One in five individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms, according to a new study publishing November 23rd in PLOS Medicine by Silvan Licher of Erasmus University Medical Center Rotterdam, the Netherlands, and colleagues.
During the COVID-19 pandemic, consultations in both primary and specialist care declined compared to pre-pandemic levels. It is unclear to what extent healthcare avoidance by the general population contributed to these declines. In the new study, researchers sent out a paper questionnaire to 8,732 participants of the Rotterdam Study, a cohort study designed to investigate chronic diseases in mid to late-life, covering several COVID-19 related topics, including healthcare avoidance. 73% of participants responded between April and July 2020 and the final population for the study was 5,656 individuals residing in the same district in Rotterdam, the Netherlands.
About one in five (20.2%) of participants reported having avoided healthcare during the pandemic. Of those, 414 participants (36.3% of avoiders) reported symptoms that potentially warranted urgent medical attention, including limb weakness (13.6%), palpitations (10.8%) and chest pain (10.2%). However, there was no data available on the severity of symptoms. Groups most likely to have avoided healthcare included females (adjusted odds ratio (OR) 1.58, 95% confidence interval (CI) 1.38-1.82), those with poor self-appreciated health (per level decrease 2.00, 95% CI 1.80‑2.22), and those with high levels of depression (per point increase 1.13, 95% CI 1.11-1.14) and anxiety (per point increase 1.16, 95% CI 1.14-1.18). Lower educational level, older age, unemployment, smoking and concern about contracting COVID-19 were also associated with healthcare avoidance.
“Findings of our study suggest that healthcare avoidance during COVID-19 may be prevalent amongst those who are in greater need of it in the population, such as older individuals, those with low perceived health and those who report symptoms of poor mental health,” the authors say. “These findings call for population-wide campaigns urging individuals who are most prone to avoid healthcare to reach out to their primary care physician or medical specialist to report both alarming and seemingly insignificant symptoms.”
“One in five avoided healthcare during COVID-19 lockdown, often with alarming symptoms like chest pain or limb weakness,” Licher adds. “Vulnerable citizens were mainly affected, emphasising the urgent need for targeted public education.”
In a new study, we found that the overall U.S. gun violence rate rose by 30% during the first year of the COVID-19 pandemic compared to the year before. In 28 states, the rates were substantially higher between March 1, 2020, and March 31, 2021, compared to the pre-pandemic period from Feb. 1, 2019, through Feb. 29, 2020. There were 51,063 incidents of gun violence events resulting in injury or death in the United States in the first 13 months of the pandemic compared to 38,919 incidents in the same time span pre-pandemic.
Early in the pandemic, gun sales in the United States surged, with more than 20% of these purchases by first-time buyers. And access to firearms is a well-established risk factor for gun-related suicide and homicide. This sharp increase in firearm purchases raises serious concerns, since the combination of increased stress, social disruption and isolation during the pandemic created a perfect storm of conditions that could contribute to increased gun violence.
These trends were also concerning since the increased rates of gun violence could strain the health care infrastructure that was overtaxed due to an unprecedented influx of COVID-19 patients.
We are a team of scientistsand physicians with expertise in preventive health care and modeling diseases of public health concern.
We used a publicly available database of gun violence events and divided those events by the number of people living in each state. We also added other factors such as age, race and ethnicity, and we recorded the status of each state’s stay-at-home orders and the number of COVID-19 cases. We found that gun violence rates increased substantially in 28 states, or 56% of all states, scattered throughout the U.S., without any clear pattern. The increase in gun violence was highest in Minnesota, with a 120% increase.
Due to ongoing police investigations, we were advised to not separate out counts of suicides and homicides before investigations are completed. To get a fuller picture, it will be important for future studies to assess comparisons of suicide and homicide rates during this same period.
The spike in gun violence in the era of COVID-19 comes as a stark reminder that greater public health resources are needed to address and prevent gun violence, even as we continue to work to mitigate the pandemic.
