Outpatient Attendance in COVID Pandemic Lockdown: An Observational Study

ABSTRACT IMAGE

INTRODUCTION

SARS-CoV-2 has brought unprecedented catastrophe to mankind. Besides physical illness, psychological pressures, the economic brunt is being faced by major sections of society. As the society curtails on its basic expenditure, several health-related issues are also nipped off. Baring major emergencies, the patient population avoids any routine visits, semi-elective or elective procedures.

To curb the disease transmission, many countries have adopted the policy of lockdown, an action for mass quarantine. The government of India ordered a nationwide lockdown for 3 weeks on March 24, 2020, which was subsequently extended and still remains in effect with some relaxations at the time of writing.

The COVID-19 pandemic has dramatically changed how outpatient care is delivered in health care practices. Several previous reports reveal a lower footfall to their outpatient departments (OPD). In the present review, we attempt to analyzed data on changes in visit volume of OPD attendance in our hospital during the pandemic lockdown and pre-pandemic era.

MATERIALS AND METHODS

RESULTS

A total sample size of 428,322 patients attended the OPD in the study period. Of these, 301,586 patients presented in Zone R (Regular period) versus 126,736patients in Zone L (Lockdown period) (P = 0.000). Besides overall reduction in OPD volume in Zone L, the individual attendance of each department in Zone L was also significantly reduced [Table 1 and Figure 1]. Collectively, only 42% of Zone R’s attendance was seen in Zone L [Table 2].

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Figure 1:

Comparison of attendance in various departments in Zone L and Zone R.

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In Zone L, Group A (<30% of previous) consisted of the least attended OPDs, Group B (30–60% of previous) consisted of moderately attended OPDs, and Group C (>60% of previous) were the OPDs with maximum attendance during the lockdown phase. The least attended OPDs include ophthalmology, ENT, dermatology, orthopedics, neurosurgery, anesthesia, and general surgery. Moderate attendance was noted in pediatric surgery, plastic surgery, urology, pulmonary medicine, pediatrics, obstetrics and gynecology, endocrinology, urban health center, rheumatology, neurology, psychiatry, medicine, nephrology, cardiology, and cardiothoracic surgery. Maximum attendance was observed in oncology with its medical, surgical and radiation wings, and in emergency OPD. Furthermore, a statistically significant rise in attendance in Zone L as compared to Zone R was noticed in oncology and radiology (P = 0.003, 0.600 respectively) [Table 3]. The gender description of our subject population was noticed and separated into male and female subsets. A significant decline in OPD attendance was apparent among both the sexes in Zone L versus Zone R. However, the gender divide was significantly higher with relatively a smaller number of females presenting in the lockdown era. A statistically significant reduction in number of women presenting in Zone L versus Zone R was noticed in cardiology, emergency, endocrinology, ophthalmology, medicine, neurosurgery, neurology, oncology, orthopedics, psychiatry, pulmonary medicine, surgery, and urology departments [Table 4 and Figure 2].

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Figure 2:

Comparison of female attendance in outpatient department in Zone L versus Zone R.

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DISCUSSION

The year 2020–2021 has brought the mankind and medical profession at the crossroads with a calamity never before seen. A hospital is nurtured primarily through it is outpatient visits besides the visits to the emergency department. The attendance to the outpatient department is reflective of the care provided by the hospital and also the care sought by the public at large. The data from several institutes documented reduction in the out-patient department during the pandemic and lockdown phase.^[2-4]

As expected, in the present study, the visit to out-patient departments were significantly reduced during the lockdown phase. This reduction can be attributed to the overall decrease in elective or preventive visits such as annual health check-ups, fear of transmission of infection among health workers, and public and travel restrictions implemented by the government at large.^[3] While maximum reduction was seen in Ophthalmology, ENT, Dermatology, Dental, Anesthesia, Neurosurgery, and Orthopedics OPD, the least reduction in patient attendance was seen the emergency wing and oncology (inclusive of medical, radiation, and surgical oncology). Rest all the OPDs documented a moderate (30–60% attendance of previous) reduction in OPD attendance and these reductions were statistically significant. These OPD trends are consistent with several previous reports documenting a fall in OPDs with a smaller number of emergent or critical procedures and issues. However, a rebound increase in these OPDs with patients presenting with chronic ailments could be expected in times to come.^[3] It was interesting to note that besides emergency visits the number of patient reduction in the OPD department of oncology was the least, which is very encouraging since any withdrawal of chemotherapy or radiotherapy in carcinomatous patients could mean a worsening stage of carcinogenesis and rapid deterioration and loss of human life. It could also be reflective of inability of primary care centers and primary care physicians to render medical services to sick oncological patients with active disease.^[5-7]

Another interesting finding in our study was the disparity in female attendance to the various OPDs. Gender bias in seeking health care by women has been reported even in the preCOVID era.^[1,8-11] This study documents a further reduction in health-care seeking behavior in women presenting to the out-patient department of the hospital during the pandemic which is of statistical significance. Although, the trend for reduced female attendance was seen in all the OPDs, the statistically significant reduction was seen in cardiology, emergency, endocrinology, ophthalmology, gastroenterology, medicine, neurosurgery, neurology, oncology, orthopedics, and psychiatry departments (P = 0.050, 0.011, 0.001, 0.001, 0.012, 0.000, 0.000, 0.004, 0.003, 0.000, 0.009, 0.006, 0.000, and 0.004, respectively).

As the mankind boggles in hands of nature and COVID pandemic peaks, waxes and wanes, the provision of healthcare to the needy is of utmost importance. Notwithstanding the fall in OPD attendance, serious attempts should be made to deliver healthcare to the recipient at their doorstep. Telemedicine can be of respite^[2,3,7] and it can be supported by an organized schemata from hospital administration bodies organizing smooth, hassle free, and less time-consuming visits to the hospitals.^[5,6] An improved OPD attendance could make not only the point of care health delivery to recipients but shall also foresee a major reduction in chronic ailments and psychological issues which could prove to be detrimental if permitted to accumulate.

CONCLUSION

OPD attendance has shown a significant reduction in COVID pandemic era especially in the non-emergent fields. Pre-existent gender divide in OPD presentation has increased all the more in the COVID pandemic era. It is imperative that measures such as telemedicine and organized protocols ensuring smooth, hassle free, and rapid OPD visits are encouraged. This could foresee a relatively healthy society with less chronic ailments and psychosocial issues.