Diagnoses of common conditions in general practice fell during lockdown – study

There was a significant reduction in the diagnosis of many common physical and mental health conditions in parts of the UK during the coronavirus lockdown, research suggests.

Electronic health records of approximately a quarter of a million people in Salford, Greater Manchester, were analysed to identify the impact of Covid-19 on general practice (primary care) by a patient safety research centre between March 1 and May 31.

Researchers found the biggest reductions were for mental health conditions and type 2 diabetes, as there were half the expected number of diagnoses.

For malignant cancer, the reduction was 16% for the time period analysed, but for the month of May there was a drop of 44%.

For circulatory system diseases such as stroke, heart failure and coronary heart disease, the study found a reduction in diagnoses of 43%.

The research, published in The Lancet Public Health, was conducted by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC).

The study used 10 years’ worth of data to create statistical models to give predicted levels of new diagnoses for the health conditions identified in general practice to be routine.

Study lead Richard Williams, from the University of Manchester, said: “We were aware that GP practices have been reporting a drop in the number of patients seeking medical help since the start of the Covid-19 pandemic.

“Thanks to electronic health records, it is possible to investigate whether this is true across a large urban area like Salford.

“Importantly, our research has revealed which conditions people are not seeking medical attention for.

“This means that, potentially, there are high numbers of people living with undiagnosed type 2 diabetes, mental health conditions and circulatory system failure.”

The authors used routinely collected primary care data that was recorded in the Salford Integrated Record system between January 1 2010 and May 31 2020.

They extracted data on symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures.

They then used computer modelling with data of monthly counts of first diagnoses of common conditions, and corresponding first prescriptions of medications indicative of these conditions.

These models were used to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31.

This information was compared with the observed numbers for the same time period.

The researchers say the gap between observed and expected cancer diagnoses (194 expected versus 163 observed) during this time period was not statistically significant, but they suggest this could be due to a delay in cancer diagnosis data being recorded in primary care after diagnosis in hospital.

They said: “The lower reduction in cancer diagnoses observed compared with the other diseases assessed could be partially explained by this time lag.

“This hypothesis is supported by the data for May, during which we observed a 44% reduction in cancer diagnoses – 38 observed versus 68 expected – which was statistically significant.”

Dr Owain Thomas, GP at a practice in Salford, said: “The conclusions of this research are a vital part in our understanding of the overall impact of Covid-19, the conditions we have looked at are usually many months or years in the making, so the reduction in new diagnoses does not represent a reduction in the burden of these diseases, more the fact that they have not yet been formally recognised.

“This will have an impact individually on those patients – the longer a patient goes undiagnosed, the more complications they are likely to suffer.

“As we move forwards, careful thought will be needed to plan services to find and support those patients who have not yet been diagnosed.”

The findings were presented at the European Society of Clinical Microbiology and Infectious Diseases Conference on Coronavirus Disease (ECCVID).