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dc.contributor.authorMoynihan, Ray
dc.contributor.authorSanders, Sharon
dc.contributor.authorMichaleff, Zoe A
dc.contributor.authorScott, Anna Mae
dc.contributor.authorClark, Justin
dc.contributor.authorTo, Emma J
dc.contributor.authorJones, Mark
dc.contributor.authorKitchener, Eliza
dc.contributor.authorFox, Melissa
dc.contributor.authorJohansson, Minna
dc.contributor.authorLang, Eddy
dc.contributor.authorDuggan, Anne
dc.contributor.authorScott, Ian
dc.contributor.authorAlbarqouni, Loai
dc.date.accessioned2021-03-28T23:46:43Z
dc.date.available2021-03-28T23:46:43Z
dc.date.issued2021
dc.identifier.issn2044-6055en_US
dc.identifier.doi10.1136/bmjopen-2020-045343en_US
dc.identifier.urihttp://hdl.handle.net/10072/403463
dc.description.abstractOBJECTIVES: 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.en_US
dc.description.peerreviewedYesen_US
dc.languageengen_US
dc.publisherBMJen_US
dc.relation.ispartofpagefrome045343en_US
dc.relation.ispartofissue3en_US
dc.relation.ispartofjournalBMJ Openen_US
dc.relation.ispartofvolume11en_US
dc.subject.fieldofresearchClinical Sciencesen_US
dc.subject.fieldofresearchPublic Health and Health Servicesen_US
dc.subject.fieldofresearchOther Medical and Health Sciencesen_US
dc.subject.fieldofresearchcode1103en_US
dc.subject.fieldofresearchcode1117en_US
dc.subject.fieldofresearchcode1199en_US
dc.subject.keywordsepidemiologyen_US
dc.subject.keywordshealth policyen_US
dc.subject.keywordsorganisation of health servicesen_US
dc.subject.keywordspublic healthen_US
dc.subject.keywordsquality in health careen_US
dc.titleImpact of COVID-19 pandemic on utilisation of healthcare services: a systematic reviewen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Articlesen_US
dcterms.bibliographicCitationMoynihan, R; Sanders, S; Michaleff, ZA; Scott, AM; Clark, J; To, EJ; Jones, M; Kitchener, E; Fox, M; Johansson, M; Lang, E; Duggan, A; Scott, I; Albarqouni, L, Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review., BMJ Open, 2021, 11 (3), pp. e045343en_US
dcterms.licensehttp://creativecommons.org/licenses/by-nc/4.0/en_US
dc.date.updated2021-03-28T21:55:09Z
dc.description.versionVersion of Record (VoR)en_US
gro.rights.copyright© Author(s) (or their employer(s)) 2021. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.en_US
gro.hasfulltextFull Text
gro.griffith.authorKitchener, Eliza M.


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