Seeking Healthcare During Lockdown: Challenges, Opportunities and Lessons for the Future

Document Type : Original Article

Authors

1 Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand

2 Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand

3 School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington, New Zealand

Abstract

Background 
In Aotearoa/New Zealand, the first nation-wide coronavirus disease 2019 (COVID-19) lockdown occurred from March 23, 2020 to May 13, 2020, requiring most people to stay at home. Health services had to suddenly change how they delivered healthcare and some services were limited or postponed. This study investigated access to healthcare during this lockdown period, whether patients delayed seeking healthcare and reasons for these delays, focusing on the accessibility of primary care services.
 
Methods 
Adults (aged 18 years or older) who had contact with primary care services were invited through social media and email lists to participate in an online survey (n = 1010) and 38 people were recruited for in-depth interviews. We thematically analysed qualitative data from the survey and interviews, reported alongside relevant descriptive survey results.
 
Results 
More than half (55%) of survey respondents delayed seeking healthcare during lockdown. Factors at a national or health system-level that could influence delay were changing public service messages, an excessive focus on COVID-19 and urgent issues, and poor service integration. Influential factors at a primary care-level were communication and outreach, use of technology, gatekeeping, staff manner and the safety of the clinical practice environment. Factors that influenced patients’ individual decisions to seek healthcare were the ability to self-manage and self-triage, consciousness of perceived pressure on health services and fear of infection.
 
Conclusion
In future pandemic lockdowns or crises, appropriate access to primary care services can be improved by unambiguous national messages and better integration of services. Primary care practices should adopt rapid proactive outreach to patients, fostering a calm but safe clinical practice environment. More support for patients to self-manage and self-triage appropriately could benefit over-burdened health systems during lockdowns and as part of business as usual in less extraordinary times.

