How the COVID-19 pandemic affected the total annual time spent by family physicians managing common diagnoses

Shlomo Vinker, Avivit Golan Cohen, Ilan Green, Eugene Merzon, Ariel Yehuda Israel

Keywords: workload, reason for encounter, complaint, COVID-19

Background:

The COVID-19 pandemic changed the way that common diseases are diagnosed and managed. Telemedicine modalities have been increasingly used. COVID-19 may have triggered new complaints, while lockdowns, social isolation, and barrier precautions adopted during the pandemic, may have decreased the transmission of several common infectious diseases.

Research questions:

To study changes in the total annual time spent by primary care physicians between 2019 and 2022 by dividing visits according to treated complaints categories.

Method:

A cross-sectional study based on the electronic medical records of all patients of LHS visits to primary care physicians in 2019 and 2022 (N=715,000 patients).
Visits had been classified according to the ICD-9 code of the visit. For each code, we calculated AADT (Accumulated Annual Duration of Time), and we calculated the change of AADT in each ICD-9 code/codes group between 2019 and 2022

Results:

We observed a marked increase in the AADT spent for visits for poorly defined complaints and administrative tasks (+26%). There was also a marked increase in AADT spent in visits for metabolic complaints such as obesity (+24%), diabetes mellitus (+6.1%), and gastrointestinal problems (+2.9%). Interestingly, less AADT was spent on respiratory infections (-30%), COPD (-23%), ophthalmological problems (-11.6%), and ear problems (-4.6%). There was also less AADT spent in visits related to injuries (-14%), arthropathies (-4.5%), and back problems (-2.1%). Less AADT was also recorded for the treatment of chronic conditions such as hypertension (-21%), and disease screening and health promotion encounters (-5.3%).

Conclusions:

The reduction of respiratory infectious diseases is temporary, but the shift from face-to-face medicine may have led to a concerning trend of spending more time on administrative tasks and shifting the treatment of ENT and Ophthalmologic problems to other specialists. These trends are the result of external forces, it is time to be proactive in influencing the case mix in our clinics.

Points for discussion:

The shift in the clinical work of family physicians - is it the same around Europe?

Are we papered to work and to teach the new remote modalities of family medicine?

How can we measure the outcomes of the new era of treatment?