J Gen Intern Med. 2022 Jan 10; doi: 10.1007/s11606-021-07254-x. Epub 2022 Jan 10.
The Impact of COVID-19 on Routine Medical Care and Cancer Screening.
Journal of general internal medicine
Neil S Wenger, Annette L Stanton, Ryan Baxter-King, Karen Sepucha, Lynn Vavreck, Arash Naeim
Affiliations
Affiliations
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue #804, Los Angeles, CA, 90024, USA. [email protected].
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
- Department of Political Science, UCLA College, Los Angeles, CA, USA.
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Departments of Political Science and Communication, UCLA College, Los Angeles, CA, USA.
- UCLA Center for SMART Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
PMID: 35013931
PMCID: PMC8744580 DOI: 10.1007/s11606-021-07254-x
Abstract
BACKGROUND: COVID-19 restrictions and fear dramatically changed the use of medical care. Understanding the magnitude of cancelled and postponed appointments and associated factors can help identify approaches to mitigate unmet need.
OBJECTIVE: To determine the proportion of medical visits cancelled or postponed and for whom. We hypothesized that adults with serious medical conditions and those with higher anxiety, depressive symptoms, and avoidance-oriented coping would have more cancellations/postponements.
DESIGN: Four nationally representative cross-sectional surveys conducted online in May, July, October, and December 2020.
PARTICIPANTS: 59,747 US adults who completed 15-min online surveys. 69% cooperation rate.
MEASURES: Physical and mental health visits and cancer screening cancelled or postponed over prior 2 months. Plan to cancel or postpone visits over the next 2 months. Relationship with demographics, medical conditions, local COVID-19 death rate, anxiety, depressive symptoms, coping, intolerance of uncertainty, and perceived COVID-19 risk.
KEY RESULTS: Of the 58% (N = 34,868) with a medical appointment during the 2 months before the survey, 64% had an appointment cancelled or postponed in May, decreasing to 37% in December. Of the 41% of respondents with scheduled cancer screening, 20% cancelled/postponed, which was stable May to December. People with more medical conditions were more likely to cancel or postpone medical visits (OR 1.19 per condition, 95% CI 1.16, 1.22) and cancer screening (OR 1.20, 95% CI 1.15, 1.24). Race, ethnicity, and income had weak associations with cancelled/postponed visits, local death rate was unrelated, but anxiety and depressive symptoms were strongly related to cancellations, and this grew between May and December.
CONCLUSIONS: Cancelled medical care and cancer screening were more common among persons with medical conditions, anxiety and depression, even after accounting for COVID-19 deaths. Outreach and support to ensure that patients are not avoiding needed care due to anxiety, depression and inaccurate perceptions of risk will be important.
© 2021. The Author(s).
Keywords: COVID-19; cancer screening; missed medical appointments
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