背景:门诊部(OPD)是包括泰国在内的低收入和中等收入国家医疗保健系统的重要组成部分。2019年冠状病毒病(COVID-19)大流行及其控制措施的相当大的影响,尤其是封锁,预计将使用OPD服务。因此,这项研究旨在评估泰国COVID-19大流行期间OPD利用的模式,包括总体利用情况和包括诊断组在内的每个亚组内的OPD利用情况,年龄组,和健康区域。
方法:本研究是对泰国全民覆盖计划(UCS)覆盖的患者4年(2017-2020年)的综合门诊数据进行的二级数据分析。中断时间序列分析和分段准泊松回归用于检查COVID-19对整体OPD利用的影响,包括对每个诊断组的影响,年龄组,卫生区域,和各省。
结果:本研究中对845,344,946次OPD访视的分析显示,在COVID-19大流行之前,每月OPD访视呈季节性和增加趋势。在封锁和封锁后期间,观察到OPD访问减少了28%(比率(RR)0.718,95%置信区间(CI):0.631-0.819)和11%(RR0.890,95%CI:0.811-0.977),分别,与封锁前相比。呼吸系统疾病受影响最大,RR为0.411(95%CI:0.320-0.527),而非传染性疾病(ICD-10:E00-E90,I00-I99)和老年人(>60岁)的就诊次数略有下降。在大多数群体中,每月OPD访问的封锁后趋势逐渐增加到大流行前的水平。
结论:在某些疾病中,COVID-19封锁期间泰国的OPD利用率下降,但是某些患者组的服务似乎仍然可用。新冠肺炎封锁后,该比率及时恢复到大流行前的水平。基于国家现实世界数据库,在COVID-19期间配备OPD利用模式的知识,可以帮助为未来的流行病更好地准备医疗保健系统。
BACKGROUND: Out-patient department (OPD) is a crucial component of the healthcare systems in low- and middle-income countries including Thailand. A considerable impact of coronavirus disease 2019 (COVID-19) pandemic and its control measures, especially the lockdown, on utilisation of OPD services was expected. This study thus aims to estimate the pattern of OPD utilisation during the COVID-19 pandemic in Thailand including overall utilisation and within each sub-groups including diagnostic group, age group, and health region.
METHODS: This study was a secondary data analysis of aggregated outpatient data from patients covered under the Universal Coverage Scheme (UCS) in Thailand over a 4-year period (2017-2020). Interrupted time series analyses and segmented Quasi-Poisson regression were used to examine the impact of COVID-19 on the overall OPD utilisation including the impact on each diagnostic group, age groups, health regions, and provinces.
RESULTS: Analysis of 845,344,946 OPD visits in this study showed a seasonal pattern and increasing trend in monthly OPD visits before the COVID-19 pandemic. A 28% (rate ratio (RR) 0.718, 95% confidence interval (CI): 0.631-0.819) and 11% (RR 0.890, 95% CI: 0.811-0.977) reduction in OPD visits was observed during the lockdown and post-lockdown periods, respectively, when compared to the pre-lockdown period. Diseases of respiratory system were most affected with a RR of 0.411 (95% CI: 0.320-0.527), while the number of visits for non-communicable diseases (ICD-10: E00-E90, I00-I99) and elderly (> 60 years) dropped slightly. The post-lockdown trend in monthly OPD visits gradually increased to the pre-pandemic levels in most groups.
CONCLUSIONS: Thailand\'s OPD utilisation rate during the COVID-19 lockdown decreased in some diseases, but the service for certain group of patients appeared to remain available. After the COVID-19 lockdown, the rate returned to the pre-pandemic level in a timely manner. Equipped with a knowledge of OPD utilisation pattern during COVID-19 based on a national real-world database could aid with a better preparation of healthcare system for future pandemics.