Disrupted access to healthcare during pandemic linked to avoidable hospital admissions

People who experienced disrupted access to healthcare, including appointments and procedures, during the covid-19 pandemic were more likely to have potentially preventable hospital admissions, finds a study published by The BMJ today.

This study, led by the Universities of Liverpool and Glasgow with support from the University of Bristol, is the first to examine the impact of disruption on health outcomes using individual level longitudinal data. The researchers say reducing the backlog from covid-19 disruption is vital to tackle the short and long term implications of the pandemic.

The covid-19 pandemic created unprecedented disruption to healthcare in the UK. This included disrupted access to appointments, for example visiting a doctor or an outpatient department, and procedures such as surgery or cancer treatment.

Previous research has described the extent of this disruption, but no study has yet examined its potential impact on health outcomes at an individual level.

To fill this knowledge gap, researchers, including ARC West’s Director Professor John Macleod, accessed data from seven longitudinal studies in the UK Longitudinal Linkage Collaboration (UK LLC). The UK LLC includes linked data for 29,276 people in England to their NHS electronic health records from 1 March 2020 to 25 August 2022.

Their main measure of interest was avoidable emergency hospital admissions.

These were defined as admissions for conditions that can be, in theory, treated through community care (‘ambulatory care sensitive conditions’) and urgent conditions that suddenly worsen and may result in admissions, but should be treated in the community whenever possible (‘emergency urgent care sensitive conditions’).

A total of 9,742 participants (35%) reported some form of disrupted access to healthcare during the covid-19 pandemic.

After adjusting for other potentially influential factors, the researchers found that, overall, people who reported any form of disruption in accessing healthcare were at increased risk of hospital admission for any (80% higher odds), acute (two-fold), and chronic (80%) ambulatory care sensitive conditions.

They then investigated outcomes according to the type of healthcare disruption experienced. This showed that people who experienced disrupted access to procedures had 77% higher odds of being admitted to hospital for any ambulatory care sensitive condition, 88% higher odds of being admitted for a chronic ambulatory care sensitive condition, 45% higher odds of an emergency urgent care sensitive admission, and 57% higher odds of any hospital admission.

People who experienced disruption in accessing appointments had 52% higher odds of hospital admission for any ambulatory care sensitive condition and 46% higher odds of any hospital admission.

These are observational findings so no firm conclusions about cause and effect can be drawn and the researchers acknowledge that not all avoidable hospital admissions would have been caused by disruption of care. What’s more, they did not have any data on people’s difficulties in accessing healthcare before the pandemic, and because healthcare disruption was self-reported, it might be subject to bias.

However, by combining individual level data from longitudinal studies with electronic health records they were able to provide a more complete and detailed picture of hospital admissions across a national healthcare system during a period of great disruption.

As such, they say:

“The external shock to the health system caused by the covid-19 pandemic seriously disrupted access to healthcare and this impact is having negative impacts on hospital admissions that could potentially be preventable.”

These findings “highlight the need to increase healthcare investment to tackle the short and long term implications of the pandemic, and to protect treatments and procedures during future pandemics,” they conclude.