Outpatient Health Service Utilization Among Adults with Diabetes, Hypertension and Cardiovascular Disease During the COVID-19 Pandemic – Results of Population-Based Surveys in Germany from 2019 to 2021

Abstract

Purpose

Fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and lockdown measures may have an impact on health care utilization particularly for people with chronic diseases. We investigated changes in outpatient utilization behavior in pandemic phases among people with selected chronic diseases in Germany.

Methods

The nationwide population-based telephone surveys German Health Update (GEDA) 2019/2020 (April 2019 to September 2020) and GEDA 2021 (July to December 2021) covered 4 out of 7 pandemic phases from the pre-pandemic to the 4th pandemic wave. Data on hypertension, diabetes and major cardiovascular diseases (CVD) in the past 12 months and visiting a general practitioner (GP) or a specialist (excluding dentist) in the past 4 weeks was collected using a standardized questionnaire. Proportions and odds ratios were derived from logistic regression models adjusted for age, sex, education and federal states.

Results

Among 27,967 participants aged ≥16 years, 8,449, 2,497 and 1,136 individuals had hypertension, diabetes and major CVD. Participants with these chronic diseases visited a GP or specialist significantly more often than the overall study population, irrespective of pandemic phases. Compared to the pre-pandemic phase, a significant reduction in specialist-visiting was found in the first pandemic wave among people with hypertension (34.3% vs 24.1%), diabetes (39.5% vs 25.5%) and major CVD (41.9% vs 25.6%). GP-visiting was lower only among people with hypertension (53.0% vs 46.0%). No difference in GP or specialist visiting was found in the 4th pandemic wave compared to the pre-pandemic phase.

Conclusion

The observed decrease particularly in specialist utilization among people with the selected chronic diseases at the beginning of the pandemic was not observed for the second half of 2021 despite the ongoing pandemic. Further studies are required to examine whether the temporary changes in the utilization of ambulatory health care have affected the disease management of people with chronic diseases.

Keywords:

• health service utilization
• outpatients
• SARS-CoV-2
• chronic disease
• cardiometabolic diseases
• diabetes
• Germany

Abbreviations

95% CI, 95% confidence interval; AAPOR, American Association for Public Opinion Research; ACSC, ambulatory care sensitive condition; CATI, computer-assisted telephone interviews; CVD, cardiovascular disease; EHIS, European Health Interview Survey; GEDA, German Health Update; GP, general practitioner; ISCED, International Standard Classification of Education; NCD, non-communicable disease; OR, odds ratio; RKI, Robert Koch-Institute; RR3, response rate 3; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; WHO, World Health Organization.

Data Sharing Statement

The dataset analysed for the current study is available from the corresponding author on reasonable request. The minimal data set underlying the findings presented in this manuscript is archived at the Health Monitoring Research Data Centre at the Robert Koch Institute (RKI) and can be accessed by all interested researchers. On-site access to the data set is possible at the Secure Data Center of the RKI’s Health Monitoring Research Data Centre. Requests should be submitted to [email protected].

Ethics Approval and Informed Consent

Both GEDA 2019/2020-EIHS and GEDA 2021 are subject to strict compliance with the data protection provisions set out in the EU General Data Protection Regulation (GDPR) and the Federal Data Protection Act (BDSG), and were approved by the Ethics Committee of the Charité –Universitätsmedizin Berlin (application number EA2/070/19) and performed in accordance with relevant guidelines and regulations including the Declaration of Helsinki. Participation in the study was voluntary. All participants were informed about the aims and contents of the study and about data protection. Verbal informed consent was obtained from all the participants prior to the interview, which was approved by the Ethics Committee of the Charité –Universitätsmedizin Berlin.

Acknowledgments

We thank all participants of the GEDA-study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

This work was supported by a research grant from the German Federal Ministry of Health to develop a diabetes surveillance system in Germany (Grant Numbers: 2522DIA700, 2523DIA002). The GEDA study was funded by the Robert Koch Institute and the Federal Ministry of Health, Germany. The Robert Koch Institute is a Federal Institute within the portfolio of the Federal Ministry of Health Germany.