Rehabilitation services for stroke and other neurological diseases have seen a slower recovery in outpatient clinics than those in inpatient settings as a result of the impact of the COVID-19 pandemic, a new report has found.
Outpatient services were largely stopped or significantly scaled back when the pandemic hit, the study said, and continue to take longer to recover post-lockdown, which could have long-term implications for patients into the future.
Decreases of around 36 per cent compared to 2019 were seen in the ability of outpatient units to interact with patients, with many appointments being delayed for between 3 and 6 months.
In an inpatient setting, the decrease was around 27 per cent at the peak COVID-19 period, although the recovery in rates of seeing patients came much quicker.
“Compared with the recovery process of inpatient services, outpatient clinic visits decreased faster and recovered much slower,” the report concluded, which was compiled by Jing Zhao, Yong Wang, Marc Fisher and Renyu Liu.
“The reduced service, or the total shutdown, of outpatient clinics for stroke patients can potentially lead to an increased incidence of stroke in the future.”
The study, conducted globally from December 2019 – when the deadly virus was at its peak in China – and July 2020, and received responses from 46 countries around the world.
It was instigated by the significant drop of stroke admissions, evaluations, and related stroke care delivery during the peak period of the COVID-19 outbreak.
The study engaged participants through the World Stroke Organisation network, with 112 responses globally, which were compared to stroke and neurology outpatient and inpatient services in a hospital setting in Shanghai, China, the country where COVID-19 was first reported and was further along in terms of its recovery.
Only 7 per cent of outpatient services remained open during the lockdown period in countries around the world, with increased precautions for the virus being implemented, such as use of personal protective equipment (PPE) and isolation techniques.
Telephone consultation and video communication became the most popular alternative option, the study found, with new patients and follow-up appointments regularly being completed this way.
Some outpatient clinics globally operated up to 80 per cent of appointments this way, it was reported, with telemedicine being permitted in South Korea for the first time during the pandemic.
“Fortunately, due to technology development, the availability of telemedicine was able to offset some of the negative impact from the pandemic related shutdown of outpatient clinics,” the report found.
“Based on current clinical experience (personal experience), the adherence of patients to their scheduled telemedicine visits was actually improved compared to prior in‐person visits, with less patients missing their scheduled telemedicine appointments.”
Inpatient stroke patients who are discharged were provided with detailed summaries for their GPs to follow, the report said, to reduce post-admission reviews, although medical home visits were still completed where necessary.
Data collected through the report from the Shanghai neurology unit – which its authors say is replicated in its pattern around the world – showed a decrease in outpatient clinic visits of 36.6 per cent during the city’s peak period of February, but then returned to 60.5 per cent, 78.3 per cent, 77.6 per cent, 89.0 per cent, and 78.8 per cent in March, April, May, June, and July respectively.
Inpatient services for all neurological diseases dropped by 23.8 per cent in February and in the following four months returned to 65.8 per cent, 82.2 per cent, 64.7 per cent, 78.5 per cent and 89.1 per cent respectively.
Stroke admissions dropped by 27.4 per cent in February and then rebounded quickly, recovering to 103.9 per cent, 92.2 per cent, 66.1 per cent, 90.0 per cent, and 100 per cent, as compared to the pre‐COVID‐19 period.
