The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

  1. Annarita Botta
  2. Gianmarco Lugli
  3. Matteo Maria Ottaviani
  4. Guido Ascione
  5. Alessandro Bruschi
  6. Federico Cagnazzo
  7. Lorenzo Zammarchi
  8. Paola Romagnani
  9. Tommaso Portaluri

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background Italy has been one of the countries most affected by the SARS-CoV-2 pandemic and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. We investigated the management of non-COVID-19 patients across all medical specialties in Italy. Methods A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from 20 February to 22 June, 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialties in combination with our geographical focus (Italy) and COVID-19. Results Of the 4643 potentially eligible studies identified by the search, 247 studies were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialties have been affected by the reorganization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine.   Conclusions Our work highlights the changes taking place in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyze future directions for the healthcare system in the case of new pandemic scenarios.  

Article activity feed

  1. Version published to 10.4084/mjhid.2022.012
  2. ScreenIT

    SciScore for 10.1101/2020.09.17.20192088: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    6 The search was conducted on 22 June 2020 on three different databases: PubMed, Embase, and Scopus without any date restriction.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    The databases were queried via an R script on their respective APIs, checked and cleaned for duplicates (via title, DOI and/or database id), and exported into Excel.
    Excel
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We strongly encourage to overcome these limitations to further promote the multiple opportunities of TM in tune with its pivotal role during the second phase of COVID-19 pandemic in Italy263. One limitation of this systematic review is the heterogeneity in publication type, which prevented the execution of a meta-analysis to summarize the findings together with a quality assessment. Another important issue is the potential underreporting, although the studies did cover experiences from the whole country. Our work thus suggests that a public health crisis has resulted from the pandemic, a concern raised in other countries too, such as France.259 More detailed, population-based studies are needed to assess whether emergency management benefited from the reorganization adopted. Nevertheless, the hub-and-spoke system and telemedicine undoubtedly played – and continue to play – a crucial role in dealing with non-deferrable and deferrable conditions, respectively.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.09.17.20192088v2 on medRxiv
  4. Version published to 10.1101/2020.09.17.20192088v1 on medRxiv