ABSTRACT
Objectives: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Design: Systematic review Eligibility: Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics, and therapeutics. Studies were excluded if from single-centres or studied only COVID-19 patients. Data sources: PubMed, Embase, Cochrane COVID-19 Study Register, and pre-prints were searched, without language restrictions, until August 10, using detailed searches with key concepts including COVID-19, health services and impact. Data analysis: Risk of bias was assessed by adapting ROBINS-I and Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures, and narrative synthesis. Outcome measures: Primary outcome was change in service utilisation between pre-pandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (e.g. triage scores). Results: 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services pre-pandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (interquartile range -51% to -20%), comprising median reductions for visits of 42%(-53% to -32%), admissions, 28%(-40% to -17%), diagnostics, 31%(-53% to -24%), and for therapeutics, 30%(-57% to -19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27(45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no change. Conclusions: Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health-systems prioritise higher-value care in the post-pandemic recovery. Funding, Study registration: No funding was required. PROSPERO: CRD42020203729
Subject(s)
COVID-19ABSTRACT
ObjectivePublic cooperation to practice preventive health behaviours is essential to manage the transmission of infectious diseases such as COVID-19. We aimed to investigate beliefs about COVID-19 diagnosis, transmission and prevention that have the potential to impact the uptake of recommended public health strategies. DesignAn online cross-sectional survey conducted May 8 to May 11 2020. ParticipantsA national sample of 1500 Australian adults with representative quotas for age and gender provided by online panel provider. Main outcome measureProportion of participants with correct/incorrect knowledge of COVID-19 preventive behaviours and reasons for misconceptions. ResultsOf the 1802 potential participants contacted, 289 were excluded, 13 declined, and 1500 participated in the survey (response rate 83%). Most participants correctly identified "washing your hands regularly with soap and water" (92%) and "staying at least 1.5m away from others" (90%) could help prevent COVID-19. Over 40% (incorrectly) considered wearing gloves outside of the home would prevent them contracting COVID-19. Views about face masks were divided. Only 66% of participants correctly identified that "regular use of antibiotics" would not prevent COVID-19. Most participants (90%) identified "fever, fatigue and cough" as indicators of COVID-19. However, 42% of participants thought that being unable to "hold your breath for 10 seconds without coughing" was an indicator of having the virus. The most frequently reported sources of COVID-19 information were commercial television channels (56%), the Australian Broadcasting Corporation (43%), and the Australian Government COVID-19 information app (31%). ConclusionsPublic messaging about hand hygiene and physical distancing to prevent transmission appear to have been effective. However, there are clear, identified barriers for many individuals that have the potential to impede uptake or maintenance of these behaviours in the long-term. Currently these non-drug interventions are our only effective strategy to combat this pandemic. Ensuring ongoing adherence to is critical. What is already known on this topicO_LIThe current strategies to prevent the transmission of COVID-19 are behavioural (hand hygiene, physical distancing, quarantining and testing if symptomatic) and rely on the public knowledge and subsequent practice of these strategies. C_LIO_LIPrevious research has demonstrated a good level of public knowledge of COVID-19 symptoms and preventive behaviours but a wide variation in practicing the recommended behaviours. C_LIO_LIAlthough knowledge can facilitate behaviour change, knowledge alone is insufficient to reliably change behaviour to the widespread extent require to combat health crises. C_LI What this study addsO_LIParticipants reveal confusion about whether wearing masks will reduce transmission, apprehension about attending health services, and perceptions that antibiotics and alternative remedies (such as essential oils) prevent transmission. C_LIO_LIAnalysis of why participants hold these beliefs revealed two dominant themes: an incomplete or inaccurate understanding of how COVID-19 is transmitted, and the belief that the behaviours were unnecessary. C_LIO_LIThis study underlines the necessity to not only target public messaging at effective preventative behaviours, but enhance behaviour change by clearly explaining why each behaviour is important. C_LI