Insulin is as essential as water for many people with diabetes. Of the more than 30 million Americans with diabetes, approximately 7.4 million rely on insulin to manage their condition. But it is one of the most costly drugs on the market, and the COVID-19 pandemic has intensified the already rampant problem of insulin hoarding or rationing.
Not only is diabetes associated with an increased risk of severe COVID-19 infection, but COVID-19 is also associated with both an increase in new diabetes diagnoses and a worsening of preexisting diabetes complications. By September 2021, death rates for people with diabetes were 50% higher than before the pandemic, a net increase of more than twice the overall death rate of the general population.
I am a pharmacist who studies ways to improve clinical, economic and quality-of-life outcomes in vulnerable populations. My recent study on how insulin prescription rates have changed because of the pandemic underscores the challenges that people with diabetes face in accessing care.
Managing diabetes during a pandemic
Although insulin is a vital component of diabetes management, the pandemic has led many patients to forgo the prescriptions they need.
My recent study looked at the insulin prescription claims of 285,343 people in the U.S. between January 2019 and October 2020. In the first week of 2019, there was an average of 17,037 new and existing insulin prescriptions picked up by patients per week. This number increased by 11 claims each week leading up to the pandemic.
By the first week of the pandemic in March 2020, however, insulin prescriptions decreased significantly by an average of around 396 prescriptions. Prescriptions continued to decrease an average of around 55 per week as the pandemic progressed through to October 2020. This decline may result from a combination of health insurance loss owing to unemployment, restricted access to clinicians and pharmacies and rationing or stockpiling of medications by both pharmacists and patients.
And the effects of the pandemic on diabetes go beyond just insulin prescriptions. Diabetes management involves visits with a variety of health care providers and routine testing. But diabetes patients in the U.S. had a significant drop in usage of health care services in 2020 compared with 2019, because of clinic closures and reduced capacities, health insurance loss and transportation difficulties. Patients are left in a bind, risking potentially life-threatening complications from missing needed diabetes care as well as risking exposure to COVID-19 if they need emergency care for those complications.
Ongoing effects of care delays
As COVID-19 overwhelmed health care systems, people with chronic conditions like diabetes have experienced significant disruptions in routine and emergency medical care. By the end of June 2020, an estimated 41% of U.S. adults had delayed or avoided medical care.
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Even now, with hospitals crowded with unvaccinated COVID-19 patients, nearly 1 in 5 American households had to delay care for serious illnesses in the past few months. These care delays have the potential to worsen chronic conditions and contribute to excess deaths directly and indirectly caused by COVID-19.
The full effect that the COVID-19 pandemic continues to have on diabetes management and care, however, has yet to be fully understood. More research on how the pandemic has affected people with diabetes is needed to ensure that these patients receive the care that they need.
Well, things are changing quite drastically in the U.S. due to the ongoing pandemic. While first writing this article, things were actually looking good for the U.S. We thought we were seeing light at the end of the tunnel due to the numerous vaccines and a large number of Americans being vaccinated. COVID-19 cases were decreasing, many states were confident and had thus eased restrictions and regulations surrounding social distancing, allowing businesses to open up. Healthcare providers who have been ensuring patient care via virtual means were also opening up for in-person visits. Unfortunately, things did not remain positive for long – the pandemic is far from over.
COVID-19 cases in certain states are once again rising with increasing the pressure on healthcare providers. Once again, some hospitals are choosing to postpone elective procedures, whereas others are updating visitation policies for the patients. Moreover, hospitals are now getting filled with regular patients as well as COVID-19 patients. Thus, healthcare providers must focus on enhancing patient safety and risk management to reduce unwanted incidents and enhance healthcare outcomes.
