Outpatient Health Service Utilization among Adults with Selected Chronic Diseases During the COVID-19 Pandemic in Germany - Results of the GEDA Studies Between 2019 and 2021

Background : Fear of SARS-CoV-2 infection and lockdown measures may have an impact on health care utilization particularly for people with chronic diseases. We investigated changes in outpatient utilization behavior in pandemic phases among people with selected chronic diseases in Germany. Methods : The nationwide telephone surveys GEDA 2019/2020-EHIS (April 2019 to September 2020) and GEDA 2021 (July to December 2021) covered 4 out of 7 pandemic phases from the pre-pandemic to the 4th pandemic wave. Data on hypertension, major cardiovascular diseases (CVD) and diabetes in the past 12 months and visiting a general practitioner (GP) or a specialist (excluding dentist) in the past 4 weeks was collected using a standardized questionnaire. Proportions and odds ratios were derived from logistic regression models adjusted for age, sex, education and federal state. Results : Among 27,967 participants aged ≥16 years, 8,449, 1,136 and 2,497 individuals had hypertension, major CVD and diabetes. Participants with these chronic diseases visited a GP or specialist significantly more often than the overall study population, irrespective of pandemic phases. Compared to the pre-pandemic phase, a significant reduction in specialist-visiting was found in the 1st pandemic wave among people with hypertension (34.3% vs. 24.1%), major CVD (41.9% vs. 25.6%) and diabetes (39.5% vs. 25.5%). GP-visiting was lower only among people with hypertension (53.0% vs. 46.0%). No difference in GP or specialist visiting was found in the 4th pandemic wave compared to the pre-pandemic phase. Conclusions : The observed decrease particularly in specialist utilization among people with the selected chronic diseases at the beginning of the pandemic was not observed for the second half of 2021 despite the ongoing pandemic. Further studies are required to examine whether the temporary changes in the utilization of ambulatory health care have affected the disease management of people with chronic diseases.