How has the COVID-19 pandemic affected the delivery of preventive healthcare? An interrupted time series analysis of adults in English primary care from 2018 to 2022

Laura Heath; José M Ordóñez-Mena; Paul Aveyard; Joseph Wherton; Brian D Nicholson; Richard Stevens

doi:10.1016/j.ypmed.2024.107923

How has the COVID-19 pandemic affected the delivery of preventive healthcare? An interrupted time series analysis of adults in English primary care from 2018 to 2022

Prev Med. 2024 Apr:181:107923. doi: 10.1016/j.ypmed.2024.107923. Epub 2024 Mar 1.

Authors

Laura Heath¹, José M Ordóñez-Mena², Paul Aveyard³, Joseph Wherton⁴, Brian D Nicholson⁵, Richard Stevens⁶

Affiliations

¹ GP and Clinical Doctoral Fellow Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. Electronic address: laura.heath@phc.ox.ac.uk.
² Medical Statistician Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
³ GP and Professor of Behavioural Medicine Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁴ Senior Researcher Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁵ GP and Associate Professor Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁶ Associate Professor of Medical Statistics Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

PMID: 38432306
DOI: 10.1016/j.ypmed.2024.107923

Abstract

Objective: Offering advice and support for smoking, obesity, excess alcohol, and physical inactivity is an evidence-based component of primary care. The objective was to quantify the impact of the pandemic on the rate of advice or referral for these four risk factors.

Methods: A retrospective cohort study using primary care data from 1847 practices in England and 21,191,389 patients contributing to the Oxford Clinical Informatics Digital Hub. An interrupted time series analysis was undertaken with a single change point (March 2020). Monthly trends were modelled from 1st January 2018 - 30th June 2022 using segmented linear regression.

Results: There was an initial step reduction in advice and referrals for smoking, obesity, excess alcohol, and physical inactivity in March 2020. By June 2022, advice on smoking (slope change -0.02 events per hundred patient years/month (EPH/month); 95% confidence interval (CI) -0.17, 0.21), obesity (0.06 EPH/month; 95% CI 0.01, 0.12), alcohol (0.02 EPH/month; 95% CI -0.01, 0.05) and physical inactivity (0.05 EPH/month; 95% CI 0.01, 0.09) had not returned to pre-pandemic levels. Similarly, smoking cessation referral remained lower (0.01 EPH/month; 95% CI -0.01, 0.09), excess alcohol referral returned to similar levels (0.0005 EPH/month; 95% CI 0.0002, 0.0008), while referral for obesity (0.14 EPH/month; 95% CI 0.10, 0.19) and physical inactivity (0.01 EPH/month; 95% CI 0.01, 0.02) increased relative to pre-pandemic rates.

Conclusion: Advice and support for smoking, and advice for weight, excess alcohol and physical inactivity have not returned to pre-pandemic levels. Clinicians and policy makers should prioritise preventive care in COVID-19 recovery plans.

Keywords: Alcohol; COVID-19; Exercise; Obesity; Prevention; Primary health care; Smoking.

MeSH terms

Adult
COVID-19* / epidemiology
COVID-19* / prevention & control
Delivery of Health Care
Humans
Interrupted Time Series Analysis
Obesity / epidemiology
Obesity / prevention & control
Pandemics* / prevention & control
Primary Health Care
Retrospective Studies