Outcomes of Delay of Care After the Onset of COVID-19 for Patients Managing Multiple Chronic Conditions

Abstract

Purpose: Many patients delayed health care during COVID-19. We assessed the extent to which patients managing multiple chronic conditions (MCC) delayed care in the first months of the pandemic, reasons for delay, and impact of delay on patient-reported physical and behavioral health (BH) outcomes.

Methods: As part of a large clinical trial conducted April 2016-June, 2021, primary care patients managing MCC were surveyed about physical and behavioral symptoms and functioning. Surveys administered between September 3, 2020, and March 16, 2021, included questions about the extent of and reasons for any delayed medical and BH care since COVID-19. Multivariable linear regression was used to assess health outcomes as a function of delay of care status.

Results: Among patients who delayed medical care, 58% delayed more than once. Among those who delayed behavioral health care, 63% delayed more than once. Participants who delayed multiple times tended to be younger, female, unmarried, and reported food, financial, and housing insecurities and worse health. The primary reasons for delaying care were lack of availability of in-person visits and perceived lack of urgency. Participants who delayed care multiple times had significantly worse outcomes on nearly every measure of physical and mental health, compared with participants who delayed care once or did not delay.

Conclusions: Delay of care was substantial. Patients who delayed care multiple times were in poorer health and thus in need of more care. Effective strategies for reengaging patients in deferred care should be identified and implemented on multiple levels.

Trial registration: ClinicalTrials.gov NCT02868983. Registered on August 16, 2016.

Keywords: COVID-19; Data Analysis; Health Services Accessibility; Linear Models; Mental Health; Multiple Chronic Conditions; Outcome Assessment; Pandemics; Patient Reported Outcome Measures; Primary Health Care.

Conflict of interest statement

Conflict of interest: None of the authors have any commercial associations that pose, or have the appearance of posing, a conflict of interest in connection with the submitted article, including but not limited to employment, consultancies, stock ownership or other equity interests, patent-licensing arrangements, honoraria, paid expert testimony, personal relationships, academic competition, and intellectual passion.

© Copyright by the American Board of Family Medicine.