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Study: Reduction in the number of patients in need of medical attention in the face of pandemic

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While nearly a quarter of Medicare beneficiaries reported having forgone medical care because of the COVID-19 pandemic, the percentage of patients who said they missed or delayed care decreased over time, according to a new study that analyzed data from three surveys spanning the period from June 2020 to April 2021.

Of the 23,058 Medicare enrollees who responded to at least one of the three surveys, 11.5% said they’d delayed or didn’t receive care because of COVID-19 disruptions.

Physician-driven factors accounted for about 70% of the forgone medical care, according to the respondents, although this percentage decreased from 66.2% during the week of July 7, 2020, to 44.7% during the weeks of April 4–25, 2021.

In summer 2020, the most common physician barrier reported was the closure of a doctor’s office. In April 2021, the most common physician barrier was that the patient’s doctor had reduced appointments.

The most common patient-driven factors reported were that the patient felt risk and wanted to stay home.

The biggest drop in the adjusted rate of seniors who said they’d forgone care due to COVID-19 occurred between June 7 and July 12, 2020, when the rate fell from 22.4% to 15.9%. The trend was lower through April 2021.

Dental care was the most common type of care that Medicare beneficiaries delayed or didn’t receive because of the pandemic (4.3%), followed by prevention (4.0%) and checkup (3.9%). Other missed care included urgent care (0.6%), surgery (1.9%), diagnostics (3.3%), vision (2.6%), and hearing (0.6%).

Mental Health Toll

“A substantial portion of Medicare beneficiaries experienced mental health problems during the pandemic,” the researchers write. “Nearly 40% of Medicare beneficiaries reported feeling more stressed or anxious, 21.5% reported feeling more lonely or sad, and 37.2% of Medicare beneficiaries reported feeling less socially connected during the pandemic.”

The study shows that forgone medical care was more prevalent among seniors with these mental health problems. Among those who reported feeling more stressed or anxious, 27.3% reported forgoing medical care, compared to 18.6% of those who didn’t have these symptoms during the week of July 7, 2020.

Similar differences were seen in the same week between those who reported feeling more lonely or sad or less socially connected and those who didn’t report these states of mind.

During the entire study period, the likelihood of forgone medical care was four percentage points higher among those who reported feeling more stressed or anxious than among those who did not. It was also three percentage points higher among those who reported feeling lonely or sad and three percentage points higher among those who reported feeling less socially connected.

The study’s estimate of forgone medical care during the pandemic, the researchers said, was lower than that of a previous study. That paper, published in November 2020, found that about 40% of US adults reported they had delayed or gone without medical care during the pandemic.

The authors attributed the discrepancy to multiple factors, including the difference between the study populations (all adults vs seniors), the difference between the study periods, and the questions asked (eg, forgone medical care overall or forgone medical care because of COVID-19).

Were Patients or Physicians the Cause?

The prominent role of physician-related factors observed in the new study reflects the patient reports in the Medicare surveys. However, it was widely reported early in the pandemic that patients were staying away from doctors’ offices out of fear of contracting COVID-19.

A survey of US primary care physicians conducted at the end of May 2020 by the Primary Care Collaborative and the Larry A. Green Center found that 79% of respondents reported fewer patient visits compared with before the pandemic. And a study based on March 2020 data found a nearly 60% drop in visits to ambulatory care practices compared to prepandemic levels.

Some practices closed, and many furloughed part or all of their staff at the time. However, only 6% of respondents to the PCC/Larry Green Center survey said they’d closed their practices.

By October, office visits had largely rebounded, although some specialties were still seeing fewer patients than before the pandemic, according to data analyzed by Harvard, the Commonwealth Fund, and Phreesia.

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