Has the pandemic changed the way people utilise health services?

Morgan Liotta

25/12/2020 11:06:41 AM

The AIHW has released a series of reports outlining how COVID-19 changed the way Australians used health services in 2019–20.

GP consult room.
The review examines key changes the pandemic has brought to the healthcare system.

As 2020 draws to a close, the phrase ‘a year like no other’ is one heard often.
In a review on the main impacts of the COVID-19 pandemic, the Australian Institute of Health and Welfare (AIHW) has released new information examining key changes the pandemic has brought to the healthcare system.
PBS and MBS use
COVID-19’s impact on the use of the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) showed marked differences compared to previous years.
After restrictions were first implemented in Australia in March, more people filled prescriptions and had telehealth consultations.
The PBS report covers the first eight months of 2020, comparing the number of prescriptions dispensed and government benefits paid with the same period in 2019. The amount of dispensed scripts was similar in the 2019 (202.6 million) and 2020 (203.8 million) periods, with an increase of 0.6% in 2020.
When compared with yearly average growth in PBS script volumes of 1.5% over the past seven years, the AIHW suggests the COVID-19 pandemic had minimal influence on overall script volumes.
However, March 2020 indicated an unusually high volume of scripts dispensed, which coincided with the introduction of national pandemic-related restrictions. This was followed by a decrease in April.
The number of prescriptions dispensed in March 2020 was 23% higher than in March 2019 – most significantly for the group of medicines used to treat respiratory-related conditions such as asthma or chronic obstructive pulmonary disease. This increase occurred after, and separate to, a similar increase related to the bushfires earlier in the year.  
With the expansion of telehealth in March and a shift away from face-to-face consultations, bulk-billing incentive payments rose from $55.6 million in March 2020 to an average of $130 million per month between April and August 2020.
A third of GP consultations (36%) were delivered by telephone or video conference following the introduction of the new telehealth MBS items in April 2020, a marked change in comparison to April 2019, when all recorded consultations were delivered face-to-face.
MBS phone consultations made up 26% of all COVID-related items between March and August 2020, with 189,046 face-to-face GP consultations and 274,117 via telephone for the month of August. This contrasted sharply with the 259,273 face-to-face consultations and zero via telephone in August 2019.
Hospital care
The annual MyHospitals updates for 2019–20 show that fewer Australians presented to hospital emergency departments (EDs) with injuries and less elective surgery was performed than previous years. Hand hygiene standards overall performed well.
The average number of daily ED presentations decreased in the early stages of the pandemic, from 5800 in the week beginning 24 February to 3400 in the week beginning 30 March. Presentations dropped by 38% between 9–30 March.
These trends coincided with restrictions tightening on public and social gatherings and activities, travel restrictions, and availability of other health services.
The AIHW highlighted that the number of COVID-related presentations to EDs does not reflect the number of diagnosed COVID-19 cases in Australia.
Non-urgent elective surgery was suspended nationally from 26 March, with a staged reintroduction from 27 April. This was to safeguard the supply of personal protective equipment (PPE) and avoid overwhelming the hospital system.
In the week beginning 16 March, 15,300 elective surgeries were performed in public hospitals, with that number dropping to 4800 by the week starting 13 April. The number of surgeries increased as restrictions eased later in the year.
Australian hospitals routinely met national benchmarks for hand hygiene standards, which continued during the pandemic, and latest data suggesting improvements in the early part of 2020 – when the pandemic hit – against already high standards.
For the period 1 April ­– 30 June 2020, the national hand hygiene compliance rate was higher than the benchmark of 80%, at 88.2%.
Mental health services
The mental health impact of COVID-19 summarises activity reported in the period March–September 2020. The AIHW anticipates this section will be updated quarterly during the life of the pandemic.
The introduction of restrictions in March brought an increase in people accessing a range of mental health-related services, with phone and online support organisations reporting substantial increases in demand. And rates are predicted to rise.
Almost 83,500 calls were made to Lifeline from 31 August – 27 September, a 15.6% increase from the same period in 2019. More than 27,500 calls were made to Beyond Blue’s general phone service, a 21.3% increase from the same time in 2019.
Both the number of mental health services delivered (15%) and mental health-related prescriptions dispensed under the PBS (5.9%) were higher in September 2020 than in the same period in September 2019.
With the Federal Government further investing in COVID-related mental health, 7.2 million Medicare-subsidised mental health-related services were delivered between 16 March and 27 September, amounting to $791 million paid in benefits. Of these, 2.5 million services were delivered via telehealth.
Cancer screening
By presenting the number of screens between January and September 2020, this report examines the impact of COVID-19 on cancer screening and compares to the previous year.
The impact was clearest for BreastScreen Australia, which experienced a drop in screening mammograms in April 2020 due to a suspension of services. The number has increased each month since the service reopened in early May.
There were around 145,000 fewer screening mammograms performed through BreastScreen in January–June 2020 when compared with previous years. This improved after restrictions were eased, with around 12,000 more screening mammograms performed in July–September 2020.
Due to changes to the National Cervical Screening Program, the number of tests conducted was expected to be lower in 2020 than in 2019, irrespective of the COVID-19 pandemic and subsequent restrictions.
AIHW data confirmed these expectations of fewer tests performed in 2020 than in 2019, but the impact of COVID-19 cannot be quantified without further years of data as 2020 is the first year affected by the transition to five-yearly screening.
The AIHW said it is also difficult to assess clear patterns in the number of bowel cancer screening participants each month, particularly during the pandemic. This is due to the National Bowel Cancer Screening Program broadening its target age groups and increasing the frequency of testing in early 2020, leading to testing kits being sent to more people in recent years.
The number of bowel cancer kits returned was at times lower in 2020 than in 2019 and the number returned did rise around the time restrictions first started to ease, overtaking the 2019 numbers by the end of June.
However, from currently available data, the AIHW assumes that the pandemic did not have a direct effect on bowel cancer screening.
The AIHW also has a separate cancer screening dataset on Victoria, where COVID-19 cases were highest and restrictions the toughest.
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