A new survey by the Physician-Patient Alliance for Health and Safety (PPAHS) found that 44% of patients have delayed or avoided doctor’s visits because of fear of COVID-19. This percentage was even higher among those diagnosed with certain chronic conditions, such as cardiovascular disease or respiratory illness. Both are risk factors for poor outcomes.
Before diving into the results of the survey, let me describe the circumstances that led up to the survey.
PPAHS’ Virtual Patient Care
In April 2020, PPAHS launched Virtual Patient Care, a free online chat line where patients can speak with a team of experienced registered nurses in order to get personalized answers to their questions.
The telehealth project and resources are thanks to the generous support of the BMS-Pfizer Alliance, as well as the efforts and resources of the following organizations:
- American Heart Association
- Anticoagulation Forum
- Heart Rhythm Society
- Mended Hearts
- Preventive Cardiovascular Nurses Association
According to Michael Wong, JD, Founder and Executive Director of PPAHS:
“Under current COVID-19 conditions, patients face the burdens of social distancing and increased difficulty in reaching clinicians busy with emergencies. Telehealth has proven essential in addressing patients’ pressing health needs and ensuring good patient-to-clinician dialogue. With today’s launch of Virtual Patient Care and the CV Virtual Clinic, vital telehealth benefits are now also extended to Afib patients in need.”
The PPAHS online survey: the impact of fear of COVID-19
As of October 5th, 2020, more than 6,000 people have visited Virtual Patient Care. Many of them have expressed both a fear of COVID-19 and a subsequent hesitancy to seek medical attention.
For instance, one individual wrote in, “More than a year ago, my doctor said I had Afib. What risks do I have for getting COVID-19?” Another patient described a sharp pain in their side, asking, “Should I be concerned? What do you think this may be? Should I see a doctor?” One other said simply, “Shortness of breath and extreme headache – go to the ER?”
In order to better understand and address these patient concerns and serve the community, PPAHS conducted an online survey with its followers from August 25 to September 7, 2020.
The results of the survey
About half of the 184 respondents (44%) reported that they had delayed or not gone to see a doctor, dentist, or another healthcare provider during the pandemic. PPAHS’ results are consistent with other research that shows about 4 in 10 US adults have avoided medical care due to COVID-19 concerns.
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This trend, coined “medical distancing,” has resulted in a 50% decrease in office-based visits, including,
- a 21% decline in primary care visits
- a 42% decline in emergency department (ED) visits
Unfortunately, PPAHS also found a higher percentage of medical distancing in respondents with clinical conditions that increase their risk of a poor outcome if infected, such as,
- atrial fibrillation (AFib) or cardiovascular disease (53%)
- chronic obstructive pulmonary disease (COPD) or respiratory illness (51%)
This increase may reflect information from the Centers for Disease Control and Prevention (CDC) that identified cardiovascular and respiratory disorders as underlying medical conditions that may increase the risks of developing severe illness from COVID-19.
However, these patients are also those who may be most in need of routine medical care for their chronic conditions. And, that may face dire consequences if their care is delayed.
Health consequences of delaying care
Research has found that patients have delayed seeing a doctor, resulting in more at-home heart attacks and delayed ED visits during the pandemic. One study found a 23% and 20% decline in ED visits for heart attacks and stroke, respectively.
As patients have begun returning to EDs, health care providers have reported seeing worse symptoms due to delayed care. Such delays are particularly significant for patients with AFib or COPD because they are at a higher risk of heart attack and stroke.
Cardiovascular conditions undiagnosed or untreated
The results of the PPAHS survey also reveal evidence of undiagnosed or untreated cardiovascular conditions. Of the 88 respondents that reported “no diagnosis” of cardiovascular disease, several included comments — such as “cardiac dysrhythmia” and “heart murmur.” This suggests that they may have an undiagnosed condition. Further, they may not be taking appropriate precautions or being monitored for further disease progression.
Cardiovascular disease can be treated with changes in diet and exercise if the condition is detected in its early stages. Left undiagnosed, cardiovascular disease may have serious health consequences.
These incidences of delayed diagnoses during COVID-19 have also been observed in the field of oncology. These delays are expected to result in more advanced stages of cancer and poorer clinical outcomes.
Related content: Clinical Care of Cancer in the Age of COVID
Another objective of the PPAHS survey was to examine medication adherence in the wake of the COVID-19 pandemic. One patient submitted a question to the nursing team on the Virtual Patient Care chat line asking, “Been taking anticoagulants for 6 months. Feel fine now. Can I get COVID if I take it?”
Patient adherence to physician-prescribed medication, in general, has consistently been observed to be poor (~50%). An analysis of the US National Disease and Therapeutic Index reveals that there was a 26% decline in visits for new medications during the pandemic.
