Fewer emergency treatments: Monitor high-risk patients

Mr Klauber, through evaluations of current data, WIdO can now for the first time shed light on the effects of the second wave of epidemics on German hospitals. What is the picture there?

Jürgen Klauber: In general, the number of cases in the second wave of epidemics decreased less than in the first wave, although the level of infection increased significantly. Perhaps this is due, among other things, to the fact that the regulations on keeping beds free became more differentiated in the second wave. As a result, the reduction in less urgent operations that could be planned in the second wave is only half of their volume in Spring 2020. In general, hospitals have acted according to political guidelines, the aim of which was to keep hospital beds free.

As early as last spring, it was reported that the number of emergency treatments fell sharply in the first wave of epidemics. What did that look like in the second wave?

In the second wave from October 2020 to January 2021, there was another big drop – minus 13 percent for heart attacks and 11 percent for strokes. Of course, the question immediately arises whether lack of access or subsequent access to the hospital will lead to collateral damage and a more serious development of the disease. Experts from Cardiac Clinics have already reported more and more severe cases arriving at the clinics. For example, heart attack patients with advanced heart damage. Apparently, some patients are hesitant for a long time to call emergency services for fear of infection – or if they have minor complaints, they have no contact with the health system at all.

Are there any clues to this in the data?

Yes, an analysis based on AOK data for a WIdO quality monitor published in December 2020 showed that in the first wave of epidemics, the decrease in the number of cases was greater for mild cases of myocardial infarction compared to severe cases. In the case of strokes, we saw a significant 30-day increase in mortality. The absolute number of hospital-related stroke deaths has also increased compared to the previous year – although the number of cases has decreased significantly. We will only be able to see in medium-term studies the subsequent damage that may result from heart attacks and strokes that may not be treated appropriately.

What do the results mean for the GP?

In a pandemic in particular, it will likely be particularly important to monitor at-risk patients. One can only repeat the call to patients over and over again to not hesitate in the event of emergency symptoms even in the event of an epidemic, and to seek direct contact with a doctor or alert emergency services immediately.

They also saw a decrease in cancer treatments. Were these the same size as for emergencies?

In breast cancer tumor interventions, there was a significant reduction of 10% in the first wave, which was half as large in the second wave. This is mainly due to the fact that the mammography examination was temporarily suspended in the first wave of epidemics. The number of mammograms with AOK-insured women for early detection or diagnosis decreased 49 percent from March to May. From the summer onwards, the situation has returned to normal.

Was this also the case with other cancer markers?

The picture of colon and rectal cancer operations differs from those of breast cancer. The decline in the second wave is 20 percent greater than it was in the spring of 2020. Here, too, we see an association with diagnoses that fell dramatically in outpatients in the first wave of epidemics. In the three months, the number of all colonoscopies performed by AOK-insured decreased by 26 percent. In light of the renewed decline in operating rooms in the second wave, it can be assumed that colon cancer diagnoses also declined significantly again in the context of the second wave of epidemics. On the basis of the available data, we cannot answer how often patients have complaints or whether colonoscopy presentation has decreased due to capacity bottlenecks. But you have to make it clear to people that screening for colon cancer saves lives, and this has been proven by many studies.

They have also recorded a decrease in inpatient treatment of diseases that, in the opinion of experts, can also in many cases be well cared for by doctors in a private clinic. How do you look over there?

A remarkable development can be seen in the so-called sensitive outpatient indicators, for which qualified outpatient treatment is often adequate: both heart failure and COPD, which we assessed as examples, have been consistent since the beginning of the epidemic with a very sharp drop in the number of cases, and it has been Each case increased with the intensity of the two epidemic waves. We cannot say from the data whether these patients who did not come to the hospital received adequate outpatient care if needed instead.

However, the continued decline in the epidemic could be an indication of an increase in the supply of inpatients here. International comparisons suggest that, too. It remains to be seen whether the Coronavirus pandemic could foster lasting structural change in this area of ​​supply.