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Impact of COVID-19 infection on social care use in people over 50 years of age: a matched cohort study in North-West London

Por: Butfield · R. · Bray · B. · Quint · J. K. · Castanon · A. · Adesanya · E. · Chen · S. · Russell · R.
Objectives

To estimate the impact of COVID-19 infection on the requirement for social care services among adults aged ≥50 years in North-West London.

Design

Population-based matched cohort study using linked routinely collected electronic social care, primary care and hospital records (the Discover dataset).

Setting

Approximately 4.7 million people with a general practitioner record in North-West London.

Participants

150 654 adults aged ≥50 years with a first diagnosis of COVID-19 between January 2020 and February 2023 and 547 704 propensity score matched comparators without a COVID-19 diagnosis during the same period.

Main outcome measures

Social care use and associated costs overall and by specific type (care home, domiciliary care, respite care, social care assessments) stratified by age group, index year, diagnosis setting, severe COVID-19 risk status, frailty and care home admission prior to index. Overall survival was also assessed.

Results

A total of 9174 (6.09%) individuals with COVID-19 required social care use (of any type) during follow-up, 2.54 times (95% CI 2.48 to 2.61; p

This increase in social care utilisation was observed for all age groups. Adults with COVID-19 had over four times higher social care costs than matched comparators (£1276 per person per year (pppy) vs £276 pppy; mean difference +£1000, 95% CI £947 to £1054, p

Conclusions

COVID-19 infection is associated with meaningfully higher social care requirements in the ≥50 years population. Reducing the need for social care use and the associated costs of care should be one of the goals of interventions to reduce the risk and severity of COVID-19 infection.

Impact of a community-based asynchronous review clinic on appointment attendance delays across an eye hospital network in London, UK: an interrupted time series analysis

Por: Ndwandwe · S. · Fu · D. J. · Adesanya · J. · Bazo-Alvarez · J. C. · Ramsay · A. I. G. · Fulop · N. J. · Magnusson · J. · Napier · S. · Cammack · J. · Baker · H. · Kumpunen · S. · Alarcon Garavito · G. A. · Elphinstone · H. · Mills · G. · Scully · P. · Symons · A. · Webster · P. · Wilson
Objective

To assess the impact of opening a large community-based asynchronous review ophthalmic clinic on attendance delays among patients with stable chronic eye disease attending a London teaching eye hospital network.

Design

Interrupted time-series analysis of routine electronic health records of appointment attendances.

Setting

A large eye hospital network with facilities across London, UK, between June 2018 and April 2023.

Participants

We analysed 69 257 attendances from 39 357 patients, with glaucoma and medical retina accounting for 62% (n=42 982) and 38% (n=26 275) of visits, respectively. Patients over 65 made up 54% (n=37 824) of attendances, while 53% (n=37 014) were from the more deprived half of the population, and 51% (n=35 048) were males.

Intervention

An asynchronous review clinic opened in a shopping centre in London, in autumn 2021, following the COVID-19 lockdown in spring 2020.

Main outcome measures

Average attendance delays (days), calculated as the difference between follow-up attendance date and the latest clinically appropriate date determined at the preceding attendance.

Results

Pre-COVID-19, attendance delays for chronic eye disease monitoring were increasing by 0.9 days per week (95% CI, 0.8 to 0.9) on average, worsening to 2.0 days per week (95% CI, 2.0 to 2.0) after the first COVID-19 national lockdown, mid-March 2020. Opening the asynchronous review clinic increased appointment capacity, with delays decreasing on average by 8.1 days per week (95% CI, 8.1 to 8.2) shortly after opening. The rate of decrease slowed to 0.3 days per week (95% CI, 0.3 to 0.3) after 5 months. We found no significant differences in average attendance delays by age, gender or level of deprivation.

Conclusion

The asynchronous review clinic significantly reduced attendance delays across the hospital network, addressing pre-existing backlog for stable chronic eye diseases. The reduction appeared to be maintained after the initial backlog had been cleared.

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