HEALTHCARE BARRIERS AND THEIR NEGATIVE DOWNSTREAM EFFECTS DURING THE COVID-19 PANDEMIC: A MIXED METHODS STUDY

ABSTRACT

BACKGROUND: Pandemic related accommodations have provided direct barriers to accessing healthcare and changes to health-maintenance routines and disease management. We aimed to examine reported access to care and impact on health using data from a community engagement survey distributed online. METHODS: Data taken from the UC-COVID study includes 1,971 adults (mean age 49.2y, 75.7% female, 68.5% white non-Hispanic). Respondents were asked to report disruptions in access to care during the early pandemic (May- August 2020), followed by open-ended questions about the types of care that was disrupted and consequences. Qualitative data was coded by three independent coders and analyzed to identify common themes. RESULTS: 68%of respondents described disruptions in access to care during COVID-19, where a visit was canceled, rescheduled, or changed to telehealth since March 2020. Participants reported direct barriers such as clinic closures (“I am not able to access my PCP because of reductions in outpatient visits”), medication shortages, and cancelation or delays in elective procedures and imaging (“My left knee needs to have elective replacement surgery, or a pain shot and have not been able to get a shot. That means that my knee hurts more and restricts my desire to exercise”). 64% of patients facing disruptions had their visits changed to telehealth and despite accessing care, faced limitations in their experiences and cited decreased quality of care (“I typically saw about 20 doctors every three months or so?and now they are all telemedicine so it feels like I'm not really getting medical help”). Patients also reported changes in disease management routines due to social distancing mandates (“Severe exacerbation of mood disorder, both directly by social distancing/isolation and indirectly by interference with therapy”). Approximately 47%and 15% of patients experienced disruptions for a chronic condition and urgent health concern, respectively, with 6% reporting negative consequences from their delayed and/or forgone care. Patients reported downstream effects from barriers, such as uncontrolled disease (“I have had more roller coaster blood glucose levels due to stress, diet, and exercise”), medical uncertainty (“Since there is no way of knowing if the [cancer] cells have multiplied without the biopsies and procedures I am uncertain the grade of Dysplasia at this time”), and increased psychological stress (“My stress and anxiety have skyrocketed, including that for the first time in my life I'm taking a sleep aid every single night. I didn't cry very often, and now I cry at least once per week, sometimes multiple days in a row.”). CONCLUSIONS: Understanding the scope and associated health effects of COVID-related disruptions in access to care is critical for healthcare providers, policymakers, and hospital organizations to create system-wide safeguards and decisions that protect patient health and wellbeing in both acute and chronic care settings, especially as the COVID-19 pandemic continues.