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Patients most at risk of missing out on non-COVID healthcare


Anastasia Tsirtsakis


17/01/2022 4:11:10 PM

New data aims to help GPs prioritise certain patient cohorts to mitigate future risk. But with the system under pressure, is this realistic?

A senior woman at home feeling worried.
People with mental health symptoms, as well as those from a low socioeconomic background and who live alone are among those at highest risk.

Since the pandemic was declared in 2020, governments and healthcare professionals have rapidly adapted to accommodate social distancing and mitigate any risk of viral transmission.
 
While necessary, some of these changes, coupled with community fear of contracting COVID-19, have resulted in people delaying routine screening and care.
 
Now, new data collected by Monash University has identified the Australians who are most at risk of missing out on non-COVID healthcare.
 
A national survey of 13,829 people, conducted during the first wave in April 2020 at the height of restrictions, found almost half of respondents needed healthcare/disability services for non-COVID-related health conditions in the first month of COVID-19 restrictions. Of those, 31.6% of respondents aged under 45 described poor access to care, as did 24.3% of those aged 45 or older.
 
Those found to be at particular risk of missing out on care, included people:

  • with symptoms of depression and anxiety
  • performing unpaid work, ie students
  • living alone
  • with a low socioeconomic status
  • living on government benefits
  • with personal experience of COVID-19, including concerns of contracting the virus.
The data are the first to examine the population prevalence and factors associated with access to healthcare and disability needs during COVID-19 restrictions, and align with previous international studies that have revealed reduced presentations for routine healthcare across hospital and primary healthcare settings.
 
The authors note that the concerning trend could result in a major increase of medical conditions, as was seen with the 2002–2004 SARS outbreak, during which chronic-care hospitalisations for diabetes plummeted and in the aftermath skyrocketed.
 
Lead author Professor Flavia Cicuttini is the Head of the Musculoskeletal Unit at Monash University and Head of Rheumatology at Alfred Hospital.
 
She said the findings could have serious implications for future health outcomes, and urged doctors to ‘pay particular attention’ to the cohorts identified by the research.
 
‘Missed opportunities in routine healthcare can lead to much worse outcomes across a raft of medical
conditions, including mental health, cancer and chronic disease,’ Professor Cicuttini said.
 
‘Our findings can help doctors identify and prioritise Australians who may have missed out on potentially life-saving medical care for non-COVID related health issues during lockdowns, and may also help identify those most at risk as our health systems buckle under the Omicron outbreak.’
 
Queensland GP and Chair of RACGP Expert Committee – Quality Care (REC–QC), Professor Mark Morgan is equally concerned about the long-term impacts of the past two years on patient health outcomes.
 
‘[The late Dr Julian] Tudor Hart is credited with first describing the Inverse Care Law in which the most needy populations receive the least access to healthcare,’ he told newsGP.
 
‘[And] COVID-19 has demonstrated that the Inverse Care Law is alive and well, 50 years later.
 
‘Patients living with serious mental illness, for example, are six times more likely to die of cardiovascular diseases and there is a 20-year life expectancy gap.
 
Cancer screening has been disrupted by the pandemic and modelling has demonstrated the price we will pay for this disruption.’
 
Professor Morgan says the ability to reach out to patients using telehealth can help to reduce access barriers, as can the use of routinely recorded data to prioritise patient needs and prompt preventive care in the highest risk patients.
 
Though he agrees that GPs are well placed for the task, he says in the current climate, practices are under enormous pressure amid soaring infection rates and increased workloads.
 
The RACGP Vision is for general practice to not only focus on the patient in front of you, but to be comprehensive, coordinated and accessible to all the patients of the GP practice,’ Professor Morgan said.
 
‘This is a “population health” approach, [and] it works best when GPs know who their patients are and are funded to use a team approach to proactive preventive care.
 
‘But first, GPs need to get past the almost impossible demands of rolling out [booster] vaccines to adults and COVID-19 vaccines to children, while simultaneously coping with vast amounts of community sickness and anxiety. All of this in the context of being short staffed and a massive shortfall in rural workforce.’
 
Attempts to boost cancer screening
There are continued concerns over delays in cancer diagnoses during the pandemic, with data showing that fewer mammograms and cervical screening tests were performed in Australia in 2020.
 
To help boost participation in cancer screening, the Federal Government is investing more than $10 million in medical research to identify new and innovative approaches.
 
With Australia committed to eliminating cervical cancer by 2035, part of that funding has gone towards researchers at the University of Melbourne to look at the use of self-collection so as to increase access and equity to screening. Further to that, Planning NSW is undertaking research to inform the development of resources and tools to support uptake of screening in people with intellectual disability.
 
Funding has also been committed to improve participation in cancer screening through BreastScreen Australia. As the second most common cancer to result in death among women in Australia, the University of Western Australia is looking to target obesity-related barriers to mammographic screening.
 
The team will also examine ways to engage Aboriginal and Torres Strait Islander women, women from diverse cultural and language backgrounds and women with different levels of educational attainment and income.
 
Funding is also being directed at a program to boost participation in the National Bowel Cancer Screening Program that will be delivered through general practice.
 
Currently the third most common cancer in Australia, screening levels currently sit below 45%, but research suggests it has the potential to save 84,000 lives by 2040 if participation hits 60%.
 
To help target those who have yet to engage with the program, a team at the University of Melbourne is trialling a project where patients will be sent an SMS through their general practice. Further to that, the Australian National University is looking into why participation rates are lower among Aboriginal and Torres Strait Islander people, and how uptake can be increased.
 
Federal Health Minister Greg Hunt said that regular screenings and early detection are essential for better health outcomes.
 
‘Australia’s cancer screening programs are world-leading and it’s simple: we know cancer screening saves lives,’ he said.
 
‘This research is critical because the more we can do to understand the challenges preventing Australians from getting regular screenings, the more we can do to innovate the programs, maximise protection and save more lives.’
 
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newsGP weekly poll What are appropriate public health measures should COVID cases spike and the healthcare system be placed under further pressure?
 
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newsGP weekly poll What are appropriate public health measures should COVID cases spike and the healthcare system be placed under further pressure?

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