COVID-19 has changed everything
The pandemic has changed everything for the entire world – one can say that it has shaken the word’s core, figuratively. For instance, many of us are still working remotely and practicing social distancing. However, the biggest changes, arguably, occurred in hospitals and health systems – telehealth became one of the only ways to ensure patient care during the pandemic and it looks like telehealth will become a permanent part of healthcare. Before diving into patient safety and risk management in the post-pandemic era, let’s see how it was before the pandemic.
1. In patient safety and risk management, patient misidentification is a common theme
Quite simply, patient safety focuses on preventing patient harm during the treatment process so that unwanted incidents don’t hamper healthcare outcomes.
Now patient safety incidents occur because several reasons, such as diagnostic testing errors, medication errors, patient falls, among other issues. While these topics have been widely discussed by experts, let’s take a look at a less discussed but crucial problem that causes patient safety incidents in many ways – patient misidentification.
Patient misidentification isn’t anything new – in fact, it has existed for decades due to a variety of reasons. However, a lot of patient safety incidents can be traced back to patient misidentification.
2. Patient misidentification causes patient record mix-ups
This one’s quite simple – when a patient comes for an in-person visit, s/he is assigned the wrong medical record due to misidentification. As a result, any subsequent action will most definitely lead to a patient safety incident as the patient will receive wrong treatment, medication, and so on.
However, if by some miracle, the patient who came in doesn’t face any harm – does it mean that future patient safety incidents won’t occur? What about the patient whose EHR was used?
3. Patient misidentification jeopardizes patient data integrity
This answers the question asked in the previous point. Whenever a medical record is used for someone else other than the actual patient, it leads to patient data integrity failure. Not only is the information in the EHR corrupt, but it also becomes quite dangerous. Just imagine that the patient who has heart disease is getting prescribed medication for chronic kidney disease – the consequences can be quite disastrous!
4. Patient misidentification generates preventable medical errors
This is closely tied to the previous points and is a consequence of them. When a patient is misidentified, they will be getting the wrong treatment, radiation overdoses, blood transfusion errors, wrong medication, and so on. While patients are usually misidentified during the registration process, it might also occur during treatment, and both of them lead to detrimental healthcare outcomes. However dangerous these events might seem, they are entirely preventable if patients are accurately identified.
While these were some of the patient safety and risk management issues in the pre-pandemic era, what do caregivers need to do in the post-pandemic one?
5. Improving patient safety in a post-pandemic world
To be honest, there are still many unresolved issues within healthcare facilities that jeopardize patient safety and risk management. However, the pandemic has added more issues into the mix – as a result, caregivers need to work on all of the problems simultaneously.
So, how can caregivers focus on patient safety as some of them are opening their doors to in-person visits?
Continue providing virtual healthcare sessions
Starting off, we all know how the pandemic has shown the many advantages of telehealth. Fortunately, a lot of patients have accepted telehealth and are even wanting to continue using it after the national health emergency is over.
If the caregivers continue to provide telehealth services, they can keep patient volumes down within their facilities and continue treating everyone. This ensures patient safety as lesser patients come in for in-person visits and keep HAIs (hospital-acquired infections) at bay.
6. Ensure everyone is properly wearing PPE
While it looked like the pandemic was waning in the U.S., COVID-19 cases have increased once again. We’re still at a critical stage, and as new infectious and dangerous variants are popping up, healthcare providers must ensure the safety of everyone that comes into their facilities.
Enforcing PPE usage on everyone is the only way to safeguard both patients and caregivers. While restrictions might have eased for other industries, enforcing PPE usage on people who visit the hospitals can reduce infections and even save lives in the process.
7. Utilize solutions that eliminate physical touch
Due to the pandemic, many organizations are working towards innovative solutions, one of which is making them contactless or at least reducing the number of physical interactions required. This is more applicable for healthcare facilities, as these are places where patients might become victims of HAIs.
While many organizations are coming up with contactless solutions, some already exist, for instance, many healthcare providers are using a touchless patient identification platform. Not only does such a solution help ensure positive patient identification, but it also reduces the risk of HAIs as it’s contactless.
