Ethnic inequalities in the impact of COVID-19 on primary care consultations: a time series analysis of 460,084 individuals with multimorbidity in South London
Abstract Background The COVID-19 pandemic caused rapid changes in primary care delivery in the UK, with concerns that certain groups of the population may have faced increased barriers to access. This study assesses the impact of the response to the COVID-19 pandemic on primary care consultations fo...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-022-02720-7 |
| _version_ | 1797945892469211136 |
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| author | Alice McGreevy Marina Soley-Bori Mark Ashworth Yanzhong Wang Emma Rezel-Potts Stevo Durbaba Hiten Dodhia Julia Fox-Rushby |
| author_facet | Alice McGreevy Marina Soley-Bori Mark Ashworth Yanzhong Wang Emma Rezel-Potts Stevo Durbaba Hiten Dodhia Julia Fox-Rushby |
| author_sort | Alice McGreevy |
| collection | DOAJ |
| description | Abstract Background The COVID-19 pandemic caused rapid changes in primary care delivery in the UK, with concerns that certain groups of the population may have faced increased barriers to access. This study assesses the impact of the response to the COVID-19 pandemic on primary care consultations for individuals with multimorbidity and identifies ethnic inequalities. Methods A longitudinal study based on monthly data from primary care health records of 460,084 patients aged ≥18 years from 41 GP practices in South London, from February 2018 to March 2021. Descriptive analysis and interrupted time series (ITS) models were used to analyse the effect of the pandemic on primary care consultations for people with multimorbidity and to identify if the effect varied by ethnic groups and consultation type. Results Individuals with multimorbidity experienced a smaller initial fall in trend at the start of the pandemic. Their primary care consultation rates remained stable (879 (95% CI 869–890) per 1000 patients in February to 882 (870–894) March 2020), compared with a 7% decline among people without multimorbidity (223 consultations (95% CI 221–226) to 208 (205–210)). The gap in consultations between the two groups reduced after July 2020. The effect among individuals with multimorbidity varied by ethnic group. Ethnic minority groups experienced a slightly larger fall at the start of the pandemic. Individuals of Black, Asian, and Other ethnic backgrounds also switched from face-to-face to telephone at a higher rate than other ethnic groups. The largest fall in face-to-face consultations was observed among people from Asian backgrounds (their consultation rates declined from 676 (659–693) in February to 348 (338–359) in April 2020), which may have disproportionately affected their quality of care. Conclusions The COVID-19 pandemic significantly affected primary care utilisation in patients with multimorbidity. While there is evidence of a successful needs-based prioritisation of multimorbidity patients within primary care at the start of the pandemic, inequalities among ethnic minority groups were found. Strengthening disease management for these groups may be necessary to control widening inequalities in future health outcomes. |
| first_indexed | 2024-04-10T21:02:19Z |
| format | Article |
| id | doaj.art-9ef7746b5ec340d99af9a531be1e0da8 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-10T21:02:19Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-9ef7746b5ec340d99af9a531be1e0da82023-01-22T12:16:10ZengBMCBMC Medicine1741-70152023-01-0121111410.1186/s12916-022-02720-7Ethnic inequalities in the impact of COVID-19 on primary care consultations: a time series analysis of 460,084 individuals with multimorbidity in South LondonAlice McGreevy0Marina Soley-Bori1Mark Ashworth2Yanzhong Wang3Emma Rezel-Potts4Stevo Durbaba5Hiten Dodhia6Julia Fox-Rushby7King’s College London, School of Life Course & Population SciencesKing’s College London, School of Life Course & Population SciencesKing’s College London, School of Life Course & Population SciencesKing’s College London, School of Life Course & Population SciencesKing’s College London, School of Life Course & Population SciencesKing’s College London, School of Life Course & Population SciencesKing’s College London, School of Life Course & Population SciencesKing’s College London, School of Life Course & Population SciencesAbstract Background The COVID-19 pandemic caused rapid changes in primary care delivery in the UK, with concerns that certain groups of the population may have faced increased barriers to access. This study assesses the impact of the response to the COVID-19 pandemic on primary care consultations for individuals with multimorbidity and identifies ethnic inequalities. Methods A longitudinal study based on monthly data from primary care health records of 460,084 patients aged ≥18 years from 41 GP practices in South London, from February 2018 to March 2021. Descriptive analysis and interrupted time series (ITS) models were used to analyse the effect of the pandemic on primary care consultations for people with multimorbidity and to identify if the effect varied by ethnic groups and consultation type. Results Individuals with multimorbidity experienced a smaller initial fall in trend at the start of the pandemic. Their primary care consultation rates remained stable (879 (95% CI 869–890) per 1000 patients in February to 882 (870–894) March 2020), compared with a 7% decline among people without multimorbidity (223 consultations (95% CI 221–226) to 208 (205–210)). The gap in consultations between the two groups reduced after July 2020. The effect among individuals with multimorbidity varied by ethnic group. Ethnic minority groups experienced a slightly larger fall at the start of the pandemic. Individuals of Black, Asian, and Other ethnic backgrounds also switched from face-to-face to telephone at a higher rate than other ethnic groups. The largest fall in face-to-face consultations was observed among people from Asian backgrounds (their consultation rates declined from 676 (659–693) in February to 348 (338–359) in April 2020), which may have disproportionately affected their quality of care. Conclusions The COVID-19 pandemic significantly affected primary care utilisation in patients with multimorbidity. While there is evidence of a successful needs-based prioritisation of multimorbidity patients within primary care at the start of the pandemic, inequalities among ethnic minority groups were found. Strengthening disease management for these groups may be necessary to control widening inequalities in future health outcomes.https://doi.org/10.1186/s12916-022-02720-7MultimorbidityPrimary careLong-term conditionsCOVID-19 pandemicEthnic inequalities |
| spellingShingle | Alice McGreevy Marina Soley-Bori Mark Ashworth Yanzhong Wang Emma Rezel-Potts Stevo Durbaba Hiten Dodhia Julia Fox-Rushby Ethnic inequalities in the impact of COVID-19 on primary care consultations: a time series analysis of 460,084 individuals with multimorbidity in South London BMC Medicine Multimorbidity Primary care Long-term conditions COVID-19 pandemic Ethnic inequalities |
| title | Ethnic inequalities in the impact of COVID-19 on primary care consultations: a time series analysis of 460,084 individuals with multimorbidity in South London |
| title_full | Ethnic inequalities in the impact of COVID-19 on primary care consultations: a time series analysis of 460,084 individuals with multimorbidity in South London |
| title_fullStr | Ethnic inequalities in the impact of COVID-19 on primary care consultations: a time series analysis of 460,084 individuals with multimorbidity in South London |
| title_full_unstemmed | Ethnic inequalities in the impact of COVID-19 on primary care consultations: a time series analysis of 460,084 individuals with multimorbidity in South London |
| title_short | Ethnic inequalities in the impact of COVID-19 on primary care consultations: a time series analysis of 460,084 individuals with multimorbidity in South London |
| title_sort | ethnic inequalities in the impact of covid 19 on primary care consultations a time series analysis of 460 084 individuals with multimorbidity in south london |
| topic | Multimorbidity Primary care Long-term conditions COVID-19 pandemic Ethnic inequalities |
| url | https://doi.org/10.1186/s12916-022-02720-7 |
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