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INTRODUCTION: Puerto Rico has endured three major environmental and public health crises (Hurricane Irma, Hurricane Maria, the unprecedented seismic activity of January 2020) and the coronavirus disease 2019 (COVID-19) pandemic during the past 5 years. All these events might lead to an unquestionable deleterious impact in the prevention of cancer and across the cancer continuum, exacerbating cancer health disparities in the future. Cancer screening plays a critical role in early cancer detection. COVID-19 has significantly hampered screening programs in many countries' cancer screening infrastructure and services, affecting adherence. Cancer is the leading cause of morbidity and mortality in Puerto Rico. Limited information is available about the impact the current pandemic on colorectal cancer screening. In this study, we aim to describe the impact of the COVID-19 pandemic on colorectal cancer screening in 2020 and assess if this impact varied by health regions. METHOD(S): This study analyzed administrative data claims from the Public Health System of Puerto Rico which is managed by the Government of Puerto Rico through the Health Insurance Administration. The Current Procedural Terminology (CPT) codes included for this study were (81528, 82270, G0104, G0105, G0121, G0328, G0464). To assess changes in the numbers of colorectal cancer screening claims between the incurred year (2016 and 2020), Poisson regression was used. Initially, we fitted this model with only the incurred year as the predictor and offsetting the model with the annual average of total insured (univariate model). Based on this model, we estimate the magnitude of association between the number of claims and incurred year using the Prevalence Ratio (PR) of claims. Lastly, Poisson univariate regression model were used for each of the seven health regions (Ponce, Bayamon, Caguas, Mayaguez, Metro, Arecibo and Fajardo) to assess potential geographic disparities. RESULT(S): The numbers of colorectal cancer screening claims significantly decreased by 40% (PRcrude: 0.60, 95%CI: 0.59, 0.62) in 2020 when compared to 2016. However, when adjusting for claim incurred month, sex, health region and offsetting the model with the annual average of total insured, the numbers of colorectal cancer screening claims significantly decreased by 34%, (PRadj: 0.66, 95%CI: 0.64, 0.67). The numbers of colorectal cancer screening claims significantly decreased in all health regions in 2020 when compared to 2016 (p<0.05). However, the most impacted region was the Eastern region, Fajardo, with a 64% (PRFajardocrude: 0.36, 95%CI: 0.30, 0.42) significant decrease in numbers of colorectal cancer screening claims. CONCLUSION(S): COVID-19 had a profound negative effect on colorectal screening in Puerto Rico. Moreover, despite the beneficiaries of this governmental health plan sharing similar sociodemographic and socioeconomic background, regional differences were observed.
ABSTRACT
Introduction: The COVID-19 pandemic has caused major changes to healthcare services, especially those related to early detection and screening practices like breast cancer. In Puerto Rico, breast cancer is the main cause of death, representing 18.9% of cancer deaths in women, making early detection even more important to prevent morbidity and mortality. This study aims to describe the impact of COVID-19 on breast cancer screening and assess differences in health utilization by age group and health regions in Puerto Rico. Method(s): This study used data on breast cancer screening medical claims from Puerto Rico Track, a project in collaboration with the Puerto Rico Public Health System and the Puerto Rico Institute of Statistics that aims to assess health access and utilization patterns in Puerto Rico. Claims including unilateral and bilateral mammography, sonommamography, and MRI were analyzed. Descriptive statistics and percentual changes between the COVID-19 baseline year (2016) compared with 2020 and 2021 were performed (overall, by age-group and health region). Result(s): A total of 193,793 screening tests were performed in 2016, compared to 66,463 in 2020, and 89,322 in 2021. Overall, a third of the medical claims for breast cancer screening (33.2%) were in the age group of 51-60 years. An overall decreasing percentual change was observed comparing 2016 vs. 2020 (65.7%), where the age group with the broadest gap reduction were among women 41-50 years old (68.2%). When comparing medical claims of 2016 (193,750) versus 2021 (89,320) (pre and post pandemic), an important decreasing change (53.9%) was observed. The age group with the highest decrease comparing 2016 to 2021 was the 41-50 years one (68.2%). The Western region of Mayaguez/Aguadilla had the highest decreasing percentual change, with a reduction of 73.6% in 2020 compared to 2016, and 62.6% when compared 2021 with 2016. Conclusion(s): Breast cancer screening was notably affected by the COVID-19 pandemic in Puerto Rico. A pattern of decreasing breast cancer screening was observed by health regions and by age. These efforts provide evidence of the need of tailored evidence-based interventions to increase breast cancer screening in the island.
