How health systems are able to adjust to unforeseen events, such as the on-going pandemic, is an issue of critical importance for future policy development in most countries. This study finds that even in a country with a relatively well-developed primary care system and, moreover, a comparably low level of primary care utilization rate per capita, a significant number of patients have been unable to receive care as expected in the first year of the Covid-19 pandemic. While remote types of services appear to have increased as the pandemic continued to affect service delivery, such types of patient consultations have been unable to make up for the overall reduction in primary care in the current case.
The findings also suggest that the fall in services has affected both men and women to a similar extent. Given what was known about the SARS-CoV-2 virus during the initial stages of the pandemic, this would be an expected finding. More generally, the relatively larger share of women to men in primary care utilization in Sweden is consistent with that of most other countries .
However, the results also indicate that patients over 65 years of age saw a particularly large reduction in primary care utilization. While this would be in line with the general recommendations by disease control agencies to specifically protect this demographic group from avoidable contacts, it may imply that some patients’ health needs have not been met during the pandemic. The potential long-term effects that this may have, in particular as the pandemic has continued into 2021, is a matter of both policy and research relevance.
The present study describes the overall changes in the delivery of primary care services. As such, it provides a basis on which to plan further, detailed investigations into the nature of the observed changes. Among other questions, future analyses will assess the extent to which some groups were more affected than others. For example, the effect of the pandemic on patients with chronic conditions, such as hypertension and diabetes, need to be investigated.
Another large group of patients are those seeking mental health care that may also have been particularly hit by the effects of the pandemic . For example, increased suicide rates have been reported in Japan , while in another study covering 21 countries, no such increases were reported .
An additional matter of relevance is the impact the pandemic has had on antibiotic prescription levels. For example, while antibiotic prescription rates in the Swedish health care system are among some of the lowest in Europe , the use of antibiotics in Sweden were reduced during the Covid-19 pandemic . This reduction, however, does not appear to have led to a subsequent increase in the prevalence of severe bacterial infections, such as pneumonia and sepsis. Understanding these impacts more fully is important for future policy guidance on the use of antibiotics.
A further issue is the type of remote contacts that have been used by providers during the pandemic . In the present study, traditional types of remote patient consultations, such as telephone and surface mail, saw a larger increase compared with more modern approaches, such as digital telemedicine (video and chat-based). A general policy issue relates to the understanding of the effectiveness of these different types of remote care and how they should be directed across various patient groups [16; 17].