] The participants included general practitioners (GP), nurse practitioners (NP), practice nurses (N) and practice managers (P), with a small number of dual-role practice managers and nurses (PMN).
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This paper is part of the previously described General Practice Pandemic Experience New Zealand (GPPENZ) study, which followed the same group of primary care healthcare team members through a series of five online surveys over a 16-week period from. We present the first qualitative analysis of the experience of large group of New Zealand primary healthcare professionals on their perception of delayed patient care during the early COVID-19 pandemic. These have been modelled in pre-pandemic settings as patient, provider/system and disease factors.] Internationally, there has been growing concern over “collateral consequences” of COVID-19 lockdowns diverting attention away from management of long-term conditions.] A UK study in a large, deprived population has retrospectively shown a reduction of 40–50% in first diagnosis of common primary care conditions from March to May 2020, with concern that some of this represents undiagnosed conditions.] With reduced screening and non-urgent diagnostic services in the UK’s relatively prolonged lockdown, modelling has predicted a large increase in avoidable cancer deaths.]Īs a patient navigates the health system, multiple factors can contribute to delaying their care. People living more sedentary lifestyles because of lockdown may have also contributed to the way symptoms were experienced for some heart conditions.] In New Zealand, ambulance services reported lower acuity calls and increasing mental health issues, suggesting there was a reduction in access to primary care.] Hospital inpatient treatment reduced the most, by 63.8% in April 2020 when compared with April 2019.] Research in both Australia and New Zealand suggests that delays in diagnosis and management contributed to this decrease in primary and secondary healthcare activity.] However, conversely, decreases in overall healthcare activity, particularly in primary care, may also result in delayed diagnosis and management. New Zealand Ministry of Health data show a reduction in both planned and unplanned care at primary and secondary levels. Many non-urgent problems were dealt with by observation and self-care.] A New Zealand patient experience study over the early pandemic lockdown period found a majority had delayed seeking healthcare during this time.
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Some New Zealand research is emerging on the impact of these changes on timely patient care.
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Elective surgery was cancelled, and in some districts, non-urgent referrals were declined or discouraged.] In secondary (hospital-based) healthcare, the National Hospital Response Framework] was implemented, with routine outpatient appointments cancelled or moved to telehealth where possible.
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In primary care, non-urgent healthcare (such as screening) was discouraged, telehealth consultations were encouraged] and patients were screened and streamed for respiratory illnesses. In response to level 4 “lockdown” from 25 March 2020,] all areas of the health sector made changes to prepare for a potential influx of unwell COVID-19 patients, as had been seen overseas. The coronavirus disease 2019 (COVID-19) pandemic brought about sudden changes in the delivery of healthcare throughout Aotearoa New Zealand.