Research

Dutch GP healthcare consumption in COVID-19 heterogeneous regions: an interregional time-series approach in 2020–2021

Maarten Homburg, Marjolein Berger, Matthijs Berends, Eline Meijer, Thijmen Kupers, Lotte Ramerman, Corinne Rijpkema, Evelien de Schepper, Tim olde Hartman, Jean Muris, Robert Verheij and Lilian Peters
BJGP Open 2024; 8 (2): BJGPO.2023.0121. DOI: https://doi.org/10.3399/BJGPO.2023.0121

Article Figures & Data

Figures

  • Figure 1.
    Figure 1. Changes in contacts from before to during the pandemic. The chart shows absolute change in contacts for COVID-19 and other complaints in 2020 and 2021 compared with 2019 by study region (University Medical Center Groningen, North; Radboud University Medical Center Nijmegen, East; and Maastricht University Medical Center, South). Grey shading represents periods of increased restrictions and rising COVID-19 infection rates. The sudden decrease in contacts in the Eastern region in week 19 of 2021 represents a failure in data extraction and not the true number of contacts.
  • Figure 2.
    Figure 2. Type of healthcare consumption by study region and year. Healthcare consumption is shown per 1000 patients for acute, prolonged (reversible), and chronic (irreversible) illness by study region (University Medical Center Groningen, North; Radboud University Medical Center Nijmegen, East; and Maastricht University Medical Center, South) and year (2019, 2020, and 2021). Grey shading represents periods of increased restrictions and rising COVID-19 infection rates
  • Figure 3.
    Figure 3. Type of healthcare contact by study region and year. Contact types are shown by study region (University Medical Center Groningen, North; Radboud University Medical Center Nijmegen, East; and Maastricht University Medical Center, South) and year (2019, 2020, and 2021). Shading represents periods of increased restrictions and rising COVID-19 infection rates.

