Chester County Medicine Spring 2021 - 14

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Back on the Path
to Good Health
BY JANET SOEFFING JACAPRARO, MD

R

outine annual physicals and lab screenings
facilitate timely diagnosis and management
of chronic conditions. Early detection of
cancer allows for a broader array of treatment options
and results in better prognoses. Vaccinations prevent
outbreaks of potentially deadly infectious diseases.
These three preventive interventions, among others,
keep us and our loved ones healthy. The value of
preventive health care is well-recognized:
* Insurers cover annual physicals, chronic disease
and cancer screenings, and vaccinations.
* Providers are compensated, in part, based
on the degree to which their patient panels
demonstrate that preventive health metrics have
been achieved.
* Public health officials trend population data each decade
and set national objectives to improve the health of Americans
over the next 10 years, largely through recommendations for
preventive health measures at individual and population levels.
Nationwide and since the start of the COVID-19 pandemic,
however, preventive health care has necessarily been deprioritized
as healthcare systems have strained to manage the care of millions
of patients with COVID-19-related illness.

How has the COVID-19 pandemic
affected preventive care services?
On the patient side, many have delayed or avoided care
in order to comply with stay-at-home orders, to follow social
distancing recommendations, and due to fear of contracting
disease at a medical facility. Some have been unable to afford
out-of-pocket costs of care in the setting of reduced income,
unemployment, and loss of insurance related to the pandemicdriven economic downturn.
On the provider side, the number of in-person ambulatory
visits have been limited by the need to stagger patients and protect
supplies of PPE. Sick visits have been managed primarily via
telemedicine to protect staff and other patients. In some cases,

14 CHESTER COUNT Y Medicine | SPRING 2021

practice loss of revenue has resulted in reduced
staff and outpatient office closures. Hospital-based
elective procedures and non-emergent services
have been canceled in order to manage the surge in
hospitalizations for persons infected with COVID-19.
Based on June and August 2020 polling,
approximately 41% of adults reported avoiding
medical care - both emergency visits and routine
care - because of concerns about COVID-19
transmission, and 40% reported they were unable
to access medical care when they wanted it. Greater
gaps in care have been noted in states harder hit by
COVID-19 and in areas with extended shutdowns.
Populations that appear to be at particular risk include
unpaid caregivers, persons with underlying and complex medical
conditions, Black and Hispanic adults, young adults, persons with
disabilities, and persons who rely on public transportation. Men
may also be disproportionately affected, as they generally seek
preventive care services at half the rate of women to begin with.
General primary care visits, during which providers screen for
and manage cardiac disease and risk factors, diabetes, substance
use disorders, and mental health conditions, declined by nearly
60% early in the pandemic. These missed visits translated into an
estimated 30% fewer annual exams, 40% fewer diabetes glucose
screenings, 42% fewer cholesterol screenings, and 51% fewer
vaccinations.
Equally concerning has been the reduction in preventive cancer
screenings by approximately 86%; in particular, screenings for
breast and colorectal cancer, which together account for one sixth
of all US cancer deaths, are down. Cervical and prostate cancer
screenings have likewise dropped.

How have reduced preventive care
services impacted our nation's health?
About 27% of patients polled report that postponed or missed
care worsened an undiagnosed or chronic medical condition,
most frequently musculoskeletal injuries, vision problems, kidney
disease, and mental health problems. There has been a steep drop
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Chester County Medicine Spring 2021

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