The Impact of Multimorbidity and Socioeconomic Status on Health Service Utilisation Before and During the COVID 19 Pandemic

Anna Evans

Keywords: General Practice, Remote Consultation, Digital Triage, Digital Exclusion, Digital Divide, Unplanned Admission, Epidemiology, Shared Care Record.

Multimorbidity is a significant and pressing burden for the individual sufferer, society, and the NHS. More than half the UK population over 65 years are currently affected by multimorbidity which disproportionately affects those who are disadvantaged in other ways. Social deprivation, non-white ethnicity, mental ill-health, disability, increasing age and female gender are all associated with multimorbidity. The same factors are also associated with digital exclusion and the digital divide. This is important because it is not known how the sudden transition to remote GP consultation, and the reliance on digital consultation methods during the COVID 19 pandemic has affected healthcare use for those suffering with multimorbidity.

Research questions:
How did personal characteristics, multimorbidity and socioeconomic status relate to frequency and mode of access to GP consultation, unplanned hospital admission or death in one area of the North West of England, before and during the COVID 19 pandemic?

This will be a descriptive epidemiological study to describe the patterns of access to GP consultation across socioeconomic groups, among patients with multimorbidity, before and during the COVID 19 pandemic. A local Shared Care Record will be interrogated, this comprises comprehensive data from primary, secondary and social care for the local area. SPSS for data preparation. STATA for advanced analysis and visualisation.

Social demographics
Age, Gender, Ethnicity, Marital status, Nationality, Native language, Employment status/benefits, Housing status, Postcode , Existence of mobile phone number, Existence of email address, Household size

Clinical data
BMI, Chronic disease diagnoses, Active diagnoses, Smoking, Alcohol , Substance abuse, Care status, Frailty score, Disability, Number of medications on repeat prescription,

Outcome of interest
Face to face GP consultation, Telephone GP consultation, Online GP consultation, Video GP consultation, Text GP consultation, Email GP consultation, Attendance at AED, Admission to hospital via AED, Attendance of ambulance services, Attendance at WIC, Out of hours GP contact, Death


Points for discussion:
AED attendance has doubled locally from 2020 to 2021 indicating significant unmet need in the population in terms of accessing health care. This is despite GP consultation rates also increasing. It is not known what effect digital triage and remote GP consultation have had on primary care access and effectiveness, particularly for people suffering with multimorbidity and who are not online.

Reports from within the workforce indicate that digital triage and remote consultation as defaults are stressful and challenging for staff as well as patients, the real impact on workload in terms of effectiveness (not just number of contacts) is unknown, but indications from secondary care are that people are presenting with more advanced disease. Analysis of the patterns will be helpful to clinicians and service providers.

This study has the potential to demonstrate the utility of a local shared care record. This is a unique database, is comprehensive for the local area and has the potential to enhance service provision, efficiency and safety. The study will be repeatable so that changes made by the service providers can be analysed in the future.