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Background Targeted screening for Gestational Diabetes Mellitus (GDM) occurs routinely at 24-28 weeks gestation using the oral glucose tolerance test (OGTT). During the COVID-19 pandemic, the Health Service Executive (HSE) and the Royal College of Obstetricians and Gynaecologists recommended discontinuing the OGTT to minimise hospital visits. Fasting plasma glucose (FPG), random plasma glucose (RPG), and glycated haemoglobin (HbA1c) were instead proposed for diagnosing GDM. This study retrospectively compared testing patterns and putative diagnostic rates for GDM in pregnancies using the HSE guidelines pre- and post-pandemic. Methods Pregnancies with complete gestation in the 18 months before (Group1) or 18 months after (Group2) adoption of revised HSE guidance at CUMH (01/05/2020) were included. Women with pre-existing diabetes mellitus were excluded. Results were extracted from databases at the Departments of Clinical Biochemistry and Haematology at CUH. Diagnostic cut-offs for GDM were: OGTT (FPG >=5.1 mmol/L or 2-h plasma glucose >=8.5 mmol/L), FPG (>=5.1 mmol/L), RPG (>=9 mmol/L), and HbA1c (>=39 mmol/mol). Diagnostic rates were compared using Chi-square analysis. The study was approved by the Cork Teaching Hospitals Clinical Research Ethics Committee. Results In Group1, 43.8% of 6,737 pregnancies had an OGTT, compared with 20.5% of 6,743 pregnancies in Group2. After implementing the revised guidelines, OGTT requests were 34.5% and 79.7% lower for primary and secondary care, respectively. Comparing Group1 with Group2, FPG was measured in 46.9 vs 49.8%, RPG in 13.3 vs 11.8%, and HbA1c in 23.7 vs 51.9%. The positive rate for GDM testing was 15.9% in Group1 and 22.0% in Group2 (p<0.00001). Conclusions OGTT use fell significantly with revised HSE guidelines, although only a modest reduction was observed in primary care. HbA1c use in pregnancy doubled during the pandemic. The proportion of pregnancies with biomarkers positive for GDM showed a small but significant increase upon adopting the new diagnostic guidelines.
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Introduction: At the beginning of the SARS-CoV-2 pandemic, health centres were places where there was a high risk of infection, and during the period of lockdown face-to-face health care was substantially reduced, forcing rapid changes in the care of multiple sclerosis patients by the specialised nursing staff in the units and monographic consultations of this disease. Development: The experience of the nursing staff of multiple sclerosis units and monographic consultations, in 8 Spanish hospitals, is collected from the beginning of the pandemic and in later stages, and the adaptations that they made to continue caring for patients are specifically described. The scientific literature about how the SARS-CoV-2 has affected patients with multiple sclerosis is also reviewed, as well as the experiences of other multiple sclerosis teams in health centres in other countries. Conclusions: During the lockdown and in later stages, new forms and previously little used forms of care were applied to multiple sclerosis patients. The nursing staff kept contact with them by telephone and online, provided them with information about safety and behaviour in relation to COVID-19. Face-to-face visits, treatments and distribution of medication were adapted. Information was provided about how patients could receive psychosocial support and about how they could maintain their quality of life.
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Introduction: Covid-19 was declared a pandemic by the World Health Organization (WHO) in March 2020. Due to the risk of coronavirus infection, a telemedicine program for multiple sclerosis (MS) patients have been designed by the Multiple Sclerosis Unit of Hospital Virgen Macarena (UEMAC): neurological visits have been replaced by house-calls, information and medical doubts have been managed through different communication channels (email and telephone);and a program of physical exercises have been designed by the neuro physiotherapist to be performed at home (telemedicine). Objective: To analyze the degree of satisfaction of MS patients who have been attended with the telemedicine program designed by UEMAC during the coronavirus pandemic. Methodology: An observational study in MS patients who have assisted using telemedicine during the coronavirus pandemic. An online interview was performed to assess the level of satisfaction with telemedicine. This survey had 6 questions with a Likert-type scale from 1 to 5 (1 was totally disagree and 5 was totally agree). In addition, it had two open questions, the last one of suggestions and improvements. Results: 518 patients completed online interviews. 86.1% reported that the remote medical care received was appropriate. As to the waiting time until the resolution of the doubt (less than 24 hours), 76.2% considered that it had been adequate. 6.6% of the total disagreed. With regard to the used communication channel, 97% used email and 3% used phone calls. 85.9% considered the communication channels adequate, and 8.9% consider them insufficient. 90% of patients reported that their medical doubts were properly resolved using telemedicine. With respect to the possibility of alternate face-to-face visits with house-calls in the future, there were different opinions: 64.9% considered it useful while 20.6% considered it unuseful and 14.5% did not pronounce. Conclusions: Our results showed that MS patients attended by telemedicine were highly satisfied. They have found telemedicine to be a convenient and an helpful option in this situation and a suitable option to implement in the future as an alternative to the face-to-face consultation.
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Background: In-center hemodialysis (HD) units pose the perfect conditions for COVID-19 transmission yet limited space and resources are obstacles to infection prevention and control (IPAC) measures. We aimed to describe IPAC measures implemented and document the infection rates within HD units during the first year of the pandemic. Methods: We invited leaders of Quebec's HD units to collect information on IPAC measures from March 1st to June 30th 2020 and HD unit characteristics. Participating units were contacted again in March 2021 to collect information about the total number of cases. The cumulative infection rate of each unit was compared to the regional cumulative infection rate using a standardized infection ratio (SIR). Results: Data was obtained from 38 units, representing 90% of Quebec's HD patients. 30% of units were perceived as crowded, and this was associated with objective distance measures between stations, which was much more likely to be <2m in units considered crowded (83.3% vs 19.2% p<0.001). IPAC measures regarding general prevention, screening procedures, physical distancing, and PPE use were implemented in 50% of units by 3 weeks and the remainder by 6 weeks. Data on cumulative infection rate was obtained in 26 units providing care to 3942 patients. The cumulative infection rate was disproportionally elevated in HD units compared to regional rates (Median SIR:2.68 IQR:1.58;4.45)(Figure 1). No difference was noted in the SIR related to specific IPAC measures or to the physical characteristics of the units. Conclusions: Hemodialysis units throughout Quebec were able to rapidly implement modified IPAC measures. Despite this, infection rates were disproportionally elevated.