Electronic health records of approximately a quarter of a million people were analysed to identify the impact of COVID-19 on general practice (primary care) by a patient safety research centre between 1st March and 31st May 2020.
According to the research published in The Lancet Public Health*, for many common physical and mental health conditions, there has been a significant reduction in the rate of initial diagnoses compared to the expected levels for this time period. The biggest reductions were for mental health conditions and Type 2 diabetes as there were half the expected number of diagnoses.
For malignant cancer the reduction was 16 per cent for the time period analysed, but for the month of May there was a drop of 44 per cent. For circulatory system diseases such as stroke, heart failure and coronary heart disease there has been a reduction in diagnoses of 43 per cent.
The research, published in the paper, 'Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study', was conducted by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC). The centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.
The study used 10 years' worth of data for Salford to create statistical models which gave predicted levels of new diagnoses for the health conditions identified in general practice to be routine.
Richard Williams, research lead for the study at the GM PSTRC, said: "We were aware that GP practices have been reporting a drop in the number of patients seeking medical help since the start of the COVID-19 pandemic. Thanks to electronic health records it is possible to investigate whether this is true across a large urban area like Salford.
"Importantly our research has revealed which conditions people are not seeking medical attention for. This means that, potentially, there are high numbers of people living with undiagnosed Type 2 diabetes, mental health conditions and circulatory system failure."
Richard will join internationally renowned experts in a special Lancet journals session to present this work at the European Society of Clinical Microbiology and Infectious Diseases Conference on Coronavirus disease (ECCVID), taking place online 23-25 September.
Dr Owain Thomas, GP at a practice in Salford, said: "The research from the GM PSTRC looking at the diagnosis of physical and mental health conditions in primary care during the pandemic in Salford is so significant because it quantifies the effect COVID-19 is having on the diagnosis of routine health conditions in General Practice.
"Since the initial lockdown in March the whole way in which patients consult with their practice has changed - there has been a dramatic shift away from face to face consultations to keep everyone safe from the spread of COVID-19.
"However, it is important to recognise the unintended consequences of reducing patient contact with primary care face to face services. The conclusions of this research are a vital part in our understanding of the overall impact of Covid-19, the conditions we have looked at are usually many months or years in the making so the reduction in new diagnoses does not represent a reduction in the burden of these diseases, more the fact that they have not yet been formally recognised. This will have an impact individually on those patients - the longer a patient goes undiagnosed, the more complications they are likely to suffer. As we move forwards careful thought will be needed to plan services to find and support those patients who have not yet been diagnosed."
Nav Kapur, Professor of Psychiatry at The University of Manchester and lead for the mental health work at the PSTRC, said: "One of the great strengths of the GM PSTRC is the opportunity to look at safety across different settings and clinical conditions. For me the reduction in mental health diagnoses and consultations was particularly striking. Going forward, I think there are two urgent priorities. First, to understand why this has happened and second to monitor and mitigate the consequences of reduced healthcare use"
Richard Williams, concludes: "It is vital that healthcare services use the findings in our research to proactively prioritise diagnosing patients who may be living with conditions which could be dangerous if left untreated. This will help to avoid health services become swamped when people feel confident enough to return to healthcare settings."
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Notes for editors:
*Link to the paper will be live from 23:30 on the 23 September 2020 - http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30201-2/fulltext
About the NIHR Greater Manchester Translational Research Centre: The NIHR Greater Manchester Patient Safety Translational Research Centre is a partnership between The University of Manchester and Salford Royal Foundation Trust in collaboration with The University of Nottingham which aims to make healthcare safer in primary care and transitions of care. It's funded by the National Institute for Health Research (NIHR) for five years from 2017 until 2022 and is one of three PSTRC in England. The GM PSTRC is responsible for research across four themes: Safety Informatics, Medication Safety, Safer Care Systems and Transitions, and Safety in Marginalised Groups. For more information visit - http://www.patientsafety.manchester.ac.uk/
About the University of Manchester: The University of Manchester, a member of the prestigious Russell Group, is the UK's largest single-site university with 38,600 students. It has 20 academic schools and hundreds of specialist research groups undertaking pioneering, multi-disciplinary teaching and research of worldwide significance. The University is one of the country's major research institutions, rated fifth in the UK in terms of 'research power' (REF 2014), and has had no fewer than 25 Nobel laureates either work or study there. The University had an annual income of £1 billion in 2014/15. Visit http://www.manchester.ac.uk
ABOUT THE NIHR: The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
* Funds, supports and delivers high quality research that benefits the NHS, public health and social care.
* Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
* Attracts trains and supports the best researchers to tackle the complex health and care challenges of the future.
* Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
* Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care.http://www.nihr.ac.uk/patientdata
Journal
The Lancet Public Health