Why has there been a drop in the diagnosis of common health conditions?

According to research published in The Lancet Public Health, there has been a significant reduction in the rate of initial diagnoses of many common physical and mental health conditions

Research published in the paper‘Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study’ conducted by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre has found that the diagnosis of common health conditions dropped significantly in comparison to usual figures for the time of year. The research analysed the electronic health records of 250,000 people to assess the impact of coronavirus on general practice between the 1st March and 31st May 2020.

The results showed that mental health conditions and type 2 diabetes had the biggest reductions in diagnoses, with just half of the expected number diagnosed. In the month of May malignant cancer diagnoses dropped by 44%, and diagnoses of circulatory system diseases in the period March to May dropped by 43%.

“We were aware that GP practices have been reporting a drop in the number of patients seeking medical help since the start of the COVID-19 pandemic. Thanks to electronic health records it is possible to investigate whether this is true,“ said Richard Williams, research lead for the study at the GM PSTRC.

“Importantly, our research has revealed which conditions people are not seeking medical attention for. This means that, potentially, there are high numbers of people living with undiagnosed type 2 diabetes, mental health conditions and circulatory system failure.”

The research is hardly surprisng after results from a poll by NHS England, released in April, revealed that 40% of people said they were avoiding contacting their GP because of concerns about burdening the NHS.

“There are going to be people, especially in the early days [of the pandemic], who were just afraid, and not going to a healthcare setting for fear of catching coronavirus,” said Richard Williams.

The team who conducted the research believe the drop in diagnoses is down to the general public avoiding contacting the GP, rather than GPs having problems diagnosing patients by ‚phone or video, or forgetting to record diagnoses, noting that they also found a reduction in prescriptions of medications relating to these conditions, despite prescriptions being possible without a formal diagnosis.

The fall in consultations is likely to be due to a number of factors, including patients having concerns about accessing GP services due to fear of contracting the virus or overburdening NHS services, and a desire to follow official messaging to stay at home to help stop the spread of COVID-19. Many specialist services were also restricted, so GPs might not have always been able to make referrals except in urgent cases.

“During a pandemic other health conditions do not cease to exist, and we’ve seen from health crises in the past that there are sometimes more deaths from conditions unrelated to the pandemic than the virus causing the pandemic itself,“ said Professor Martin Marshall, chair of the Royal College of GPs, in response to the study. “We urge patients who have concerns about their health to seek medical assistance, particularly if they have signs that could indicate serious conditions, such as cancer.

“Access to general practice is currently different from usual, with most consultations being conducted remotely, for the very reason we want to limit footfall in our surgeries and, therefore, help stop the spread of the virus. We hope this is reassuring for patients. For those who do need to come to the practice for a face-to-face appointment, safety measures will have been implemented to try to keep patients as safe as possible.”

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