Objectives To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.
Design Systematic review.
Eligibility Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19.
Data sources PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact.
Data analysis Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis.
Outcome measures Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores).
Results 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference.
Conclusions Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery.
PROSPERO registration number CRD42020203729.
- quality in health care
- organisation of health services
- public health
- health policy
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Contributors Conception/design: RM, LA, SS, ZAM, AMS, JC, MaJ, MiJ. Acquisition, analysis or interpretation of data: RM, SS, ZAM, AMS, JC, EJT, MaJ, EK, MF, MiJ, EL, AD, IS, LA. First draft of the manuscript: RM, LA. Manuscript drafting, revision, approval: RM, SS, ZAM, AMS, JC, EJT, MaJ, EK, MF, MiJ, EL, AD, IS, LA. Overall guarantors: RM, LA. The guarantor accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.
Funding RM is funded by an Australian National Health and Medical Research Council (NHMRC fellowship grant number 1124207), and is a chief investigator of NHMRC Centre for Research Excellence (grant number 1104136).
Disclaimer All authors write as individuals and do not necessarily represent the views of their employers or affiliated organisations.
Competing interests RM has helped organise the Preventing Overdiagnosis international scientific conferences.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information. We have provided all data about all included studies, and a list of those studies, in the supplemental files.
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