Changes in Reasons for Visits to Primary Care as a Result of the COVID-19 Pandemic: by INTRePID

Context: The COVID-19 pandemic has resulted in changes in healthcare delivery in many countries around the world.

Objective: To examine the impact of the pandemic on reasons for visits to primary care through the International Consortium of Primary Care Big Data Researchers (INTRePID).

Study Design and Analysis: Cross-sectional retrospective analysis of visit volume, modality and reason for visit from 2018-2021.

Setting: Patients seen in primary care settings in Argentina, Australia, Canada, China, Peru, Norway, Singapore, Sweden and USA.

Outcome Measures: Monthly visit volume, rates of virtual vs in-person visits for the top 10 reasons for visits to primary care and for common conditions.

Results: There were over 215 million visits to primary care in INTRePID countries during the study period. The average monthly visit volume decreased in the first year of the pandemic for INTRePID countries (-20.4% to -43.5%, p=.03 to <.001) except for in Norway, Canada and Sweden (.3%, -.8% and - 9.7%, p=.68, .84, .11 respectively) and increased in Australia (+19%, p=0.013). While Argentina, China and Singapore had little to no virtual care, in the other INTRePID countries the average monthly virtual visit rate ranged from a low in Peru (7.3% first year, 5.2 % second year of the pandemic) to a high in Canada (75.8% first year, 62.5% second year of the pandemic). For anxiety/depression the average monthly visit volume in the first year of the pandemic was higher than pre-pandemic in Australia, Canada, Peru and Singapore (18.9% to 42.2%, p=.004 to <.001). Average monthly visit volume for coughs and colds dropped for all countries in the first year of the pandemic (-47.0% to -86.5%, p=.92 to <.001).

Conclusions: While visits to primary care generally declined, the rapid introduction of virtual visits mitigated much of the visit volume disruption in many countries. The pandemic resulted in changes in how primary care is delivered and some changes in what is seen in primary care. It appears that virtual care is likely to be part of a new normal in primary care delivery in many countries.