Use of primary care during the corona pandemic: a national population study from the perspective of the patient and the healthcare provider

BACKGROUND During the COVID-19 pandemic, the number of patients that were admitted to hospitals for non-COVID conditions dropped substantially. From March to July 2020, national protection regulations restricted movement among all Dutch citizens, which may have influenced health care seeking behavior. Of particular concern are potential 'side-effects' related to COVID-19, such as delay or failure to seek medical attention in primary care. When left unheeded, such demand for care can result in deleterious health consequences for individuals. This project will quantify changes in healthcare utilization in primary care during the pandemic. It will additionally identify risk groups for targeted education, and will finally determine causes that explain observed changes in healthcare utilization from a patient's perspective. RESEARCH QUESTIONS 1. What are the national and regional consequences of COVID-19 on the use of (regular) primary care during the COVID-19 outbreak, compared to the monitoring period one month or year before the outbreak? 2. What are actual reasons for care avoidance from the perspective of the patient and primary care provider? URGENCE Since the COVID-19 outbreak, people have started shunning care. In addition, the care capacity in general practice is still far from the old level. Decreases in the use of (regular) primary care can lead to additional complications due to, for example, late-diagnosed or untreated heart and vascular diseases or oncological conditions. Although the first peak is behind us, the impact of COVID-19 on healthcare capacity will remain significant due to measures taken and virus flares. It is critical to monitor the change in health care demand and use and identify reasons for changes in healthcare utilization in order to minimize avoidable harm to public health. HYPOTHESIS This study provides insight into the changing use of primary care during the COVID-19 outbreak. It exposes which care needs are being postponed, it identifies groups at risk for targeted public education and identifies the underlying reasons for care avoidance. PLAN OF APPROACH For this mixed-methods study, we make use of seven existing population studies: 6 regional GP registry databases (total: 1,390,000 patients, from 326 general practices), and within ERGO we repeatedly measure the degree and reasons of care avoidance from the perspective of patients (n = 8,732) and caregivers. This unique combination of data from both general practitioners (GP registrations) and patients (ERGO) provides detailed and real-time insight into the consequences of COVID-19 on primary care. Within this national study, we will perform prospective data extractions in order to continue to monitor changes in healthcare use. Keywords / Keywords general practitioner, primary care, prevention, care avoidance, care use, patient, citizen, COVID-19, population research, complications, cardiovascular disease, oncology, incidence, avoidable harm, public health, epidemiology