Changes in Healthcare Utilization During the COVID-19 Pandemic and Potential Causes-A Cohort Study From Switzerland

Erika Harju; Alexandre Speierer; Katharina Tabea Jungo; Sara Levati; Stéphanie Baggio; Stefano Tancredi; Nazihah Noor; Pierre-Yves Rodondi; Stéphane Cullati; Medea Imboden; Dirk Keidel; Melissa Witzig; Irène Frank; Philipp Kohler; Christian Kahlert; Luca Crivelli; Rebecca Amati; Emiliano Albanese; Marco Kaufmann; Anja Frei; Viktor von Wyl; Milo A Puhan; Nicole Probst-Hensch; Gisela Michel; Nicolas Rodondi; Patricia Chocano-Bedoya

doi:10.3389/ijph.2023.1606010

Changes in Healthcare Utilization During the COVID-19 Pandemic and Potential Causes-A Cohort Study From Switzerland

Int J Public Health. 2023 Jul 26:68:1606010. doi: 10.3389/ijph.2023.1606010. eCollection 2023.

Authors

Erika Harju^{1

2

3}, Alexandre Speierer⁴, Katharina Tabea Jungo⁴, Sara Levati⁵, Stéphanie Baggio^{4

6}, Stefano Tancredi⁶, Nazihah Noor⁶, Pierre-Yves Rodondi⁷, Stéphane Cullati^{6

8}, Medea Imboden^{9

10}, Dirk Keidel^{9

10}, Melissa Witzig^{9

10}, Irène Frank³, Philipp Kohler¹¹, Christian Kahlert^{11

12}, Luca Crivelli⁵, Rebecca Amati¹³, Emiliano Albanese¹³, Marco Kaufmann¹⁴, Anja Frei¹⁴, Viktor von Wyl^{14

15}, Milo A Puhan¹⁴, Nicole Probst-Hensch^{9

10}, Gisela Michel¹, Nicolas Rodondi^{4

16}, Patricia Chocano-Bedoya^{4

6}

Affiliations

¹ Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
² School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
³ Clinical Trial Unit, Cantonal Hospital Lucerne, Lucerne, Switzerland.
⁴ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁵ Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.
⁶ Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
⁷ Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland.
⁸ Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland.
⁹ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland.
¹⁰ Department of Public Health, University of Basel, Basel, Switzerland.
¹¹ Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
¹² Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
¹³ Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
¹⁴ Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
¹⁵ Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zürich, Switzerland.
¹⁶ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

Objectives: To describe the frequency of and reasons for changes in healthcare utilization in those requiring ongoing treatment, and to assess characteristics associated with change, during the second wave of the pandemic. Methods: Corona Immunitas e-cohort study (age ≥20 years) participants completed monthly questionnaires. We compared participants reporting a change in healthcare utilization with those who did not using descriptive and bivariate statistics. We explored characteristics associated with the number of changes using negative binomial regression. Results: The study included 3,190 participants from nine research sites. One-fifth reported requiring regular treatment. Among these, 14% reported a change in healthcare utilization, defined as events in which participants reported that they changed their ongoing treatment, irrespective of the reason. Reasons for change were medication changes and side-effects, specifically for hypertension, or pulmonary embolism treatment. Females were more likely to report changes [Incidence Rate Ratio (IRR) = 2.15, p = 0.002]. Those with hypertension were least likely to report changes [IRR = 0.35, p = 0.019]. Conclusion: Few of those requiring regular treatment reported changes in healthcare utilization. Continuity of care for females and chronic diseases besides hypertension must be emphasized.

Keywords: COVID-19; digital follow-up; healthcare delivery; healthcare utilization; population-based study.

Copyright © 2023 Harju, Speierer, Jungo, Levati, Baggio, Tancredi, Noor, Rodondi, Cullati, Imboden, Keidel, Witzig, Frank, Kohler, Kahlert, Crivelli, Amati, Albanese, Kaufmann, Frei, von Wyl, Puhan, Probst-Hensch, Michel, Rodondi and Chocano-Bedoya.

MeSH terms

Adult
COVID-19* / epidemiology
Cohort Studies
Female
Humans
Hypertension*
Pandemics
Patient Acceptance of Health Care
Switzerland / epidemiology
Young Adult

Grants and funding

This study is part of Corona Immunitas research network, coordinated by the Swiss School of Public Health (SSPH+), and funded by fundraising of SSPH+ including funds of the Swiss Federal Office of Public Health and private funders (ethical guidelines for funding stated by SSPH+ were respected), by funds of the Canton of Zurich and by institutional funds of the Universities. The center Basel was additionally funded as part of COVCO Basel by the cantons Basel-Stadt and Basel-Landschaft. The funding bodies had no influence on the design, conduct, analysis, or interpretation of the study, as well as on the decision to publish, preparation or revisions of the manuscript.