COVID-19 has led to reduced preventive health care in Minnesota

The COVID-19 pandemic had a significant impact on preventive care in 2020 as patients, especially children, had fewer clinic visits, according to a Minnesota organization that tracks quality measures.

As a result, screenings for colorectal cancer and depression were down compared with 2019 and the quality of care was not as good for patients with diabetes, asthma and vascular disease, according to MN Community Measurement, which has been collecting data from the state's clinics for nearly 20 years.

"I think it is not surprising to see declines," said Julie Sonier, chief executive of the organization. "Nonetheless it confirms that there are plenty of reasons why we need to pay extra attention to how do we recover."

Health officials are concerned about poor long-term health outcomes should essential care continue to get delayed during the ongoing pandemic.

"More than half of Minnesota adults have a chronic condition that could put them at greater risk for severe illness and hospitalization from COVID-19," Minnesota Department of Health Assistant Commissioner Mary Manning said. "The consequences of delayed care and undiagnosed chronic conditions may result in increased deaths and disability in the coming years."

When the pandemic first took hold in 2020, many clinics stopped seeing patients to reconfigure physical spaces and policies to prevent the spread of the coronavirus that causes COVID-19. Financial shortfalls also caused some health care systems to reduce the number of locations or lay off workers.

Patient fear also played a role, especially for parents.

The number of children 12 and older who had a clinic visit fell 27% in 2020, and of those there were nearly 8% fewer screenings for depression.

Clinic visits by children with asthma fell 16% and the percentage of those who had optimal asthma control went down from 58% in 2019 to 56% in 2020.

"For kids, they just weren't getting care," Sonier said. "What is going to be really important is outreach to kids who didn't get care in 2020."

The decline in adult clinic visits was not as stark, but screenings for depression were down 9% and colorectal cancer screenings fell 2.8%.

Optimal care for three chronic conditions decreased, with asthma care down 6.7%, vascular care down 6.5% and diabetes care down 4.8%. In some cases, care fell short of standards because patients were not given laboratory tests to monitor their condition.

Although the MN Community Measurement data do not include information on how many people had untreated depression, the decline in screening rates for both children and adults raises concern among mental health advocates.

"We know that more people are struggling. It would help if there would be an effort to look at screening for both kids and adults and really ramp that up," said Sue Abderholden, executive director of NAMI Minnesota.

"This is concerning," she said, "but is this a trend that we are going to see again in 2021 or is it just because of the pandemic?"

The recent increase in new COVID-19 cases could make it more difficult for patients and the health care system to return to more normal patterns of preventive care.

Minnesota health officials announced 1,012 more COVID-19 infections on Friday, the highest one-day total since mid-May, bringing the state's total to 617,788 cases.

Hospitalizations have also increased, with 267 COVID-19 patients as of Thursday, including 80 who were in intensive care.

The test positivity rate is 4.3%, still below the cautionary level of 5%. But Minnesota's per capita case growth rate is 10%, which state officials consider to be "high risk."

Six more deaths were reported, including five who were residents of long-term care facilities. Altogether, there have been 7,694 COVID-19 related fatalities.

A total of 3.19 million Minnesotans have gotten at least one COVID-19 shot, but Minnesota still has not met its goal of vaccinating 70% of those 16 and older. That number is now 69.4%.

While clinic visits were down, much care was done electronically. But telehealth visits do not include blood tests, blood pressure readings and other procedures that are needed for preventive care or chronic disease management.

"When things started to open back up, much of it was in telehealth initially, and telehealth continues to be a significant part of physician visits," said Dr. Marilyn Peitso, president of the Minnesota Medical Association. "Many things can be done with telehealth but many things require in-person visits."

Peitso urged patients to seek care rather than wait for the pandemic to end.

"The pandemic is still with us and it is going to be with us for the foreseeable future," she said. "As daunting as that is there are other things that affect people's health and it is important to pay attention to your general health and not just COVID."

Glenn Howatt • 612-673-7192

Twitter: @GlennHowatt