In the PPAHS survey, two out of three respondents reported on their medication adherence. Positively, the rate was higher among those diagnosed with certain chronic illnesses:
- COPD or another respiratory illness (84%)
- Atrial fibrillation or cardiovascular disease (91%).
Reasons why patients are medical distancing
Fear of contracting COVID-19
The survey found that the number one reason for delaying or not going to see a doctor, dentist, or other clinician was fear of contracting the coronavirus (50%). Patients diagnosed with atrial fibrillation and other cardiovascular diseases are particularly fearful. Fully 92% of those respondents extremely or moderately concerned about getting COVID-19.
One respondent even wrote in just one word: “Panic”. Some attribute this fear to news coverage of coronavirus outbreaks which have driven a public perception of all medical facilities as germy and overrun with highly contagious COVID-19 patients.
Medical professionals have been attempting to combat medical distancing and stigma by assuring patients that medical offices and care providers are taking all the precautions to be safe.
Hard to reach a doctor or get an appointment
The next reasons for delaying or not going to see a clinician included:
- Difficulty contacting a clinician (21%)
- Being unable to get an appointment (37%)
This has been a persistent problem during the COVID-19 pandemic. Medical professionals and patients have grappled with what procedures and visits are considered “essential”.
According to recent reports by the CDC, routine immunizations for young children are among the medical services delayed or canceled during the COVID-19 pandemic. One study also found that 50% of cancer patients experienced delay or disruption to their health care, with one in eight not knowing when their treatment might resume.
The next set of reasons included the following:
- “Didn’t think the symptoms were serious enough” (13%)
- Self-management (such as changing diet, physical activities, etc.) (14%)
- “Got advice from a friend or family member” (10%).
Being unable to contact or make an appointment with a doctor may have been a factor in these responses. However, not thinking the symptoms were serious enough raises concerns about the consequences of undiagnosed conditions and delayed diagnosis.
Cost of care
Cost (10%) or lack of healthcare insurance (5%) were also cited as reasons for delaying or not going to see a doctor, dentist, or other healthcare provider.
According to the Economic Policy Institute, since the onset of COVID-19 and subsequent hit to the economy, roughly 6.2 million workers have lost access to health insurance that they previously got through their employer.
Survey respondents also spoke to further obstacles even if insured. These included:
- “insurance kicked my specialist clinic out of network”
- “insurance didn’t cover telehealth.”
Empowering patients to seek care
Given the reasons patients had for delaying care, PPAHS asked what information or resources they would like to have before going to see a healthcare provider.
Almost two out of three respondents indicated that they would like to know:
- “How safe is the healthcare facility”
- “What steps they are taking to ensure my safety”
Survey respondents also said:
- Steps I can take to prevent getting COVID when I go or bringing COVID back to my home (35%)
- Tips and resources for managing my health, so that I minimize the number of healthcare visits (24%)
- Speaking with a nurse, doctor, or other clinicians before I go in to make sure I really need to (29%). A majority of respondents said they would use Virtual Patient Care because they can “get free advice without having to leave my home” (58%).
With the result of this survey, using the Virtual Patient Care platform, PPAHS can more precisely anticipate and address patients’ fears and empower them to seek medical attention when needed.
The existing chat line will continue to connect patients with the nursing team so they can get their questions answered:
- Whether or not they should seek medical attention
- How they can self-manage their health
In addition, PPAHS plans to add:
- A simple assessment tool that patients can use to gauge whether they or a family member may be experiencing a stroke or heart attack and are in need of medical attention, such as the B.E. F.A.S.T. assessment.
- An easy-to-use two-part checklist to:
- assess whether a healthcare facility has taken appropriate steps to be COVID-safe; and
- how to reduce the risk of contracting COVID or bringing it back home.
With this growing system of information and resources, PPAHS hopes to better serve the community and improve health care outcomes.
Elise M. V. Wong
Elise M.V. Wong is the Director of Communications & Research for the Physician-Patient Alliance for Health & Safety. She was the key researcher in PPAHS’s study with the American Hospital Association on nursing attitudes and beliefs to identify medical practices and technologies to reduce the occurrence of respiratory compromise and failure in patients receiving opioids. This research was presented by her at the International Conference on Opioids at Harvard University.
Elise has also conducted independent research on maternal and child health during the opioid epidemic, specifically on the care of opioid-using pregnant women and their newborns. During this time, she evaluated national and international clinical guidelines, examined those guidelines in practice through interviews with medical professionals and experts, and developed policy recommendations in managing the care of these patients.
Elise graduated from the Princeton School of Public and International Affairs with a certificate in Global Health & Health Policy. She has worked in Washington, D.C for both McAllister & Quinn, a government relations and business development firm, and Capitol Street, a consulting firm that provides U.S. health care policy research and analysis.
It’s not hard to understand them. Of course fear of the disease causes us to make strange decisions.
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