The COVID-19 Impact on Oral Healthcare Demand and Performance: The Experience of a Clinical and Academic Centre in Portugal (EU)
DOI:
https://doi.org/10.20344/amp.18280Keywords:
COVID-19, Dental Care, Health Services Accessibility, Pandemics, Portugal, SARS-CoV-2Abstract
Introduction: The SARS-CoV-2 pandemic has reshaped the global landscape as we know it and had a tremendous effect on healthcare systems around the world. However, its impact on oral healthcare is still to be fully assessed. The aim of this study was to understand if and how COVID-19 affected the demand and performance of oral healthcare, taking the Clinical and Academic Centre of Coimbra as an example, more specifically, the Department of Stomatology of the Coimbra Hospital and University Centre and the Dentistry Department of the Faculty of Medicine of the University of Coimbra.
Material and Methods: An observational study was designed for collecting the data of a series of key oral healthcare indicators: number of appointments; referrals from primary healthcare; missed appointments; number of surgeries performed in the operating room; number of biopsies; number of patients admitted through the emergency department and epidemiologic parameters over two 18-month periods between September 2018 and August 2021: pre-COVID-19 and during the COVID-19 pandemic, with the latter divided in four stages. A statistical analysis which included descriptive and inferential procedures was then performed, with an established significance level of 5% and the application of parametric tests, t-Student test for a sample and for independent samples and One-Way ANOVA for the variance analysis.
Results: There was a general decline in all indicators comparing the pre-COVID-19 with the COVID-19 period, with a reduction of 50.61% in the number of appointments, 44.06% in referrals, 24.41% in surgeries, 26.30% in biopsies and 32.33% in patients seen in the Emergency Room. The number of missed appointments also increased by 181.82%. All variations revealed statistically significant differences (p < 0.05). The individual COVID-19 stage analysis, when compared with the pre-COVID-19 reference, and variance analysis of these different stages also showed statistically significant differences (p < 0.05 and p < 0.001), except for the number of biopsies during the third and fourth stages.
Conclusion: The results of this study suggest that the SARS-CoV-2 pandemic has had a considerable impact on oral healthcare demand and performance. However, results also show a remarkable adjustment and improvement in the provided care, with a positive evolution throughout the COVID-19 period.
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References
Portugal. Decree-Law nr. 353/2015. Official Gazette, I Series, nr. 200 (2015/10/13). p. 8909-11.
M8 Alliance Members. World Health Summit. [cited 2022 Jan 24]. Available from: https://www.worldhealthsummit.org/m8-alliance/members.html.
Portugal. Dispatch nr. 3653/2016. Official Gazette, II Série, nr. 50 (2016/03/11). p.8724.
Portugal. Dispatch nr. 6669/2017. Official Gazette, II Série, nr. 148 (2017/08/02). p. 16069–70.
Portugal. Decree-Law nr. 147/2016. Official Gazette, I Series, nr. 97(2016/05/19) . p.1616–9.
Malheiro R, Maia G, Moreira C, Tavares F, Machado Amador A, Carvalho F, et al. Redes de Referenciação Hospitalar - Estomatologia (Hospital Referral Network - Stomatology). Lisbon: Office of the Minister of Health; 2017.
Sharma A, Ahmad Farouk I, Lal SK. COVID-19: A review on the novel coronavirus disease evolution, transmission, detection, control and prevention. Viruses. 2021;13:202. DOI: https://doi.org/10.3390/v13020202
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727–33. DOI: https://doi.org/10.1056/NEJMoa2001017
Bestetti RB, Furlan-Daniel R, Silva VM. Pharmacological treatment of patients with mild to moderate COVID-19: a comprehensive review. Int J Environ Res Public Health. 2021;18:7212. DOI: https://doi.org/10.3390/ijerph18137212
Zeng B, Gao L, Zhou Q, Yu K, Sun F. Effectiveness of COVID-19 vaccines against SARS-CoV-2 variants of concern: a systematic review and metaanalysis. BMC Med. 2022;20:200. DOI: https://doi.org/10.1186/s12916-022-02397-y
World Health Organization. Timeline - COVID-19. [cited 2022 Jan 24]. Available from: https://www.who.int/news/item/27-04-2020-who-timeline---covid-19.
Fusco A, Dicuonzo G, Dell’atti V, Tatullo M. Blockchain in healthcare: insights on COVID-19. Int J Environ Res Public Health. 2020;17:1–12. DOI: https://doi.org/10.3390/ijerph17197167
AJMC Staff. A timeline of COVID-19 developments in 2020. [cited 2022 Jan 24] Available from: https://www.ajmc.com/view/a-timeline-of-covid19-developments-in-2020.
World Health Organization. Coronavirus (COVID-19) Dashboard. [cited 2022 Jan 24]. Available from: https://covid19.who.int/.
Ritchie H, Mathieu E, Rodés-Guirao L, Appel C, Giattino C, Ortiz-Ospina E, et al. Coronavirus pandemic (COVID-19). OurWorldInData.org 2020. [cited 2022 Jan 24]. Available from: https://ourworldindata.org/coronavirus.
