L’impact de l’épidémie de COVID-19 sur les soins de premier recours en région Provence-Alpes-Côte d’Azur: retour d’expérience sur la mise en place d’un dispositif de surveillance en temps réel à partir des données régionales de l’Assurance maladie

Davin, B.; Jardin, M.; Guerrera, H.; Mabille, J; Tréhard, H.; Lapalus, D.; Ménager, C.; Nauleau, S.; Cassaro, V.; Verger, P.; Guagliardo, V.

Background: Starting in spring 2020, the Covid-19 pandemic markedly impacted the French healthcare system. Lockdown and risks of exposure to the coronavirus induced patients to modify their ways of use. The objective of this article was to share feedback on the implementation of a real-time monitoring system concerning (a) the activity of private practitioners in southeastern France, and (b) the evolution of reimbursements for drugs prescribed to publicly insured persons with diabetes, for treatment of mental health disorders, and for performance of some vaccines. Methods: Data regarding 2019 and 2020 were extracted from regional health insurance databases. They were used to elaborate several indicators relative to the general health insurance scheme, which were calculated and updated each week, starting with Week 2. Results: We observed a drop in private physician activity during the lockdown (-23% for general practitioners; -46% for specialist doctors), followed by a return to a semblance of normalcy. Concomitantly, a boom in teleconsultations occurred: at the height of the crisis they represented 30% of medical acts. The initial stage of the lockdown was characterized by peak provisioning for drugs, whereas vaccination strongly declined (-39 % regarding measles, mumps and rubella vaccine among children aged less than 5 years; -54 % regarding human papillomavirus vaccine among girls aged 10 to 14 years). Conclusion: The Covid-19 pandemic could lead to health effects other than those directly attributable to the coronavirus itself. Renouncing care may result in healthcare delays highly deleterious for people and society. Public authorities are preoccupied with these questions; they have set up action plans aimed at encouraging patients to seek treatment without delay. That said, the Covid-19 pandemic crisis has also created opportunities, such as the expansion of teleconsultation and tele-appraisal. Although partial, these indicators can provide useful information enabling public decision makers to be reactive and to implement specific actions to meet the health needs of the population.