Tables

  • Table 1. COVID-19 pandemic phases in the Netherlands based on infection rates and restrictive measures
    Phase of the COVID-19 pandemic in 2020 and 2021Description of COVID-19 infection rates and containment measures
    2020 Phase 0
    week 1–8     		- No confirmed COVID-19 infections in the Netherlands
      Phase 1
    week 9–22     		- First wave of COVID-19 infections
    - First lockdown (that is, promotion of good hand hygiene, social distancing, working at home, and schools, restaurants, amusement industry closed)
    - Highest infection rates: week 15
      Phase 2
    week 23–40     		- Decrease in infection rates
    - Gradual relaxation of restrictive measures
    - Lowest infection rates: week 28
    2020–2021 Phase 3
    2020 week 40
    to
    2021 week 3     		- Second wave of COVID-19 infections
    - Stricter containment measures, start of a partial lockdown followed by a strict lockdown (curfew, and schools, stores, and sport facilities closed)
    - Highest infection rates: weeks 44 and 52
    2021 Phase 4
    week 4–16     		- Emergence of the Alpha variant (B1.1.7) of concern, further increase in infection rates, and continued lockdown measures
    - Highest infection rates: week 16
      Phase 5
    week 17–43     		- Decrease in infection rates
    - Gradual opening up of society and only minor restrictions
    - Lowest infection rates: week 26
      Phase 6
    week 44–52     		- Epidemic rise with the Delta variant (B.1.617.2) of concern and a steep increase in infection rates
    - Lockdown measures reintroduced
    - Highest infection rates: week 48
  • Table 2. Characteristics of included patients registered with GPs by study region and year
    North (UMCG), n (%)East (RUMC), n (%)South (MUMC), n (%)
    Characteristic 201920202021201920202021201920202021
    Population 261 789 (100)267 219 (100)265 084 (100)41 100 (100)42 015 (100)40 591 (100)122 750 (100)124 106 (100)129 197 (100)
    Sex
    Female131 543 (50)134 258 (50)133 111 (50)20 791 (51)21 243 (51)20 488 (50)62 356 (51)62 971 (51)65 437 (51)
    Male130 246 (50)132 961 (50)131 973 (50)20 309 (49)20 772 (49)20 103 (50)60 394 (49)61 135 (49)63 760 (49)
    Age, years
    0–45923 (2)8249 (3)10 769 (4)1688 (4)2365 (6)2424 (6)2657 (2)3765 (3)5200 (4)
    5–1426 394 (10)26 822 (10)26 539 (10)5672 (14)5651 (13)5509 (14)10 746 (9)10 910 (9)11 477 (9)
    15–2432 147 (12)33 320 (12)33 788 (13)5127 (12)5236 (12)5061 (12)13 138 (11)13 316 (11)13 964 (11)
    25–4458 576 (22)60 086 (22)58 905 (22)12 319 (30)12 662 (30)12 073 (30)28 830 (23)29 149 (23)29 387 (23)
    45–6472 987 (28)74 034 (28)73 181 (28)10 713 (26)10 694 (25)10 437 (26)34 818 (28)35 132 (28)36 763 (28)
    65–8455 427 (21)55 278 (21)53 873 (20)4935 (12)4852 (12)4634 (11)27 557 (22)27 344 (22)28 576 (22)
    ≥8510 335 (4)9430 (4)8029 (3)646 (2)555 (1)453 (1)5004 (4)4490 (4)3830 (3)
    Number of contacts per patient
    056 027 (21)63 459 (24)50 217 (19)7499 (18)9012 (21)7069 (17)32 475 (26)33 831 (27)24 217 (19)
    1–583 920 (32)87 366 (33)86 001 (32)18 933 (46)19 738 (47)19 057 (47)45 497 (37)45 390 (37)47 823 (37)
    6–1043 708 (17)42 485 (16)45 054 (17)7259 (18)6927 (16)7507 (18)19 353 (16)19 373 (16)22 489 (17)
    >1078 134 (30)73 909 (28)83 812 (32)7409 (18)6338 (15)6958 (17)25 425 (21)25 512 (21)34 668 (27)
    Urbanisationa,b
    Very high12 741 (5)13 799 (5)15 096 (6)4362 (11)4314 (10)3948 (10)8149 (7)8361 (7)8183 (6)
    High26 858 (10)27 399 (10)27 109 (10)7263 (18)7084 (17)6677 (16)51 720 (42)52 022 (42)54 670 (42)
    Average47 563 (18)48 455 (18)60 879 (23)16 183 (39)16 829 (40)16 635 (41)16 216 (13)17 028 (14)19 244 (15)
    Low70 113 (27)71 425 (27)60 747 (23)9776 (24)10 407 (25)10 415 (26)22 402 (18)22 604 (18)24 764 (19)
    Very low87 078 (33)87 954 (33)88 488 (33)915 (2)810 (2)688 (2)12 893 (11)13 081 (11)14 747 (11)
    Missing17 436 (7)18 187 (7)12 765 (5)2601 (6)2571 (6)2228 (5)11 370 (9)11 010 (9)7589 (6)
    Socioeconomic Statusa,c
    Low87 432 (33)87 822 (33)89 329 (34)11 636 (28)11 592 (28)11 204 (28)39 656 (32)40 486 (33)44 175 (34)
    Middle111 052 (42)113 786 (43)114 756 (43)16 488 (40)17 142 (41)16 996 (42)48 469 (39)48 648 (39)52 553 (41)
    High40 078 (15)41 345 (15)42 000 (16)9340 (23)9727 (23)9785 (24)19 559 (16)20 153 (16)21 473 (17)
    Missing23 227 (9)24 266 (9)18 999 (7)3636 (9)3554 (8)2606 (6)15 066 (12)14 819 (12)10 996 (9)

    • aData on urbanisation and socioeconomic status (SES) is derived from Statistics Netherlands (CBS). Not all included patients could be linked to CBS data after pseudonymisation. bUrbanisation: very high: ≥2500 addresses/km2; high: 1500–2499 addresses/km2; average: 1000–1499 addresses/km2; low: 500–999 addresses/km2; and very low: <500 addresses/km2. cSES: based on standardised household income in the Netherlands: low: 0–40 percentile; middle: 41–80 percentile; and high: 81–100 percentile. MUMC = Maastricht University Medical Center. RUMC = Radboud University Medical Center Nijmegen. UMCG = University Medical Center Groningen.

