Health care use increased after SARS-CoV-2 infection in Ontario

Editor’s note: Find the latest news and guidance on long-term COVID at Medscape’s Long-term COVID Resource Center.

Healthcare use among adults in Ontario, Canada, increased in the post-acute phase of SARS-CoV-2 infection, particularly for those with long-lasting symptoms, according to a new report.

So far, patients have experienced more health care encounters overall, as well as more hospital admissions, home care encounters, and long-term care days.

“We planned this study about a month before the World Health Organization published its definition of prolonged COVID last year. At the time, there were signs that the post-COVID health care burden was going to be significant, but we didn’t have a clear understanding of how large that burden would be,” said study author Candace McNaughton, MD, PhD, professor Associate of Medicine at the University of Toronto and Emergency Physician at Sunnybrook Health Sciences Center. Medscape Medical News.

“Even back then, we were already seeing patients in clinics and in the emergency department for symptoms like palpitations, shortness of breath, or cognitive dysfunction months after even mild infections,” he said. “We wanted to know if these symptoms could be directly related to his COVID episodes several months earlier.”

The study was published on October 17 in CMJ.

Comparing the sexes

McNaughton and colleagues conducted a retrospective cohort study to quantify the post-acute burden of health care use after SARS-CoV-2 infection among community-dwelling adults in Ontario. They compared people with positive or negative polymerase chain reaction (PCR) test results between early January 2020 and late March 2021. During that time, COVID-19 tests were widely available and free. throughout the province.

The researchers linked PCR test results to health care encounters. They started the analysis about 2 months after the PCR test. They matched patients with positive results and those with negative results on a comprehensive propensity score based on more than 20 factors. They compared person-year rates for healthcare encounters at the middle and 99th percentiles. Because previous studies had found that SARS-CoV-2 infection affects women and men differently, the research team evaluated differences between women and men in the amount and type of health care they used.

Between January 2020 and March 2021, more than 11 million PCR tests were completed for more than 3.7 million adults in Ontario. Among the 3.6 million people included in the study, some 269,000 (7.4%) had a positive PCR test result. The mean follow-up was 240 days. The matched cohort included about 532,000 people, and their average age was 44 years. About 51% were women.

Among women, the rate per person per year for each type of health care encounter except emergency department visits was significantly higher among those who tested positive. The increase was greatest for long-term care days, about 0.81 more days per person per year. There were 0.49 more outpatient encounters, 0.36 more days in hospital, and 0.31 more home care encounters.

For women, on average, the number of long-term care days was 151% higher; of days of hospitalization, 48% higher; of home visits, 7% higher; and external consultations, 6% higher.

At the 99th percentile, women who tested positive had an additional 28 home care encounters per person per year, as well as an additional 6 days in the hospital. The 99th percentile of total health care encounters was 56.7 higher in women who tested positive than those who tested negative.

Among men, the rate per person per year for each type of health care encounter except home care visits and emergency department visits was significantly higher among those who tested positive. The increase was greatest for long-term care, with about 0.48 more days, followed by 0.47 more days in hospital and 0.14 more outpatient encounters.

For men, on average, the number of long-term care days was 92% higher; of days of hospitalization, 53% higher; visits to the emergency room, 4% higher; and external consultations, 3% higher. Home care visits were 11% lower.

At the 99th percentile, men who tested positive had an additional 8.7 days in the hospital per person per year, although the number of home care visits was significantly lower. The 99th percentile of total health care encounters was 39.3 higher for men who tested positive than for those who tested negative.

scarce resources

The largest increase in health care use occurred among the top 1% of infected people. In practical terms, about 1% of people infected with SARS-CoV-2 will spend an additional 7 days in hospital over the next year, McNaughton said.

“Based on the number of people infected during the first half of 2022, this 1% of people infected will use a lot of hospital days,” he said. “This can create a huge challenge on top of the ongoing nursing shortage, rural hospital closures, and ongoing healthcare needs for patients with cancer, heart attacks, and strokes.”

Also, based on the number of recent infections, a primary care provider who had 20 clinic visits per day before the COVID-19 pandemic will need to find time and resources for 100 more clinic visits per year, McNaughton noted.

“All of this means that people with prolonged COVID will experience the burden of needing more health care, and they, and everyone in the health care system, will be competing with each other for scarce resources,” he said. “In other words, a person with cancer may spend their hospital stay in an emergency department hallway rather than in an upstairs hospital room because there are not enough staffed hospital beds, or it may mean someone with uncontrolled diabetes may have to go to the ED because they couldn’t make an appointment with their primary care provider for several weeks or more.”

McNaughton and her colleagues would like to better understand why some people have more doctor visits and what factors contribute to greater needs for certain types of health care. This could inform future policy and funding considerations.

Health care use was higher among women and increased the most across all encounter types, while additional health care use among men was largely concentrated in a small subset. In addition, the use of home care decreased among men. This could mean that the men received unpaid care from family after their illness, and such care may have been provided in other ways before the pandemic, the study authors write.

Future studies should investigate the burden of prolonged COVID care, as well as the effects of new variants, treatments, and vaccines, the authors write.

“There is hope”

Commenting on the findings for Medscape, Kieran Quinn, MD, PhD, a palliative care specialist and clinical scientist at Sinai Health System in Toronto, said, “Research suggests that approximately 60% of Canadians have been infected with COVID-19. 19, so that means there are a lot of people with persistent symptoms who need help from their health care providers.”

Dr Kieran Quinn

Quinn, who was not involved in this study, investigated post-acute COVID-19 conditions and patients’ anticipated healthcare use. He and his colleagues plan to launch a clinical trial soon to discover new treatments for patients with long-term effects.

“I know that many people suffering from the post-COVID-19 condition feel abandoned by our healthcare system and that things can seem hopeless as we currently have no proven treatments for them. There is hope,” she said. “Our goal is to ensure that the right person gets the right care at the right time.”

The study was supported by ICES, which is funded in part by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. The study authors are supported by several grants. They and Quinn have disclosed no relevant financial relationships.

CMJ. Published on October 17, 2022. Full text

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.

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