PDF(Pubmed)
Abstract：
BACKGROUND: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world\'s highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies.
OBJECTIVE: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru.
METHODS: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (≥0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users.
RESULTS: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units.
CONCLUSIONS: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users.
OBJECTIVE: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru.
METHODS: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (≥0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users.
RESULTS: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units.
CONCLUSIONS: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users.
摘要：
背景：COVID-19大流行导致全球感染和未感染患者的医疗保健可及性下降，给慢性病患者带来特殊负担，包括心理健康问题。秘鲁经历了这场大流行的重大破坏，由于COVID-19，导致医疗保健系统崩溃，并导致世界上人均死亡率最高。了解医疗保健利用的趋势，特别是在精神保健方面，对于为大流行应对工作提供信息和指导未来的恢复战略至关重要。
目的：本研究旨在分析秘鲁一家国家医院在COVID-19大流行期间门诊医疗和精神病咨询的趋势。
方法：这项观察性研究是在利马的一家国立医院进行的，秘鲁。我们分析了所有服务的用户护理数据，包括精神科服务,从2019年5月到2022年12月。数据是为每月服务的用户计算的，包括每月在心理健康服务中看到的用户数量。社会人口统计学变量，如性别(女性或男性)，年龄（≥0岁），医疗预约类型（定期或额外），和护理方式(当面或远程会诊)被考虑在内。进行了中断时间序列回归模型，以评估门诊医疗和精神病咨询的数量。根据服务模式进行亚组分析，包括全面磋商，仅限远程监测/远程咨询，或仅面对面，适用于所有服务用户和心理健康服务用户。
结果：共纳入1,515,439名参与者，女性占样本的275,444/484,994(56.80%)。只有345,605/1,515,439（22.81％）次访问涉及远程医疗。与大流行开始时的预期预测（P<.001）相比，每月门诊总人数显着减少，随后每月增加298.7个用户。在大流行开始时，面对面干预措施显着减少（P<0.001），在接下来的几个月里逐渐恢复。相比之下,远程医疗的使用最初有所增加，但随后在大流行结束时有所下降。在精神卫生部门也观察到了类似的趋势。
结论：在大流行期间，普通服务和精神科服务的医疗保健利用率都大幅下降，特别是在大流行开始时（2020年3月）。然而,在整个大流行期间,两种病例均未观察到显著趋势.在此期间，远程医疗咨询总体上大幅增加，特别是在心理健康使用者中。
目的：本研究旨在分析秘鲁一家国家医院在COVID-19大流行期间门诊医疗和精神病咨询的趋势。
方法：这项观察性研究是在利马的一家国立医院进行的，秘鲁。我们分析了所有服务的用户护理数据，包括精神科服务,从2019年5月到2022年12月。数据是为每月服务的用户计算的，包括每月在心理健康服务中看到的用户数量。社会人口统计学变量，如性别(女性或男性)，年龄（≥0岁），医疗预约类型（定期或额外），和护理方式(当面或远程会诊)被考虑在内。进行了中断时间序列回归模型，以评估门诊医疗和精神病咨询的数量。根据服务模式进行亚组分析，包括全面磋商，仅限远程监测/远程咨询，或仅面对面，适用于所有服务用户和心理健康服务用户。
结果：共纳入1,515,439名参与者，女性占样本的275,444/484,994(56.80%)。只有345,605/1,515,439（22.81％）次访问涉及远程医疗。与大流行开始时的预期预测（P<.001）相比，每月门诊总人数显着减少，随后每月增加298.7个用户。在大流行开始时，面对面干预措施显着减少（P<0.001），在接下来的几个月里逐渐恢复。相比之下,远程医疗的使用最初有所增加，但随后在大流行结束时有所下降。在精神卫生部门也观察到了类似的趋势。
结论：在大流行期间，普通服务和精神科服务的医疗保健利用率都大幅下降，特别是在大流行开始时（2020年3月）。然而,在整个大流行期间,两种病例均未观察到显著趋势.在此期间，远程医疗咨询总体上大幅增加，特别是在心理健康使用者中。