Portugal. Decree-Law nr. 14-A/2020. Official Gazette, I Series, nr. 55 (2020/03/18). p. 2–4.
Portugal. Decree-Law nr. 8/2020. Official Gazette, I Series, nr. 217-A (2020/11/08). p. 2–8.
Machado B, Antunes L, Caetano C, Pereira JF, Nunes B, Patrício P, et al. The impact of vaccination on the evolution of COVID-19 in Portugal. Math Biosci Eng. 2022;19:936–52. DOI: https://doi.org/10.3934/mbe.2022043
Portugal. Dispatch nr. 3301-A/2020. Official Gazette, II Series, nr. 52-B (2020/03/15).
Portuguese Medical Association and Association of the Portuguese Stomatologysts. Plano de contingência para ajustamento urgente da atividade clínica dos Serviços e Clínicas ou Consultórios de Estomatologia (Contingency plan for urgent adjustment of clinical activity of Services, Clinics or Stomatology Offices). Lisbon: OM; 2020.
Portuguese Medical Association and Association of the Portuguese Stomatologysts. Recomendações Para a Retoma da Atividade Clínica em Estomatologia no Contexto da Pandemia COVID-19 (Recommendations for the Resumption of Clinical Activity in Stomatology in the Context of the COVID-19 Pandemic). Lisbon: OM; 2020.
Directorate-General of Health. Guideline No. 022 of the 1st of May, 2020.COVID-19: procedimentos em clínicas, consultórios ou serviços de Saúde Oral dos cuidados de saúde primários, setor social e privado (Procedures in clinics, offices or Oral Health). Lisbon: DGS; 2020.
COVID-19 Task-Force. Plano de vacinação contra a COVID-19 (COVID-19 vaccination plan). Lisboa: XXII Government of the Portuguese Republic; 2020.
Kaye AD, Okeagu CN, Pham AD, Silva RA, Hurley JJ, Arron BL, et al. Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives. Best Pract Res Clin Anaesthesiol. 2021;35:293–306. DOI: https://doi.org/10.1016/j.bpa.2020.11.009
Muller AE, Hafstad EV, Himmels JP, Smedslund G, Flottorp S, Stensland SO, et al. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: a rapid systematic review. Psychiatry Res. 2020;293:113441. DOI: https://doi.org/10.1016/j.psychres.2020.113441
Hall H. The effect of the COVID-19 pandemic on healthcare workers’ mental health. JAAPA.2020;33:45-8. DOI: https://doi.org/10.1097/01.JAA.0000669772.78848.8c
Moynihan R, Sanders S, Michaleff ZA, Scott AM, Clark J, Emma J, et al. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ. 2021;11:e045343. DOI: https://doi.org/10.1136/bmjopen-2020-045343
Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, et al. Impact of COVID-19 on routine care for chronic diseases: a global survey of views from healthcare professionals. Diabetes Metab Syndr. 2020;14:965–67. DOI: https://doi.org/10.1016/j.dsx.2020.06.042
Sutherland K, Chessman J, Zhao J, Sara G, Shetty A, Smith S, et al. Impact of COVID-19 on healthcare activity in NSW, Australia. Public Heal Res Pract. 2020;30:1–9. DOI: https://doi.org/10.17061/phrp3042030
Aguiar A, Pinto M, Alves F, Barbosa P, Monteiro H, Bigotte J, et al. A roadmap for lifting restrictive measures for COVID-19. Int J Tuberc Lung Dis. 2021;25:687-90. DOI: https://doi.org/10.5588/ijtld.21.0248
Duggal M, Dahiya N, Kankaria A, Chaudhary M, Bachani D. Restructuring the healthcare system to protect healthcare personnel amidst the COVID-19 pandemic. Front Public Health. 2020;8:588203. DOI: https://doi.org/10.3389/fpubh.2020.588203
Guo H, Zhou Y, Liu X, Tan J. The impact of the COVID-19 epidemic on the utilization of emergency dental services. J Dent Sci. 2020;15:564-67. DOI: https://doi.org/10.1016/j.jds.2020.02.002
Araf Y, Akter F, Tang YD, Fatemi R, Parvez SA, Zheng C, et al. Omicron variant of SARS-CoV-2: Genomics, transmissibility, and responses to current COVID-19 vaccines. J Med Virol. 2022;94:1825-32. DOI: https://doi.org/10.1002/jmv.27588
Mistry P, Barmania F, Mellet J, Peta K, Strydom A, Viljoen IM, et al. SARS-CoV-2 variants, vaccines, and host immunity. Front Immunol. 2022;12:809244. DOI: https://doi.org/10.3389/fimmu.2021.809244
Phan T, Boes S, McCullough M, Gribschaw J, Marsh JW, Harrison LH, et al. First detection of SARS-CoV-2 Omicron BA.4 variant in Western Pennsylvania, United States. J Med Virol. 2022;94:4053-5. DOI: https://doi.org/10.1002/jmv.27846
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