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BACKGROUND The COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge of hospitalizations. There have been concerns that care deferral may have negative health effects and hopes telemedicine could provide a viable alternative. OBJECTIVE To measure the extent and reason for care deferral during a health system shutdown, to understand whether telemedicine was acceptable as a care delivery alternative and to estimate whether acceptance of telemedicine had changed during the shutdown. METHODS Cross-sectional analysis of survey responses from 1,694 primary care patients in a mid-sized northeastern city. The survey was conducted during the \'lock down\' and while the healthcare system was shut down except for care that could not be delayed. Our mains outcome was respondent report of telemedicine use and care deferral during the shutdown. RESULTS : Deferred care is widespread - nearly half of respondents deferred care - but it was largely for preventive services, particularly dental and primary care, and did not cause concern about negative health effects. A quarter of those who delayed care were concerned about the health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic and was overwhelmingly viewed as a viable option to deliver deferred care, particularly by those over age 65, female and college educated. Mental health services stood out for high levels of deferred care. CONCLUSIONS Temporary health system shutdowns will necessarily lead to deferred care. However, much of the deferral will be for preventive services. The health effect can be moderated by prioritizing surgical and orthopedic services and moving other service lines to telemedicine. The need for telemedicine options is particularly acute for mental health services. CLINICALTRIAL
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JMIR_public_health_and_surveillance
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COVID-19, Deferred Care and Telemedicine: A Problem, A Solution and a Potential Opportunity.
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