Fear of contacting GPs during Covid outbreak 'fuelling missed diagnoses'
Concerns around contacting GPs during the coronavirus outbreak could be fuelling a rise in missed or delayed diagnoses, researchers have said.
A growing body of research has suggested that patients have avoided seeking medical attention because of the pandemic. Figures have revealed a large increase in the numbers of people dying at home, while visits to A&E have been markedly reduced.
Meanwhile results from a poll by NHS England, released in April, revealed that 40% of people said they were avoiding contacting their GP because of concerns about burdening the NHS.
Now researchers say an analysis of GP records has revealed diagnoses of conditions from cardiovascular problems to mental health problems were up to 50% lower over the spring than expected.
While the study only covers Salford, the team say a similar situation could be occurring elsewhere, particularly in other areas of high deprivation.
“It is not unreasonable to assume this is also happening across the country,” said Richard Williams, first author of the research from the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre.
Writing in the Lancet, Williams and colleagues report how they analysed records from January 2010 onwards for more than 240,000 people in Salford to predict the diagnoses of common conditions expected between 1 March to 31 May. They then compared these predictions with the actual number of diagnoses recorded during this period.
The results reveal that while 2,147 diagnoses were expected for common mental health problems such as anxiety and depression, just 1,073 diagnoses were recorded.
Reductions were also seen in diagnoses of circulatory system diseases – such as coronary heart disease and stroke – and type 2 diabetes, with cases of the latter about half those expected.
While the pandemic has triggered a major shift to predominantly remote appointments, the team say it is unlikely their findings are down to GPs having problems diagnosing patients by phone or video, or forgetting to
record diagnoses, noting they also found a reduction in prescriptions of medications relating to these conditions, despite prescriptions being possible without a formal diagnosis.
Instead, the team say the reduction is probably down to patients avoiding seeking medical care.
“There are going to be people, especially in the early days [of the pandemic], who were just afraid, and not going to a healthcare setting for fear of catching coronavirus,” said Williams.
And while remote appointments have been welcomed by some, Williams added that for others it might have brought new challenges in accessing GP care – particularly in areas of high deprivation. .
While the team saw no clear signs of a reduction in cancer diagnoses during the spring, they say it is likely due to such patients being referred to specialists, who then make the diagnosis, meaning that there is a lag before a diagnosis is recorded in GP records.
The team warn there could be a surge in demand for healthcare, with delayed diagnoses meaning some patients could have severe illnesses by the time they approach the NHS.
Williams said it was important that it is made “crystal clear” that healthcare services are safe and that patients should engage with them as usual, despite local or nationwide coronavirus measures.
“If you have got patients who are undiagnosed and untreated, then the effect on their long-term health and mortality is obviously going to be significant,” he said.
Prof Martin Marshall, the chair of the Royal College of GPs, said the findings chime with data from the Royal College that showed a drop in demand for routine GP consultations at the height of lockdown.
However, he said demand for such appointments was back to near-normal levels, adding while many consultations are conducted remotely, faceto-face appointments are available.
“During a pandemic, other health conditions do not cease to exist, and we’ve seen from health crises in the past that there are sometimes more deaths from conditions unrelated to the pandemic than the virus causing the pandemic itself,” said Marshall.
“As GPs and our teams approach a likely second wave of Covid-19, we do not want to see this happen and we urge patients who have concerns about their health to seek medical assistance, particularly if they have signs that could indicate serious conditions, such as cancer.”