Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
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.
Top-30
Journals
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25
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35
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BMJ Open
34 publications, 3.48%
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Frontiers in Public Health
31 publications, 3.18%
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PLoS ONE
29 publications, 2.97%
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International Journal of Environmental Research and Public Health
28 publications, 2.87%
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BMC Health Services Research
25 publications, 2.56%
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BMC Public Health
20 publications, 2.05%
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Healthcare
19 publications, 1.95%
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Scientific Reports
17 publications, 1.74%
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PLOS Global Public Health
11 publications, 1.13%
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Journal of Clinical Medicine
9 publications, 0.92%
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BMJ Global Health
9 publications, 0.92%
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JAMA network open
7 publications, 0.72%
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Frontiers in Neurology
6 publications, 0.61%
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Vaccine
6 publications, 0.61%
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Internal Medicine Journal
6 publications, 0.61%
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Vaccines
5 publications, 0.51%
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Cancers
5 publications, 0.51%
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International Journal of Public Health
5 publications, 0.51%
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The Lancet Regional Health - Western Pacific
5 publications, 0.51%
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Journal of Multidisciplinary Healthcare
5 publications, 0.51%
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Global Health Action
4 publications, 0.41%
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Telemedicine Journal and e-Health
4 publications, 0.41%
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Journal of primary care & community health
4 publications, 0.41%
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Antibiotics
4 publications, 0.41%
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Frontiers in Medicine
4 publications, 0.41%
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Archives of Public Health
4 publications, 0.41%
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Journal of Affective Disorders
4 publications, 0.41%
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Health Science Reports
4 publications, 0.41%
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BMJ
4 publications, 0.41%
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Publishers
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Springer Nature
181 publications, 18.55%
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Elsevier
148 publications, 15.16%
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MDPI
95 publications, 9.73%
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BMJ
65 publications, 6.66%
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Frontiers Media S.A.
60 publications, 6.15%
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Wiley
51 publications, 5.23%
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Taylor & Francis
45 publications, 4.61%
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Public Library of Science (PLoS)
42 publications, 4.3%
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Cold Spring Harbor Laboratory
38 publications, 3.89%
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SAGE
36 publications, 3.69%
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JMIR Publications
26 publications, 2.66%
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Oxford University Press
25 publications, 2.56%
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Ovid Technologies (Wolters Kluwer Health)
25 publications, 2.56%
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American Medical Association (AMA)
13 publications, 1.33%
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Mary Ann Liebert
5 publications, 0.51%
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Baishideng Publishing Group
5 publications, 0.51%
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Emerald
5 publications, 0.51%
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CMA Impact Inc.
4 publications, 0.41%
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Royal College of General Practitioners
4 publications, 0.41%
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Institute of Electrical and Electronics Engineers (IEEE)
4 publications, 0.41%
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AME Publishing Company
4 publications, 0.41%
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AOSIS
3 publications, 0.31%
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Cambridge University Press
3 publications, 0.31%
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Medknow
3 publications, 0.31%
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SciELO
3 publications, 0.31%
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IOS Press
2 publications, 0.2%
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eLife Sciences Publications
2 publications, 0.2%
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Georg Thieme Verlag KG
2 publications, 0.2%
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Walter de Gruyter
2 publications, 0.2%
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- We do not take into account publications without a DOI.
- Statistics recalculated weekly.