A retrospective analysis of patient encounters during COVID-19 at an Irish general practice.

Problem

Electronic Medical Record systems (EMRs) have played an important role in monitoring the COVID-19 pandemic’s impact. However, the findings of EMR studies illustrating COVID-19’s impact on primary care / general practice are mixed. This study aimed to provide greater clarity on these matters, particularly with respect to the pandemic’s impact on services in Ireland.

Approach

This study retrospectively examined ‘Reasons for Encounters’ (RFEs) at a general practice in Cork, Ireland, from March 2020 to March 2021. Secondary analyses involving comparisons between the 2020-21 data and 2010-14 data from the same facility were also conducted to further illustrate COVID-19’s impact. Data was collected using the practice’s EMR system which facilitated the recording of ‘Visit date’, ‘Visit reason’ (as defined by the ICPC-2 classification framework), and ‘Patient age’ details. Data was analysed using Microsoft Excel and SPSSv26.0.

Findings

4,523 patients attended the practice from March 2020-March 2021, and there were 45,028 RFEs in this period. The mean number of RFEs per patient was 9.95 and the mean number of RFEs per day was 142.95. Most patients were 26yrs-69yrs (n = 27,306, 60.6%). Patients ≥70yrs accounted for 20.7% of the sample (n = 9,296), children and young adolescents (0-14yrs) made up 9.7% (n = 4,348), and the proportion of older adolescents and young adults (15-25yrs) was 9.1% (n = 4,077). Most RFEs were ICPC-2 code ‘A’s (‘General and Unspecified’) (n = 31,451, 69.85%), with ‘Medication renewal’ (A50) (n = 8,442;18.7%), and ‘Administrative procedure’ (A62) (n = 8,409;18.7%) RFEs most common. RFEs were highly prevalent in the winter, particularly during November 2020-February 21 (n = 13,847; 30.7%). Secondary analyses comparing 2020-21 and 2010-14 data showed that patient and RFE numbers increased by 86.8% and 63.88% respectively; that patients’ age profile remained similar; that the prevalence of ICPC-2 ‘General and Unspecified’ codes increased by 38.29%; and that RFE monthly trends were notably different with a high concentration of RFEs during the winter period only being evident in the 2020-21 data.

Consequences

The findings indicate that the demand for primary care / general practice services in Ireland is high; that the COVID-19 pandemic coincided with a large increase in general presentations with non-ICPC-2 system-specific symptoms; that the ICPC-2 coding framework used during the study period could be better suited to capturing the nuances of these general presentations; and that the pandemic’s impact on primary care / general practice in Ireland was most felt during the winter. Clinicians, policymakers, and researchers should seek to improve EMR systems at the primary care / general practice level to better monitor and respond to pandemics and epidemics.