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• Altered healthcare-seeking behaviours during the COVID-19 pandemic and moving forward
  Anmol B Patel
  Published on: 19 December 2021

• Published on: 19 December 2021

  Altered healthcare-seeking behaviours during the COVID-19 pandemic and moving forward

  • Anmol B Patel, Junior Doctor Dartford and Gravesham NHS Trust

  Dear Editor,
  The impact of the COVID-19 pandemic on the NHS and its patients is indisputably far reaching, and this study [1] provides a much-needed perspective into how healthcare seeking behaviours were influenced during this time. The Emergency Department Syndromic Survey System (EDISS) data showed Emergency departments (ED) across the country showed a 25-50% decrease in attendances [2], raising concerns that individuals with possibly, life-threatening illnesses were potentially avoiding hospitals rather than seeking medical attention in a timely manner [2]. By looking into how the general population evaluated the severity, urgency and impact of various eye symptoms [1], the authors provide us with a better understanding of the driving forces and barriers to seeking healthcare, by doing which, they shed light on areas for which nationwide public health messages might not be sufficiently educating people on the importance of accessing healthcare appropriately for conditions that can be life-threatening, or in this case sight-threatening.
  The WHO declared the SARS-CoV-2 infection a pandemic on 11th March 2020 [3]. Subsequently, the UK Government imposed a national lockdown on 23rd March 2020 [4], with the aim of reducing pressures on the NHS and curbing infection rates. “Vulnerable” individuals were advised to “shield” [5]. The NHS saw a transition from face-to-face consultations to increasingly more virtual consultations [6], with many elective procedures bei...

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  Dear Editor,
  The impact of the COVID-19 pandemic on the NHS and its patients is indisputably far reaching, and this study [1] provides a much-needed perspective into how healthcare seeking behaviours were influenced during this time. The Emergency Department Syndromic Survey System (EDISS) data showed Emergency departments (ED) across the country showed a 25-50% decrease in attendances [2], raising concerns that individuals with possibly, life-threatening illnesses were potentially avoiding hospitals rather than seeking medical attention in a timely manner [2]. By looking into how the general population evaluated the severity, urgency and impact of various eye symptoms [1], the authors provide us with a better understanding of the driving forces and barriers to seeking healthcare, by doing which, they shed light on areas for which nationwide public health messages might not be sufficiently educating people on the importance of accessing healthcare appropriately for conditions that can be life-threatening, or in this case sight-threatening.
  The WHO declared the SARS-CoV-2 infection a pandemic on 11th March 2020 [3]. Subsequently, the UK Government imposed a national lockdown on 23rd March 2020 [4], with the aim of reducing pressures on the NHS and curbing infection rates. “Vulnerable” individuals were advised to “shield” [5]. The NHS saw a transition from face-to-face consultations to increasingly more virtual consultations [6], with many elective procedures being cancelled during this time [7].
  With these structural and logistical changes, came changes to healthcare-seeking behaviours of the British population. With the reduction in ED attendances [2] comes the major risk of harm to patients who perceive COVID-19 as a barrier to seeking help. As described by the authors [1], the Rosenstock health belief model [8] outlines factors that influence an individual’s decision to seek medical help, of which COVID-19 and the lockdown presents as a barrier to the patient seeking medical attention in times when they think they require it. A study from an Emergency Eye Department (EED) at a tertiary eye centre in Leicester found a shocking 53% reduction in attendances during the 1st lockdown in March 2020 [9]. Furthermore, they noted a higher proportion of macula-off retinal detachment, a late sign of retinal tears, suggesting they may have resulted from possible delayed presentations to the emergency department. They observed a 60% reduction in the number of retinal tear cases presenting to ED [9], of which some could have progressed to retinal detachment.
  The change in healthcare seeking behaviours attributed to COVID-19 is likely multifactorial, including perceived risk of contracting COVID-19 infection in higher risk environments such as hospitals, challenges associated with travel arrangements to point of care, reduced support from friends and family to aid appropriate contact with healthcare services. This is an area that requires further study to better understand the individual factors impacting decision-making in this context.
  Somewhat independent of COVID-19, this survey identifies the need for individuals to be able to assess severity of their symptoms and seek help accordingly [1]. It has been previously identified that knowledge of eye disease is lacking amongst the general population [10]. This results in a significant barrier to accessing healthcare and can skew the risk assessment undertaken by individuals when deciding on how to act based on their symptoms. In a way, COVID-19 has shown a clear need for more effective communication of public eye health messages prompting people to access services when required with appropriate urgency. Moreover, the survey indicated that non-white individuals reported a reduced perception of severity and urgency of medical attention [1], suggesting an inadequacy in the way our healthcare messages are communicated to all groups of society.
  Despite there being a larger emphasis for vulnerable individuals and those above the age of 70 to shield during the pandemic [5], the Leicester EED did not find any significant differences in the average age of patients pre-COVID-19 and during the pandemic. The survey noted that people of greater age were more likely to consider symptoms to be of greater seriousness [1], which may offset the perceived risk of COVID -19 infections. However, more data would be required to understand this relationship better.
  COVID-19 has elucidated the need for a better understanding of healthcare seeking behaviours, not only during a pandemic, but also as we return to a more “normal” state of affairs, and this study provides a much-needed glimpse into factors affecting patients’ decision-making and ways in which they can be empowered to access healthcare as we continue to tackle the pandemic, and beyond.

  References:
  1. Butt GF, Hodson J, Wallace GR, et al. Public perceptions of eye symptoms and hospital services during the first UK lockdown of the COVID-19 pandemic: a web survey study. BMJ Open Ophthalmology 2021;6:e000854. doi: 10.1136/bmjophth-2021-000854
  2. Thornton, J . Covid-19: A&E visits in England fall by 25% in week after lockdown. BMJ 2020; 369: m1401
  3. WHO . Rolling updates on coronavirus disease (COVID-19), https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-a... (Accessed 19 Dec 2021)
  4. UK Government . Number of coronavirus (COVID-19) cases and risk in the UK, https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public (Accessed 19 Dec 2021)
  5. UK Government . Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19, https://www.gov.uk/government/publications/guidance-on-shielding-and-pro... (Accessed 19 Dec 2021)
  6. Gilbert AW, Billany JCT, Adam R, et al. Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative. BMJ Open Quality 2020;9:e000985. doi: 10.1136/bmjoq-2020-000985
  7. Dunn P, Allen L, Cameron G, Alderwick H. COVID-19 policy tracker. Available from: https://www.health.org.uk/news-and-comment/charts-and-infographics/covid.... (Accessed 19 Dec 2021)
  8. Rosenstock, I.M., 2000. Health Belief Model.
  9. Poyser A, Deol SS, Osman L, et al. Impact of COVID-19 pandemic and lockdown on eye emergencies. European Journal of Ophthalmology. 2021;31(6):2894-2900
  10. Irving EL, Sivak AM, Spafford MM. “I can see fine”: patient knowledge of eye care. Ophthalmic Physiol Opt 2014;34:38-45.

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  Conflict of Interest:
  None declared.

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