Post-COVID Healthcare in Latin America
During ESOMAR’s webcast Dynamic, Diverse, Digital we shared trends from our HCP ongoing tracking study and which are the likely trends for the post-covid future.
This is an initiative that Fine Research has been developing since March 2020 and which involved collecting data from over 16,000 interviews from LatAm HCPs. It has been widely used by researchers, healthcare decision makers, and marketers as a reference to understand and preview the ongoing transformations in healthcare in the region.
A summary of results was publish at Research World Magazine and the article can be accessed here
The last wave includes responses from 2,521 medical professionals from Brazil, Mexico, Argentina, Colombia and Chile, covering the post-pandemic scenario on topics such as telemedicine, impact on diseases, emotional health of doctors and patients, COVID vaccines and relationships with the pharma industry.
You can read our executive summary below or check our FULL REPORT
Is Post-COVID already here?
It is not difficult to set a list of abrupt changes that we have seen during this pandemic. However, it may be more challenging to identify which of these have been merely circumstantial and which are trends that will grow and consolidate over time.
In order to address such broad topic, we can put ourselves in the shoes of the HCPs as key stakeholders of the healthcare system. The first and most intriguing question is whether we are already in the post-pandemic.
On this point there is no unified front among healthcare professionals other than praising the benefits of vaccination. Vaccination against COVID has been massively valued by professionals, and in the last six months they have shown an increased trust in vaccines. But is the combination of comprehensive vaccination and a temporary drop of cases a firm trend? Or shall we expect in LatAm what we see in some other parts of the world with repeated waves and spread of new virus variants?
By November 2021, only 8% believed that their country was still in an acute phase of the epidemic. In general, while the improvement in the reduction of severe cases is acknowledged, physicians tended to be cautious and the return of severe waves of COVID – albeit not an unanimously anticipated outcome – is the most likely scenario for HCPs in Colombia and Mexico. On the other side of the spectrum, Brazilian doctors are significantly more confident that severe waves are unlikely to return.
Beyond the varied perspectives, it is noticeable that physicians present a more cautious vision than their own patients, who are mostly confident that serious waves are part of the past and even, for many, that the pandemic is already completely over in their country.
But in this context of cautious optimism , it is worth asking – assuming there are no abrupt changes – how permanent will these transformations we have seen over time be?
Worsening of health conditions
Among the trends that were intense at the peak of the pandemic – but circumstantial in nature – are the reduction in the number of treated patients and the limited operation of healthcare institutions across different specialties.
The sharp plunge in visits to doctors during the most intense phase of the pandemic undoubtedly stands out in Latin America. In May 2020, we identified a 61% drop in the number of patients seen in relation to pre-pandemic levels. The data further suggests that this was only marginally offset by the increased use of non-face-to-face forms of care, whether by telephone, WhatsApp or videoconferencing, making the impact of reduced medical care extremely relevant.
At that time, physicians identified that only 6 out of 10 of their patients managed to keep an adequate adherence to their treatments, with slight variations among the different diseases such as diabetes, cancer, HIV, or autoimmune, heart and respiratory diseases.
They also reported a significant drop in preventive medicine and, for example, the number of breast or prostate cancer screenings in October 2020 fell by more than 60% from pre-pandemic levels, according to data previously released by Fine.
In November 2021, in a context where COVID-19 cases and mortality in the region have tended to decline, at least temporarily, professionals reported that patients have lost their fear of infection in the examination room (and also in clinical tests) and therefore face-to-face care is almost reestablished. Considering the estimates of more than 2500 doctors in the region, the number of patients seen is now only 16% below pre-COVID levels.
However, the worsening of many diseases is still reflected in clinical practice. For example, more than 4 out of 10 physicians report complications of chronic diseases and late diagnoses due to lack of consultation during the pandemic.
In addition, this reduced contact has been paralleled by other health effects, and physicians describe most of their patients as showing a more sedentary lifestyle and a worsening of eating habits, in a context of increased economic restrictions.
Professionals from Mexico, Argentina and Brazil, moreover, are the ones who most strongly express the impact of the weakened economy on the access to healthcare and claim that about half of their patients are facing financial restrictions that limit their access to medicines and even to medical consultation.
Considering the significant levels of infection in the region, this is followed by post COVID or long COVID syndrome, which is also a significant area of concern for HCPs.
Increased fatigue is the most common symptom, but also shortness of breath, joint or chest pain, cardiovascular and psychiatric/neurological symptoms, resulting in general in a worsening of quality of life for these patients.
Would this be worsening further over time? Not necessarily, and the good news is that physicians estimate that in 12 months the levels of reduced adherence and late diagnosis would tend to be mitigated by the current normalization of patient care.
