Changes in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID)
Uy Hoang,
Simon de Lusignan,
Simon de Lusignan,
Jo-Anne Manski-Nankervis,
Seo Young Kang,
Karen Tu,
Signe Flottorp,
Amy Pui Pui Ng,
Christine Hallinan,
Zheng Jye Ling,
Knut-Arne Wensaas,
Christine Mary Hallinan,
Lay Hoon Goh,
Robert Sarkadi Kristiansson,
Jessica Gronsbell,
Young Sik Kim,
Zhou Li,
Wilson D Pace,
William CW Wong,
Ellen Stephenson,
Robert Sarkadi Kristiansson
Affiliations
Uy Hoang
Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
Simon de Lusignan
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Simon de Lusignan
1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Jo-Anne Manski-Nankervis
1 Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
Seo Young Kang
1 International Healthcare Center, Asan Medical Center, Seoul, Republic of Korea
Karen Tu
scientist
Signe Flottorp
17 Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
Amy Pui Pui Ng
clinical assistant professor
Christine Hallinan
Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
Zheng Jye Ling
4 Department of Medical Informatics, National University Health System, Singapore
Knut-Arne Wensaas
Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
Christine Mary Hallinan
2 Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
Lay Hoon Goh
8 Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Robert Sarkadi Kristiansson
3 Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
Jessica Gronsbell
1 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Young Sik Kim
11 Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Zhou Li
12 Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
Wilson D Pace
14 DARTNet Institute, Aurora, Colorado, USA
William CW Wong
12 Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
Ellen Stephenson
1 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Introduction Through the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA.Methods Visit definitions were agreed on centrally, implemented locally across the various settings in INTRePID countries, and weekly visit counts were shared centrally for analysis. We evaluated the weekly rate of primary care physician visits during 2019 and 2020. Rate ratios (RRs) of total weekly visit volume and the proportion of weekly visits that were virtual in the pandemic period in 2020 compared with the same prepandemic period in 2019 were calculated.Results In 2019 and 2020, there were 80 889 386 primary care physician visits across INTRePID. During the pandemic, average weekly visit volume dropped in China, Singapore, South Korea, and the USA but was stable overall in Australia (RR 0.98 (95% CI 0.92 to 1.05, p=0.59)), Canada (RR 0.96 (95% CI 0.89 to 1.03, p=0.24)), Norway (RR 1.01 (95% CI 0.88 to 1.17, p=0.85)), Sweden (RR 0.91 (95% CI 0.79 to 1.06, p=0.22)) and the UK (RR 0.86 (95% CI 0.72 to 1.03, p=0.11)). In countries that had negligible virtual care prepandemic, the proportion of visits that were virtual were highest in Canada (77.0%) and Australia (41.8%). In Norway (RR 8.23 (95% CI 5.30 to 12.78, p<0.001), the UK (RR 2.36 (95% CI 2.24 to 2.50, p<0.001)) and Sweden (RR 1.33 (95% CI 1.17 to 1.50, p<0.001)) where virtual visits existed prepandemic, it increased significantly during the pandemic.Conclusions The drop in primary care in-person visits during the pandemic was a global phenomenon across INTRePID countries. In several countries, primary care shifted to virtual visits mitigating the drop in in-person visits.