Keywords

Main Subjects


  1. Worldometers.info. Worldometer: COVID-19 Coronavirus Pandemic, https://www.worldometers.info/coronavirus/. Accessed September 30, 2020. Published 2020.
  2. Modesti PA, Wang J, Damasceno A, et al. Indirect implications of COVID-19 prevention strategies on non-communicable diseases. BMC Med. 2020;18(1):256. doi:10.1186/s12916-020-01723-6
  3. New Zealand Government. Alert system overview. https://covid19.govt.nz/alert-system/alert-system-overview/.  Accessed September 25, 2020. Published 2020.
  4. Leclerc QJ, Fuller NM, Knight LE, Funk S, Knight GM. What settings have been linked to SARS-CoV-2 transmission clusters? Wellcome Open Res. 2020;5:83. doi:10.12688/wellcomeopenres.15889.2
  5. Mazey S, Richardson J. Lesson-drawing from New Zealand and Covid-19: the need for anticipatory policy making. Polit Q. 2020. doi:10.1111/1467-923x.12893
  6. Baddock K. COVID-19-the frontline (a GP perspective). N Z Med J. 2020;133(1513):8-10.
  7. Hall K. Doctors Desperate to Get Message Across That Kiwis Needing Medical Help Can Still Be Treated. tvnz.co.nz website. https://www.tvnz.co.nz/one-news/new-zealand/doctors-desperate-get-message-across-kiwis-needing-medical-help-can-still-treated-v1. Published April 12 2020.
  8. Christey G, Amey J, Campbell A, Smith A. Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand. N Z Med J. 2020;133(1513):81-88.
  9. Huston P, Campbell J, Russell G, et al. COVID-19 and primary care in six countries. BJGP Open. 2020;4(4):bjgpopen20X101128. doi:10.3399/bjgpopen20X101128
  10. Spencer J, Oung C. How Has Lockdown Affected General Practice and Where Do We Go from Here? Nuffield Trust; 2020.
  11. Helsper CW, Campbell C, Emery J, et al. Cancer has not gone away: a primary care perspective to support a balanced approach for timely cancer diagnosis during COVID-19. Eur J Cancer Care (Engl). 2020;29(5):e13290. doi:10.1111/ecc.13290
  12. Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 2020;4(5):e10-e11. doi:10.1016/s2352-4642(20)30108-5
  13. Lange SJ, Ritchey MD, Goodman AB, et al. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions - United States, January-May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):795-800. doi:10.15585/mmwr.mm6925e2
  14. Goodyear-Smith F, Ashton T. New Zealand health system: universalism struggles with persisting inequities. Lancet. 2019;394(10196):432-442. doi:10.1016/s0140-6736(19)31238-3
  15. Reid J, Cormack D, Crowe M. The significance of socially-assigned ethnicity for self-identified Māori accessing and engaging with primary healthcare in New Zealand. Health (London). 2016;20(2):143-160. doi:10.1177/1363459315568918
  16. Lockett H, Lai J, Tuason C, Jury A, Fergusson D. Primary healthcare utilisation among adults with mood and anxiety disorders: an analysis of the New Zealand Health Survey. J Prim Health Care. 2018;10(1):68-75. doi:10.1071/hc17077
  17. Millar E, Stanley J, Gurney J, et al. Effect of multimorbidity on health service utilisation and health care experiences. J Prim Health Care. 2018;10(1):44-53. doi:10.1071/hc17074
  18. Jatrana S, Crampton P. Do financial barriers to access to primary health care increase the risk of poor health? longitudinal evidence from New Zealand. Soc Sci Med. 2020:113255. doi:10.1016/j.socscimed.2020.113255
  19. Dunlop C, Howe A, Li D, Allen LN. The coronavirus outbreak: the central role of primary care in emergency preparedness and response. BJGP Open. 2020;4(1). doi:10.3399/bjgpopen20X101041
  20. Imlach F, McKinlay E, Middleton L, et al. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Fam Pract. 2020;21(1):269. doi:10.1186/s12875-020-01336-1
  21. Imlach F, McKinlay E, Middleton L, et al. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Fam Pract. 2020;21(1):269. doi:10.1186/s12875-020-01336-1
  22. Cumming J, McDonald J, Barr C, et al. New Zealand: Health System Review. World Health Organization; 2014.
  23. Ministry of Health. Annual Update of Key Results 2018/19: New Zealand Health Survey. https://www.health.govt.nz/publication/annual-update-key-results-2018-19-new-zealand-health-survey.  Accessed September 1, 2020. Published 2019.
  24. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. doi:10.1186/1475-9276-12-18
  25. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa
  26. Ministry of Health. New Zealand ePrescription Service. https://www.health.govt.nz/our-work/digital-health/other-digital-health-initiatives/emedicines/new-zealand-eprescription-service.  Accessed September 16, 2020. Published 2020.
  27. Ludeke M, Puni R, Cook L, Pasene M, Abel G, Sopoaga F. Access to general practice for Pacific peoples: a place for cultural competency. J Prim Health Care. 2012;4(2):123-130. doi:10.1071/hc12123
  28. Arber S, Sawyer L. The role of the receptionist in general practice: a 'dragon behind the desk'? Soc Sci Med. 1985;20(9):911-921. doi:10.1016/0277-9536(85)90347-8
  29. Richards T, Scowcroft H. Patient and public involvement in COVID-19 policy making. BMJ. 2020;370:m2575. doi:10.1136/bmj.m2575
  30. Stokes T, Atmore C, Penno E, et al. Protocol for a mixed methods realist evaluation of regional District Health Board groupings in New Zealand. BMJ Open. 2019;9(3):e030076. doi:10.1136/bmjopen-2019-030076
  31. Wilson N, Mizdrak A, Summers J, Baker M. Weekly Deaths Declined in NZ’s Lockdown – But We Still Don’t Know Exactly Why. Wellington: University of Otago; 2020.
  32. Hanna TP, Evans GA, Booth CM. Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic. Nat Rev Clin Oncol. 2020;17(5):268-270. doi:10.1038/s41571-020-0362-6
  33. Usher K, Durkin J, Bhullar N. The COVID-19 pandemic and mental health impacts. Int J Ment Health Nurs. 2020;29(3):315-318. doi:10.1111/inm.12726
  34. Walker C, Gerada C. Extraordinary Times: Coping Psychologically Through the Impact of COVID-19. BMJ Opinion; 2020.
  35. Hollander JE, Carr BG. Virtually perfect? telemedicine for COVID-19. N Engl J Med. 2020;382(18):1679-1681. doi:10.1056/NEJMp2003539
  36. Wyatt JC. Fifty million people use computerised self triage. BMJ. 2015;351:h3727. doi:10.1136/bmj.h3727
Volume 11, Issue 8
August 2022
Pages 1316-1324
  • Receive Date: 16 December 2020
  • Revise Date: 09 March 2021
  • Accept Date: 13 March 2021
  • First Publish Date: 13 April 2021