A survey of more than 1000 general practices on the impact of COVID-19 since the beginning of March, led by a Monash University researcher, warns that there will be a second wave of coronavirus infections and hospital admissions between mid-June to mid-July due to the loosening of social distancing restrictions, and more importantly, a rise in hospital admissions for people with chronic illness who have been unable or unwilling to seek their usual ongoing medical care.
In addition, there will be an increase of patients presenting with diseases that are normally kept in check with screening such as diabetes and cervical cancer, with this wave expected between August and January next year.
The prediction comes from a comprehensive ongoing survey of more than 1000 general practices across New South Wales and Victoria, that was started at the beginning of March this year in response to the COVID-19 crisis. An initiative of 5 Primary Health Networks (PHNs) across eastern Australia, the work has been conducted by Outcome Health and led by Research Director and Monash University Adjunct, Associate Professor Christopher Pearce.
To date three reports, produced every fortnight by Outcome Health, also warns of a significant rise in patients with disease that were previously screened for.
The reports state that:
there will be an increase from August until at least Christmas in people with conditions that were previously kept controlled through screening
since early March, there has been a 60 per cent reduction in screening for cervical cancer
the development of care plans for people with diabetes is down by two thirds (18,000 to 5,000)
diabetes testing down by one third (1.35 per cent to 0.8 per cent) compared to the same time last year
in the first two weeks of March, pathology and radiology were down by 75 per cent (480,000 to 120,000)
According to Associate Professor Pearce, “GP data shows significant numbers of patients with chronic disease are not interacting with their practices and not having regular pathology of radiology testing that goes with proper management of their condition.” The reports are used by the Public Health Networks to support their general practices in responding to the pandemic.
Those with chronic conditions aren’t presenting to their GPs with minor problems which will worsen, exacerbating the “second wave” that is likely to hit hospitals next month, the reports warn. This will be coupled with the peak of the influenza season, despite an overall increase in flu vaccinations up by 88 per cent compared to the same time last year.
Associate Professor Pearce, added that there are also adverse effects on health due to physical distancing, people exercising less, dietary changes and decreased social interaction.
The report also warns that rural areas hit hard by bushfires, such as the Gippsland Primary Health Network which was part of the surveyed region, will receive a “double hit” on mental health issues.
The surveys also mapped the rapid uptake of telehealth by general practice in the wake of COVID-related telehealth Medicare Benefit Schedule claim numbers being created on 13 March and then for general medical consults a fortnight later.
Surprisingly the study found that telehealth remains consistent at around 40 per cent of consultations, with only 2 per cent of consults using video.
Most telehealth consultations were related to mental health, alcohol and other drugs and dementia/Alzheimer’s issues. The majority of face-to-face consultations related to flu vaccinations.
The rise of telehealth has had a significant financial impact on general practice – with GPS recording between 25 per cent and 75 per cent reduction in practice income, despite costs remaining the same or increasing (due to costs of having to purchase PPE etc).
The study also acknowledges the huge, and immediate, impact that COVID-19 had on general practices. While hospitals had time to prepare for what was predicted to be a surge of COVID-19 cases, “in only a few weeks the (GP) workforce has moved to a virtual model of care with primary health care at the front line of COVID-19 impact,” Professor Pearce said.