Title: Community level mapping of the impact of COVID-19 on non-COVID related service utilisation in Wales
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background COVID-19 has, and continues to, cause worldwide disruption, including the prioritisation of healthcare services for COVID-19 and unknown demand for specialist services. The COVID-19 pandemic has led to a decrease in the overall number of attendances to general practices, hospital, and accident and emergency (A&E) departments in the UK. It is unknown how this will impact the health and subsequent healthcare use for non-COVID-19 conditions in the future. Aims (including research question) Our overall aim is to answer the following question: How has COVID-19 impacted non-COVID-19 healthcare service use and provision in Wales and how does the vary at the local community level? To answer this we propose the following research questions: 1. What impact has COVID-19 had on people attending general practices, hospitals, and accident and emergency for non-COVID-19 related illness over time and how does this vary across Wales? 2. Have the reasons to attend general practices, hospitals and A&E changed during the pandemic and does this vary geographically? 3. Have national and local lockdowns impacted how people access healthcare services across Wales? Within these research questions we will also investigate specific health conditions prioritised with the help of public engagement. These include diagnoses of common mental health disorders, attendances to general practice for cancer screening, and emergency admissions to hospital or A&E with a dental diagnosis or injury relating to domestic violence. Plan of investigation We will utilise the Secure Anonymised Information Linkage (SAIL) databank to conduct a national observational longitudinal data linkage study. This enables us to rapidly access data for general practice, hospital, and accident and emergency attendances whilst simultaneously linking covariates for the population of Wales. We will fit geospatial statistical methods for analyses; allowing us to adjust our service utilisation models for localised variations in socio-environmental phenomena. This will enable us to determine geographical differences in our outcomes whilst simultaneously adjusting for individual, residential and area level covariates. The resulting statistical models will enable us to identify 'hot' and 'cold' spots; areas with abnormal levels of health and care service use. This can aid us in gaining a better understanding of the wider determinants of health and inequity that are influencing localised population health. Benefits to service users, carers and the public and the social care community. Our project will benefit service users by providing a national level analysis of service utilisation. This enables us to identify areas of health and care service inequality which can be targeted to help ensure everyone in Wales is receiving the same high-quality services. We can also do this using an individualised digital record spanning primary and secondary care; leading to personalised care. By analysing data at a fine scale we can accurately identify and predict the areas that will be in the most need. By targeting these areas we can help to prevent conditions that are associated with poor access to services. Similarly, we can identify areas of inequity in relation to key covariates which may help people to remain active and independent in their homes and communities such as access to green spaces (e.g. gardens and parks).

Lay abstract: Aim(s) and objective(s) of the research Our overall aim is to answer the following question: How has COVID-19 impacted non-COVID-19 healthcare service use and provision in Wales and how does the vary at the local community level? We aim to answer this question by using existing data available in the Secure Anonymised Information Linkage (SAIL) databank. The data available includes the dates and types of attendance to general practice, hospital, and accident and emergency departments. Using this we are also able to investigate specific health conditions prioritised with the help of public engagement. These include diagnoses of common mental health disorders, attendances to general practice for cancer screening, and emergency admissions to hospital or A&E with a dental diagnosis or injury relating to domestic violence. Background to the research, specifically what is the problem being addressed and why is this research important COVID-19 has caused significant disruption to health and care services. Whilst services were prioritised for COVID-19 patients, there has been a decrease in the overall attendances to general practice, hospital and accident and emergency departments. It is unknown how this decrease in service use will impact the health and wellbeing of people over time. Furthermore, we do not know if particular communities in Wales have been impacted more by the indirect effects of COVID-19 and why this may be. What you hope to discover We hope to discover which communities are at the highest risk of the indirect negative effects of COVID-19 such as accessing health and care services. We also hope to discover the underlying individual, residential and area level characteristics that may impact the use of health and care services in Wales. These include things such as prior health conditions, access to gardens and parks, and levels of deprivation. Public involvement Our project was strengthened with public involvement. We were able to ask members of the public which health and care services they thought were the most important to investigate within our study. This directly influenced our priority areas. We will also continually involve members of the public in our study to ensure our research is timely and relevant. Dissemination A strength of our study is the ability to create maps of Wales with 'hot' spots that highlight areas in the most need. We will use this to our advantage to gain public interest in our project via social media platforms. We will also utilise our research teams networks and Swansea University’s existing knowledge transfer team to maximise the dissemination of our findings. The team will focus on providing our research to key decision makers within provider organisations, policymakers and others who can use it to improve health and social care services and policies.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE