Gail L. Rose, PhD; Levi N. Bonnell, MS, MPH; Jessica Clifton, PhD; Lisa Watts Natkin, PhD; Juvena R. Hitt, MPH; Jennifer O’Rourke-Lavoie
Corresponding Author: Gail L. Rose, PhD; University of Vermont - Larner College of Medicine
Contact Email: gail.rose@uvm.edu
Section: Original Research
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PURPOSE: Many patients delayed health care during COVID-19. We assessed the extent to which patients managing multiple chronic conditions (MCC) delayed care in the first months of the pandemic, reasons for delay, and impact of delay on patient-reported physical and behavioral health (BH) outcomes.
METHODS: As part of a large clinical trial conducted April, 2016 - June, 2021, primary care patients managing MCC were surveyed about physical and behavioral symptoms and functioning. Surveys administered between September 3, 2020 and March 16, 2021 included questions about the extent of and reasons for any delayed medical and BH care since COVID-19. Multivariable linear regression was used to assess health outcomes as a function of delay of care status.
RESULTS: Among patients who delayed medical care, 58% delayed more than once. Among those who delayed behavioral health care, 63% delayed more than once. Participants who delayed multiple times tended to be younger, female, unmarried, and reported food, financial, and housing insecurities and worse health. The primary reasons for delaying care were lack of availability of in-person visits and perceived lack of urgency. Participants who delayed care multiple times had significantly worse outcomes on nearly every measure of physical and mental health, compared to participants who delayed care once or did not delay.
CONCLUSIONS: Delay of care was substantial. Patients who delayed care multiple times were in poorer health and thus in need of more care. Effective strategies for reengaging patients in deferred care should be identified and implemented on multiple levels.