New data aims to help GPs prioritize certain patient cohorts to mitigate future risk. But with the system under pressure, is it realistic?
Since the declaration of the pandemic in 2020, governments and healthcare professionals have quickly adapted to accommodate social distancing and mitigate any risk of viral transmission.
Although necessary, some of these changes, coupled with community fear of contracting COVID-19, have caused people to delay testing and routine care.
Now, new data collected by Monash University has identified which Australians 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 the restrictions, found that almost half of respondents needed health/disability services for non-work related health conditions. COVID during the first month of COVID-19 restrictions. Of these, 31.6% of respondents aged under 45 described poor access to care, as did 24.3% of those aged 45 or over.
People deemed particularly at risk of missing out on care included people:
- with symptoms of depression and anxiety
- perform unpaid work, i.e. students
- to live alone
- with low socioeconomic status
- living on government benefits
- with personal experience of COVID-19, including fears of contracting the virus.
The data is the first to examine population prevalence and factors associated with healthcare access and disability needs during COVID-19 restrictions, and aligns with previous international studies that have revealed reduced presentations for routine healthcare in hospitals and primary healthcare facilities.
The authors note that the worrying trend could lead to a significant increase in medical conditions, as seen with the SARS epidemic of 2002 to 2004, during which chronic care hospitalizations for diabetes fell and soared. arrow thereafter.
Lead author, Professor Flavia Cicuttini is Chief of the Musculoskeletal Unit at Monash University and Chief of Rheumatology at Alfred Hospital.
She said the findings could have serious implications for future health outcomes and urged doctors to “pay special attention” to the cohorts identified by the research.
“Missed opportunities in routine health care can lead to far worse outcomes in a series of medical care
conditions, including mental health, cancer and chronic disease,” Prof Cicuttini said.
‘Our findings can help doctors identify and prioritize Australians who may have missed potentially life-saving medical care for non-COVID-related health conditions during lockdowns, and can also help identify those most at risk as our healthcare systems warp under the Omicron outbreak.’
Queensland GP and Chair of the RACGP – Quality Care (REC-QC) Expert Committee, Professor Mark Morgan is also 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 reverse care law in which the most needy populations receive the least access to health care,’ he said. newsGP.
‘[And] COVID-19 has demonstrated that the Reverse Care Act is alive and well, 50 years later.
“Patients with severe mental illness, for example, are six times more likely to die from cardiovascular disease and there is a 20-year life expectancy gap.
“Cancer screening has been disrupted by the pandemic and modeling has demonstrated the price we will pay for this disruption.”
Professor Morgan says the ability to reach patients using telehealth can help reduce barriers to access, as can using regularly recorded data to prioritize patient needs and speed up preventative care. in patients most at risk.
While he recognizes that GPs are well placed for this task, he says, in the current climate, practices are under enormous pressure amid soaring infection rates and rising disease. workload.
“The RACGP vision is that general practice should not just focus on the patient in front of you, but should be comprehensive, coordinated and accessible to all patients in the general practitioner’s practice,” said Prof Morgan.
“It’s 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 must overcome the nearly impossible demands of deployment [booster] vaccines for adults and COVID-19 vaccines for children, while simultaneously dealing with large amounts of disease and anxiety in the community. All this against a backdrop of staff shortages and a massive rural labor shortage.
Try to boost cancer screening
Delays in cancer diagnoses during the pandemic are a continued concern, 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 went to researchers at the University of Melbourne to examine the use of self-collection to to increase access and equity to screening. Additionally, Planning NSW undertakes research to inform the development of resources and tools to support uptake of screening for people with developmental disabilities.
Funds have also been committed to improve participation in cancer screening through BreastScreen Australia. As the second most common cancer to kill women in Australia, the University of Western Australia is looking to target obesity-related barriers to mammography screening.
The team will also look at ways to engage Aboriginal and Torres Strait Islander women, women from diverse cultural and linguistic backgrounds, and women with different levels of education and income.
The funding is also directed towards a program to stimulate participation in the national bowel cancer screening program which will be offered by general practice.
Currently the third most common cancer in Australia, screening levels are currently below 45%, but research suggests it has the potential to save 84,000 lives by 2040 if uptake reaches 60%.
To help target those who have not yet taken part in the programme, a team from the University of Melbourne is piloting a scheme in which patients will receive a text message via their GP practice. Additionally, the Australian National University is studying why participation rates are lower among Aboriginal and Torres Strait Islander people, and how adoption can be increased.
Federal Health Minister Greg Hunt said regular screenings and early detection are essential for better health outcomes.
“Australia’s cancer screening programs are among the best in the world and it’s simple: we know cancer screening saves lives,” he said.
“This research is essential because the more we can do to understand the challenges that prevent Australians from getting tested regularly, the more we can do to innovate programs, maximize protection and save more lives.”
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