By Falguni Shah, Associate Director, Standards Interpretation Department
An estimated 41% of adults in the U.S. have avoided medical care during the pandemic because of concerns about COVID-19.
Even though restrictions are lifting in many states, delayed care has far reaching implications for screening and disease management. Since early 2020, breast cancer screenings have reduced by 89%, and colorectal cancer screenings have reduced by 85%.
If routine care continues to be avoided, adults will miss opportunities for managing chronic conditions, getting routine vaccinations, and, possibly, early detection of new conditions.
Explanation Behind Delayed Care
There’s no one single reason that individuals are postponing medical visits. Research shows that there has been a spectrum deciding factors throughout the different phases of the pandemic, including:
- local public health officials recommending minimizing visits for nonurgent health care reasons
- stay-at-home orders
- awareness of overcrowded hospitals and concern about the prevalence of COVID-19 positive patients in hospitals
- misconceptions that hospitals are only serving COVID-19 patients, possibly resulting in patients not seeking emergent care until symptoms become severe
- attempts at communicating the need to continue preventative care may not be understood by patients with low health literacy or limited English proficiency
Postponed Emergency Visits
Not only is routine care being delayed, but many people are hesitant to go to the emergency department.
Postponed visits to the emergency room can impact acute myocardial infarction patients who may then suffer permanent harm as a result, given the importance of timing from the onset of cardiac symptoms to obtaining coronary reperfusion.
Impact on Pediatric Patients
It’s not just older patients who are delaying treatment and preventive services. The problem is trickling down to younger patient populations, including children.
As of May 2020, a decline exists in age-based vaccines for almost every age group of children, compared with averages for recent past years. This includes failure to get routine childhood vaccinations, including measles. Unvaccinated children are vulnerable to preventable infections and can spread infections to others.
School and daycare closures may deter preventative care due to lack of childcare. Patients may feel their presence is needed more at home, where they may be assisting with remote education.
There are a few safety actions to conditions, which might encourage people to seek preventive care and, by extension, lead to better health outcomes.
One important tactic is proactively communicating to patients to seek preventive care. This can be accomplished by strategically including a few key items in patient communications, including:
- risks involved in delaying medical care
- COVID-19 precautions by the organization
- home based testing options for colon cancer screening by low-risk individuals
- reminders for parents on the importance of protecting children against diseases that are preventable with a vaccine
Re-Thinking Facility Space
Many organizations have increased patients’ confidence in their safety precautions by re-arranging facility space to provide immunizations in dedicated clinics, rooms or buildings.
Similarly, creative ideas include:
- closing waiting rooms and allowing patients to check in via phone
- vaccinating in the parking lot
As we navigate this virus, it’s critical to keep open communication with patients and remind them that preventive screenings can be lifesaving.
Falguni Shah is Associate Director, Standards Interpretation at The Joint Commission. She is a behavioral health professional with experience in public health and academics.