Hospitals must protect patients at all costs
Patient safety incidents have always been an issue of the U.S. healthcare system, and with COVID-19 cases spiking once again, it looks like hospitals and health systems have their hands full. However, with careful planning, utilizing appropriate strategies, and making informed decisions, hospitals can prevent deaths, medication errors, mix-ups, and more – improving patient safety in the process.
If the nursing shortage is bad now, chances are it’s going to get much worse.
“Hospitals were having difficulty finding nurses to fill positions before the pandemic,” notes Kendra McMillan, MPH, RN, Senior Policy Advisor for Nursing Practice and Work Environment at the American Nurses Association (ANA). “In fact, according to the US Bureau of Labor Statistics, 175,900 RN openings were projected each year through 2029, when we factor in nurses leaving the workforce for reasons such as retirement.Unfortunately, the pandemic’s demand on the healthcare system has further exacerbated a long-standing projection that has burdened our nursing workforce.”
Kendra McMillan, MPH, RN, ANA Senior Policy Advisor for Nursing Practice and Work Environment
Doctors and nurses are overworked, thanks to chronic staffing shortages made worse by a pandemic that drove thousands from the field, writes The New York Times. On the West Coast, “the nursing shortage affecting the whole nation is impacting the Northwest region as well,” according to an article in The Bulletin (headquartered in Bend, OR), quoting a Kaiser spokeswoman.
“Finding experienced nurses has always been a challenge in Southern California,” according to Cherie Fox, RN, MSN, CCRN-K, Executive Director Acute Care Services, Providence Mission Hospital, Mission Viejo, California. “Following the COVID-19 pandemic, we are seeing nurses retire, move out of the area, and reduce hours, all of which has amplified our staffing challenge just a bit.” Fox led the initial team that opened the COVID ICU and telemetry units during the pandemic. She recently coauthored a paper in Critical Care Nurse detailing Providence Mission Hospital’s COVID response.
And a recent study found that nurses are reporting large declines in their mental health. More alarming, nurses, especially those who are younger, are feeling less committed to the profession.
Multiple factors, coupled with the pandemic, are influencing the nursing shortage, according to McMillan. These include burnout, work environment stress, workplace violence, an aging workforce that is retiring, and an aging population with comorbidities.
Multiple Solutions
To address the growing crisis, hospitals are pursuing multiple solutions, including hiring travel nurses. “I’ve talked to several emergency departments across the country that are having those issues where they’re having to have temporary nurses come in to the emergency department,” says Ron Kraus, MSN, RN, EMT, CEN, TCRN, ACNS-BC, Emergency Nurses Association president and Emergency Department Clinical Nurse Specialist at Indiana University Health Methodist Hospital.
ENA President Ron Kraus, MSN, RN, EMT, CEN, TCRN, ACNS-BC
Providence Mission Hospital has also made use of travel nurses and offers a referral bonus to current caregivers. Fox notes that nurses are taking time off while others are getting ready for vacations. “While the time off is needed and approved, it does add further to dependence on traveling nurses.”
“Hiring bonuses, tuition reimbursement, and loan repayment are examples of incentives offered to nurses to boost recruitment and retention efforts,” notes the ANA’s McMillan. But, she adds, hiring bonuses don’t support efforts to retain nurses who are already employed in the organization.
“Nurses are facing longer shifts and are working more consecutive shifts to meet the persistent demands on our healthcare system” notes McMillan. The nurses who remain are burned out physically, mentally, and emotionally.”
The ENA, notes Kraus, is focusing on helping hospitals create a healthy work environment. Having a healthy work environment that empowers nurses, while supporting their needs, helps to overcome fatigue and moral distress, notes Fox.
Calling it an “amazing profession,” Kraus would encourage individuals to enter the profession. For a lot of us, it was very trying, but it’s a calling,” he says.