  • Table 3. Time-series analysis of care consumption for the different phases of the pandemic compared with pre-pandemic of patients registered with their GPs localised in the North (UMCG), East (RUMC), and South (MUMC) of the Netherlands in 2019, 2020, and 2021
    North (UMCG)East (RUMC)South (MUMC)
    Mean number of contacts per week per 1000 patients, pre-pandemic 107.18 91.52 91.21
    Time (SE)–0.07 (0.1)0.02 (0.11)–0.09 (0.09)
    Intercept (SE) TAI (SE) Intercept (SE) TAI (SE) Intercept (SE) TAI (SE)
    Phase 1a9.88 (8.92) –6.86 (2.24)a 12.85 (9.91) –5.74 (2.49)a 8.07 (8.12)–2.58 (2.04)
    Phase 1b –28.05 (9.84)a 1.14 (2.19) –24.12 (10.93)a 0.09 (2.44)–10.72 (8.96)0.59 (2)
    Phase 2a6.57 (10.01)–0.07 (2.77)–5.44 (11.12)1.12 (3.08)14.90 (9.11)0.91 (2.52)
    Phase 2b–5.67 (9.16)1.24 (1.06)–5.74 (10.18)–0.59 (1.18)10.50 (8.34)–0.47 (0.97)
    Phase 3a–2.21 (11.48)1.37 (5.19)–5.43 (12.75)–5.12 (5.76)11.48 (10.44)–3.41 (4.72)
    Phase 3b6.92 (10.08)1.29 (1.93) 37.88 (11.19)a –8.01 (2.14)a 9.77 (9.17)0.45 (1.75)
    Phase 3c–13.60 (12.34)9.67 (5.19)–20.26 (13.71)6.28 (5.76)–10.72 (11.23) 11.79 (4.72)a
    Phase 48.32 (10.03)0.80 (0.99)–11.84 (11.14)1.79 (1.10)16.38 (9.13)1.01 (0.90)
    Phase 5a–4.02 (13.35) 3.91 (1.41)a –52.71 (14.83)a 8.15 (1.57)a 11.72 (12.15) 2.65 (1.29)a
    Phase 5b10.21 (12.44)0.42 (0.67)–0.60 (13.82)–0.62 (0.74) 23.99 (11.32)a –0.67 (0.61)
    Phase 6a25.86 (14.54)–1.63 (3.67) 71.06 (16.15)a –24.02 (4.08)a 21.96 (13.23)–0.81 (3.34)
    Phase 6b 31.26 (15.77)a –13.03 (5.19)a 6.37 (17.52) –12.62 (5.76)a 25.16 (14.35) –11.01 (4.72)a
    Summer 8.02 (4.07)1.41 (4.52)0.21 (3.7)
    Autumn –3.25 (3.87)–4.72 (4.3)–6.12 (3.53)
    Winter 6.44 (3.87)7.51 (4.3)1.57 (3.52)
    R2 0.470.610.40
    Adjusted R2 0.350.520.27
    Residual SE 11.60 (df = 127)12.88 (df = 127)10.55 (df = 127)
    F statistic 3.97a (df = 28; 127)7.09a (df = 28; 127)3.05a (df = 28; 127)

    • a P<0.05. df = degrees of freedom. MUMC = Maastricht University Medical Center. RUMC = Radboud University Medical Center Nijmegen. SE = standard error. TAI = time after intercept. UMCG = University Medical Center Groningen.

Supplementary Data

  • MTH_10.3399BJGPO.2023.0121_supp_v2.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy. 
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BJGP Open
Vol. 8, Issue 2
July 2024
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Dutch GP healthcare consumption in COVID-19 heterogeneous regions: an interregional time-series approach in 2020–2021
Maarten Homburg, Marjolein Berger, Matthijs Berends, Eline Meijer, Thijmen Kupers, Lotte Ramerman, Corinne Rijpkema, Evelien de Schepper, Tim olde Hartman, Jean Muris, Robert Verheij, Lilian Peters
BJGP Open 2024; 8 (2): BJGPO.2023.0121. DOI: 10.3399/BJGPO.2023.0121
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Intended for Healthcare Professionals
 
 

British Journal of General Practice