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Keeping patients on track

March 9th, 2021

Quick Safety – The Joint Commission

Keeping patients on track with preventative care during pandemic

Doctor & Patient

Due to fear of exposure to COVID-19, many patients are not seeking preventative care, placing their health in jeopardy. An estimated 40.9% of adults in the U.S. have avoided medical care during the pandemic because of concerns about COVID-19.

Issue: 

Due to fear of exposure to COVID-19, many patients are not seeking preventative care, placing their health in jeopardy. An estimated 40.9% of adults in the U.S. have avoided medical care during the pandemic because of concerns about COVID-19. This includes 12.0% who avoided urgent or emergency care, and 31.5% who avoided routine care.1 Also taking a hit during the pandemic are health-related screenings. Since early 2020, breast cancer screenings have reduced by 89.2%, and colorectal cancer screenings have reduced by 84.5%.2 The potential negative impact of the choice to postpone these screenings is clear.

Other reasons for postponing or avoiding preventative care include:

• Local public health officials recommending minimizing visits for nonurgent health care reasons.3
• Stay-at-home orders may be in place.3
• Awareness of overcrowded hospitals and concern about the prevalence of COVID-19 positive patients in hospitals.4
• A misconception that hospitals are only serving COVID-19 patients. This may result in patients not seeking emergent care until symptoms become severe.5
• For patients with low health literacy or limited English proficiency, attempts at communicating the need to continue preventative care may not be understood.6

If routine care continues to be avoided, adults will miss opportunities for managing chronic conditions, getting routine vaccinations, and, possibly, early detection of new conditions.1 Postponed visits to the emergency room can impact acute myocardial infarction patients who may then suffer permanent harm as a result, given the importance of timing from the onset of cardiac symptoms to obtaining coronary reperfusion.

Children are also impacted by failure to seek preventative care. As of May 2020, a decline exists in age-based vaccines for almost every age group of children, compared with averages for recent past years.7 This includes failure to get routine childhood vaccinations, including measles.8 Unvaccinated children are vulnerable to preventable infections and can spread infections to others.

Finally, school and daycare closures may deter preventative care due to lack of childcare. Patients may feel their presence is needed more at home, where they may be assisting with remote education.9

Safety actions to consider:
Health care organizations can use any of the following strategies/actions (those actions applicable to their setting, needs and resources) to encourage patients to seek preventative care, which may result in better outcomes during this time of uncertainty.

Reach out proactively and encourage patients to seek preventative care. 
• Communications to patients could note the risks of delaying preventative care.1
• To address concerns about potential exposure to COVID-19 while seeking health care, organizations could describe precautions taken to reduce this risk.1
• Organizations and providers should promote and encourage the use of a home-based test for colon cancer screening for low risk individuals.

Provide immunizations in dedicated clinics, rooms or buildings. 
• Waiting rooms could be closed and patients could check in via phone.
• Vaccines could even be given in the parking lot.
• Parents should be reminded of the importance of protecting children against diseases that are preventable with a vaccine.

Resources:
1. Czeisler ME, Marynak K, Clarke KEN, et al. Delay or avoidance of medical care because of COVID-19-related concerns – United States, June 2020. Morbidity and Mortality Weekly Report, Sept. 11, 2020;69(36):1250-1257.
2. London JW, Fazio-Eynullayeva E, Palchuk MB, et al. Effects of the COVID-19 pandemic on cancer-related patient encounters. JCO Clinical Cancer Informatics, 2020;4:657-665.
3. Lange SJ, Ritchey MD, Goodman AB, et al. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions — United States, January-May 2020. Morbidity and Mortality Weekly Report, June 26, 2020;69(25):795-800.
4. Moroni F, Gramegna M, Ajello S, et al. Collateral damage: Medical care avoidance behavior among patients with myocardial infarction during the COVID-19 pandemic. JACC Case Reports, August 2020;2(10):1620-1624.
5. Ahmed T, Lodhi SH, Kapadia S, et al. Community and healthcare system-related factors feeding the phenomenon of evading medical attention for time-dependent emergencies during COVID-19 crisis. BMJ Case Report, 2020;13:e237817. doi:10.1136/bcr-2020-237817
6. Saxena S, Skirrow H, Bedford H. Routine vaccination during COVID-19 pandemic responseBritish Medical Journal, June 2020;369:m2392.
7. Bramer CA, Kimmins LM, Swanson R, et al. Decline in child vaccination coverage during the COVID-19 pandemic — Michigan Care Improvement Registry, May 2016-May 2020. American Journal of Transplantation, 2020;00:1930–1931.
8. Santoli JM, Lindley JC, DeSilva MB, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration — United States, 2020. Morbidity and Mortality Weekly Report, May 15, 2020;69(19):591-593.
9. Fryer K, Delgado A, Foti T, et al. Implementation of obstetric telehealth during COVID‑19 and beyondMaternal and Child Health Journal, June 2020;24:1104–1110.

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