The impact of the COVID-19 pandemic on urban-rural outpatient primary care utilisation in Malaysia: a retrospective time series and spatiotemporal analysis

BACKGROUND: The COVID-19 pandemic significantly affected healthcare utilisation worldwide, underscoring the importance of monitoring it to indicate whether essential health services were maintained during crises. This study explored how the pandemic affected outpatient department (OPD) utilisation in public primary care facilities in Malaysia by analysing utilisation trends and comparing it across geographical regions, including urban-rural disparities.

METHODS: Monthly OPD attendance from 1,053 public primary care health clinics in Malaysia, from January 1, 2019, to June 30, 2021, was analysed. The study duration was divided into four distinct periods: pre-pandemic, pandemic with the first lockdown implementation, pandemic after the first lockdown was lifted, and pandemic with the second lockdown implementation. An interrupted time series analysis was conducted to assess the impact of different interventions at national, regional, urban-rural, and district levels. Data were then aggregated at the district level and the utilisation changes were visualised in a choropleth map. Additionally, simple linear regression (SLR) was performed to explore the association between utilisation changes and urbanisation rates of the district, for each period.

RESULTS: Nationally, OPD utilisation dropped by nearly 13% at the onset of the first lockdown and continued to decline by almost 24% monthly thereafter. In terms of urban-rural differences, urban areas in the Central and Eastern Regions showed greater fluctuations in OPD utilisation during different periods. Results from the SLR revealed that higher urbanisation rates were associated with more pronounced changes in utilisation, although the direction of these changes varied across time periods.

CONCLUSION: The OPD utilisation was affected during the COVID-19 and sporadic urban-rural differences were observed in some areas of the country. This study offers important insights into the geographic and urban-rural patterns of healthcare utilisation during the pandemic, which are crucial in improving healthcare equity in Malaysia.