Did the Pandemic Permanently Affect Low-Value Healthcare?

In this exclusive MedPage Today video, Quoc-Dien Trinh, MD, chief of urology at Brigham and Women’s Faulkner Hospital and an associate professor of surgery at Harvard Medical School in Boston, addresses the concerns that fellow urologists have about the decreased utilization of low-value healthcare services during the COVID-19 pandemic, and what the future holds for their patients.

Trinh’s research was presented at the recent American Urological Association annual meeting.

Following is a transcript of his remarks:

Obviously the pandemic has caused a lot of chaos in the healthcare system. Obviously we think of the early phases of the pandemic where we were lacking equipment, people were being reassigned to other services, cancer surgeries were potentially being postponed. So these are probably the things that you think of first when you think about how the pandemic affected the healthcare system in early 2020, March 2020.

But what is also of concern is that yes, acute care was being affected, but also you have to think of all preventive care as well. Because we’re in the middle of a pandemic, people are concerned, people are not going outside, there’s lockdowns in places. And as a result, what we have seen is a decrease in use of certain services, whether it is cancer screening like colonoscopies or prostate-specific antigen tests.

And these are things that we described in studies that were published in JAMA Oncology and then in Cancer Cell of how the pandemic affected our healthcare system of Mass General Brigham, which encompasses a number of different hospitals in the New England area.

So, as a fault to this study, and this is what we were intended to do here, what we were curious about is to see, well, there’s definitely a decrease in preventive care as described. But what we were also interested to see is if there was also a proportionally higher decrease in low-value care. And the definition of low-value care is services that may not be of clear benefit. And we know that in American healthcare, there’s a lot of issues with that.

It’s like, yes, we’re doing good things, we’re doing tests when we need to do them, but there’s also a lot of services that may not be necessary that a lot of people are getting. And I’ll give you an example, getting a prostate cancer screening at an advanced age. There’s very little benefit generally described for prostate cancer screening at advanced age. So we were curious to see if during the pandemic there was potentially a greater decrease in low-value care, which would be a good thing.

So the results reflect the hypothesis that we had from the get-go. And the idea is that during the pandemic, especially in the early phases of March to June 2020, there was a decrease in preventive care in general, whether it’s cancer screening or other tests that were done, there was a decrease. And that reflects the fact that people had issues trying to get into the hospital, people were concerned, scared of coming into the hospital, availability of physicians was potentially lower, probably lower.

But what we did find that was interesting is that the decrease in so-called low-value care outpaced the decrease in high-value care, which is a good thing. Which is the fact that what this really shows is that during the pandemic there was adjustments that were made and people thankfully were really focused on what was important and maybe de-focused towards doing these low-value services.

I’d be curious to see if these changes that were made out of necessity saying, okay, wait a second here. What is very important for my patient? I should be doing this test. Oh, this test, probably not, and I will not do it. Well, one has to wonder if that adaptation will continue in the post-pandemic [era], where now that we’ve faced that situation, are we going to go back to our bad habits? Or are we going to continue providing high-value care to those who need it and decrease or deescalate low-value care among patients who don’t need these tests? So that’s definitely one question.

Another question that is of interest that we are trying to study is that we saw all these tests that were not done during the pandemic — I’m curious to see if those people that we missed or we delayed diagnosis for cancer, for example, or other conditions, if we have done a good job in picking them back up in the post-pandemic or post-first wave, second wave of the pandemic era.

And some of these answers, we have already started addressing them in studies. In one study, for example, we saw that there was an uptick of cancer screening tests in the second wave of the pandemic, which is greater than what was being done the year before, which suggests that we have at least caught back some of these patients. But this is an example of high-value care.

I guess the other question is, who are the patients that we were not able to capture as part of this? Because one would think that somebody who is very affluent, who’s on top of their healthcare, has family, a good support system, will say, hey, wait a second. I didn’t get my colonoscopy last year. I’m due for one this year. But I am also sure that there are many people who missed their colonoscopy in 2020 that potentially are not coming back to get it, because they may not understand the importance of it, and the system may not be in place to bring them back into the system. And this is a huge area of interest to me and also to many researchers around the world.