Report: As ambulatory visits fell in California, kids saw steeper declines than adults

During the Covid-19 pandemic, ambulatory visit volumes fell by more than 50% across California, with one population seeing especially steep declines — children, according to a new report.

Released by Manifest MedEx, California’s largest nonprofit health information network, the report is based on an analysis of 4 million state residents who were continuously covered by the same insurer in 2020.

Though ambulatory visit volumes fell to a low of 50% below pre-pandemic levels in late March last year, visits eventually stabilized and then rebounded to about 20% below 2019 levels by June.

Ambulatory visit volumes for adolescents and children, however, saw a steeper drop compared to adults. Visits for adolescents declined by 25%, and for children over 5 years old, that figure dropped by 36%.

The decline could be explained by the fact that adolescents and children had fewer respiratory infections and that schools and sports required fewer doctor visits, but the decrease is worrying.

“It’s concerning that children are having less contact with their pediatricians and teachers, both of whom play a key role in identifying medical, development, and social issues, and it’ll be important for us to monitor children’s health utilization in the coming months,” said Claudia Williams, Manifest MedEx’s CEO, in an email.

Another especially concerning trend is the drop in volume of preventive services, such as cancer screenings, which fell by 20% to 40% in California during the pandemic, Williams said. This includes drops in mammography screenings, which declined 20% below pre-pandemic levels; colonoscopy screenings, which dropped by 34%; and cervical cancer screenings, which fell 41%.

“Missing preventive care, such as cancer screenings, could have a negative lasting effect, including diagnosing at later stages,” Williams said.

“It will be important to catch up quickly on these screening services and monitor whether cancers are diagnosed at later stages across the next few years,” she added.

In contrast, patient volumes for other services like hip arthroplasty and positron emission tomography scans were only down by 3% and 2%, respectively, compared to 2019.

As 2020 wore on, visits rebounded though not to pre-pandemic levels. Ambulatory visit volumes hovered around 250,000 a month from October through December, even as Covid-19 cases soared from around 225,000 to 2 million. This shows medical offices and Californians grew used to living with the deadly disease and taking the necessary precautions, the report states.

As visits continue to climb, providers will need to catch up on missed care as well as identify and proactively reach out to those patients most in need, like those who are high-risk and those who experienced gaps in care, Williams said.

Providers can do this by focusing campaigns on increasing preventive cancer screening and ensuring that every child and adolescent has a wellness visit where  referrals can be provided for needed services, she said.

Photo: Geber86, Getty Images