeking help for serious non-COVID health problems during the COVID-19 pandemic: A qualitative study.

OBJECTIVES: During COVID-19 the UK general population has been given strong messages to stay at home. Concurrently unprecedented changes occurred in healthcare access with moves to remote/triage systems. Data have shown that the number of people accessing healthcare services decreased and there are significant concerns that the pandemic has negatively affected help-seeking for serious conditions, with potentially increased morbidity and mortality. An understanding of help-seeking is urgently needed to inform public campaigns. We aimed to develop an in-depth, theory-based understanding of how, when and why people sought help for potentially serious symptoms (e.g., related to major cardiovascular events or cancer diagnoses) during the pandemic, and what influenced their decisions. DESIGN: Qualitative semi-structured interviews. METHODS: We interviewed 25 adults recruited through a targeted social media campaign. Interviews were conducted via telephone or online platform. Our topic guide was informed by the Model of Pathways to Treatment and the Capability-Opportunity-Motivation-Behaviour model. RESULTS: The analysis identified four main themes: Delay in recognition, Holding on to concerns, Weighing it up and Long-term impacts. Multiple societal and environmental factors influenced participants' help-seeking and motivation, capability and opportunity to seek help, with long-term impacts on well-being and future help-seeking. CONCLUSIONS: There is a need for clear guidance about pathways to raise concerns about symptoms and gain advice while usual healthcare contacts are paused or stopped. Recommendations for future interventions to support help-seeking during pandemics include clearer messaging, co-produced with end-users, on when, where and how to seek help.

Differences in the rates of new diagnoses reported pre and during the COVID-19 pandemic

BackgroundExcess deaths from conditions other than COVID-19 have been reported during the pandemic. Difficulty accessing healthcare is a possible explanation. We aimed to assess changes in rates of new diagnoses for common conditions before and during the pandemic.MethodsParticipants aged 50 years and older in three waves of the English Longitudinal Study for Ageing were asked whether a doctor had told them that they had newly developed any of 11 medical conditions: hypertension, angina or heart attack, heart failure, diabetes, stroke, chronic lung disease, asthma, arthritis, cancer, dementia, or blood disorder. Responses were compared between pre-COVID Wave 9 (W9) in 2018 to 2019, COVID Wave 1 (CW1) in June and July 2020, and COVID Wave 2 (CW2) in November and December 2020. Multivariate logistic regression on weighted data was performed to assess variation by sex, age group (50 to state pension age (SPA), SPA to 74, 75 and over), and wealth quintile.ResultsThe overall rate of new diagnoses reported per 1,000 participants per year was 116.76 in W9 (n=7,289), 110.10 in CW1 (n=5,825), and 138.23 in CW2 (n=5,339). Diagnosis rates dropped from W9 to CW1 to CW2 for dementia (9.09 to 4.01 to 2.25 respectively), angina and heart attack (13.50 to 11.67 to 10.86), and stroke (7.05 to 6.18 to 4.12). In contrast, the rate increased for arthritis (29.11 to 37.42 to 44.58) and diabetes (18.83 to 21.06 to 23.60). Multivariate analysis found that increasing age was a predictor for dementia diagnosis in cw2 (odds ratio 2.20;95% confidence interval 1.12 to 4.30). No other regression analyses were statistically significant.ConclusionDrops in diagnosis rates for dementia and cardiovascular disease during the pandemic could be contributing to increased deaths from conditions other than COVID-19. Policy initiatives are underway to encourage people to seek healthcare as normal, and it will be important to maintain adequate access to healthcare for major conditions in any future lockdown. The reasons for the reported substantial rise in arthritis and smaller rise in diabetes diagnosis rates are not clear and require further investigation.

Socio-demographic predictors of uptake of a virtual group weight management program during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has had a significant adverse impact on the delivery of weight management programmes (WMPs), in order to ensure the safety of patients and healthcare professionals. Videoconferencing could provide safe remote access to group WMPs during the COVID-19 pandemic. The objectives of this study were to determine the uptake of a virtual group WMP and its predictors. METHODS: All patients enrolled on a face-to-face group WMP, which constitutes part of a Tier 3 WMP delivered by the NHS, at the time of the COVID-19 pandemic lockdown were invited to transfer to a virtual format of the group WMP. Baseline data included weight, BMI, age, gender, ethnicity and Index of Multiple Deprivation (IMD) quintile score. The outcomes were accept/decline transfer to the virtual group WMP. Logistic regression was performed to assess for predictors of uptake. RESULTS: The 315 participants were included, of which 72.1% (n = 227) accepted. After adjusting for gender, deprivation and BMI; older patients (OR 0.966, [95% CI 0.944, 0.989]; p = 0.003) and Black, Asian and Minority Ethnicity (BAME) patients (OR 0.460 [95% 0.248, 0.851]; p = 0.023) were less likely to accept the virtual group WMP. CONCLUSION: Strategies aimed at improving uptake of group WMP among BAME and older adult groups are needed, particularly considering the increased risk of severe COVID-19 in these two groups, and the links between obesity and poor COVID-19 outcomes.