It will take longer, however, to reverse the emotional aftermath of the pandemic. Increased anxiety, resulting from increased mental health vulnerability, is affecting 2 out of 3 of their patients, as reported by professionals.
Although 3 out of 10 doctors believe that the emotional impact of the pandemic tends to remain at lower levels, almost half of them imagine that it will worsen.
The latter is valid for patients but also for physicians, and 9 out of 10 doctors acknowledge being emotionally affected. More than a quarter of the 2521 doctors surveyed in November 2021 report not sleeping as well as before the pandemic; a third feel more pressured and anxious, and more than half report being more tired.
Even with the decrease in cases, nearly a quarter of physicians say they fear getting COVID or infecting their families. While it is true that the fear of infection has plummeted, it is noteworthy that almost 4 out of every 10 doctors have received a positive diagnosis of COVID, which is obviously several times the reported figures in the populations of the different countries.
In fact, more than half of the professionals report having been in contact with COVID-infected patients in the past week.
There have been, however, a few variations in physicians’ feelings. In a population where vaccination has advanced rapidly, doctors consistently report less concerns about personal and family infection, they experience less uncertainty, and have also overcome the isolation experienced at the peak of the pandemic.
However, physicians’ fatigue stands out more nowadays, and the proportion of professionals who recognize that they are more easily irritated is also higher compared to the data we collected in May 2020.
Consequently, the higher level of risk of burn-out in the profession should not come as a surprise. And indeed, 9 out of 10 doctors believe it has increased and will remain relevant in the foreseeable future. Despite the fact that a good part of the doctors believe that the next waves of COVID will be more benign, the risk of burn-out emerges as a trend that a relative majority believes will be heightened or continue as is now and only less than a third of the doctors believe that it will tend to reduce.
Regarding telemedicine, the most frequent perspective is to imagine its continuity, but at a lower level than during the pandemic.
Today, 82% of consultations in the region are face-to-face and two thirds of physicians say that in the future they would only use telemedicine in a few cases or that it is not applicable to them at all. However, 3 out of 10 imagine a hybrid model where they will switch face-to-face with virtual healthcare.
Applications specialized in virtual medical care still account for a marginal portion of consultations (only 3%) with the most common forms of telemedicine being the use of telephone, email, chats or in some cases the videoconferencing platforms that are most commonly used by the general population.
In our opinion, the data suggests that telemedicine will accelerate much more slowly than the dizzying pace it showed during the pandemic, but it is far from disappearing, defining a permanent niche in medical care for some specialties, types of patients or methods of consultation organized by healthcare organizations.
Its expansion is facilitated by the fact that professionals see the growth in the use of electronic prescribing as a firmly established trend.
Virtual fatigue and the craving for in-person connections
In any case, any use of telemedicine will coexist with a strong preference for face-to-face relationships. Consistently what we see across the board is a certain fatigue with excessive virtual communication and an appetite for the return of face-to-face relationships at all levels.
For example, webinars have multiplied in all professions and medical training has been no exception, yet while nearly 3 out of 10 doctors would like to receive more invitations to webinars, an equivalent proportion would prefer to receive fewer or none. This contrasts with the interest for in-person medical conferences, of which 6 out of 10 would like to receive more invitations and only 1 out of 10 would like to receive fewer or none.
Likewise, we see that a majority of doctors recognize the sharp drop in visits from representatives of the pharmaceutical industry, but 70% of those interviewed are quite or very interested in receiving these visits.
This does not mean that they want to discontinue non-face-to-face relationships, but rather that face-to-face visits emerge as an indispensable factor that they imagine should be part of the future relationship between doctors and the industry.
Half call for a return to a format based primarily on face-to-face relationships and an almost similar proportion favor a format that combines face-to-face and virtual ones. Only 6% choose a future made exclusively of virtual connections.
In summary, the pandemic has profoundly modified the landscape of the healthcare system and the relationship between its participants.
Undoubtedly, the current situation shows a reversal of several trends, while others seem to persist further, and the challenge for the different actors will be how to better integrate hybrid relationship models that can take advantage of the benefits of technology with the face-to-face approaches generally preferred by healthcare professionals all over Latin America. This is valid for patient care but also for prescription, training, and interaction with the pharmaceutical industry.
The evidence provided by this survey strongly supports the need for policies aimed at mitigating the multiple consequences of the pandemic on the population health. This goes beyond the efforts – very necessary but also insufficient – of COVID vaccination and treatment, to include support to the healthcare system in order to deal with low adherence, late diagnosis, post covid syndrome, increased restrictions to healthcare access and emotional vulnerabilities.
Finally, the data also reinforce evidences of the increased burn out risk in the profession and the need to create specific policies aimed at “caring for those who care for us” as an urgent priority.
* We want to acknowledge and thank Forsta for the support with the technology used for this project