Offering advice and support for smoking, obesity, excess alcohol, and physical inactivity is an evidence-based component of primary care. The objective was to quantify the impact of the pandemic on the rate of advice or referral for these four risk factors. A retrospective cohort study using primary care data from 1847 practices in England and 21,191,389 patients contributing to the Oxford Clinical Informatics Digital Hub. An interrupted time series analysis was undertaken with a single change point (March 2020). Monthly trends were modelled from 1st January 2018 – 30th June 2022 using segmented linear regression. There was an initial step reduction in advice and referrals for smoking, obesity, excess alcohol, and physical inactivity in March 2020. By June 2022, advice on smoking (slope change −0.02 events per hundred patient years/month (EPH/month); 95% confidence interval (CI) -0.17, 0.21), obesity (0.06 EPH/month; 95% CI 0.01, 0.12), alcohol (0.02 EPH/month; 95% CI -0.01, 0.05) and physical inactivity (0.05 EPH/month; 95% CI 0.01, 0.09) had not returned to pre-pandemic levels. Similarly, smoking cessation referral remained lower (0.01 EPH/month; 95% CI -0.01, 0.09), excess alcohol referral returned to similar levels (0.0005 EPH/month; 95% CI 0.0002, 0.0008), while referral for obesity (0.14 EPH/month; 95% CI 0.10, 0.19) and physical inactivity (0.01 EPH/month; 95% CI 0.01, 0.02) increased relative to pre-pandemic rates. Advice and support for smoking, and advice for weight, excess alcohol and physical inactivity have not returned to pre-pandemic levels. Clinicians and policy makers should prioritise preventive care in COVID-19 recovery plans.

中文翻译：

---

COVID-19 大流行如何影响预防性医疗保健的提供？ 2018年至2022年英国初级保健成年人的间断时间序列分析

为吸烟、肥胖、过量饮酒和缺乏身体活动提供建议和支持是初级保健的循证组成部分。目的是量化大流行对这四个风险因素的建议或转诊率的影响。这是一项回顾性队列研究，使用来自英格兰 1847 个诊所的初级保健数据以及牛津临床信息学数字中心贡献的 21,191,389 名患者。对单个变化点（2020 年 3 月）进行了中断时间序列分析。使用分段线性回归对2018年1月1日至2022年6月30日期间的每月趋势进行建模。 2020 年 3 月，针对吸烟、肥胖、过量饮酒和缺乏身体活动的建议和转诊初步减少。到 2022 年 6 月，关于吸烟的建议（斜率变化 -0.02 事件每百名患者年/月（EPH/月）； 95% 置信区间 (CI) -0.17, 0.21）、肥胖（0.06 EPH/月；95% CI 0.01, 0.12）、酒精（0.02 EPH/月；95% CI -0.01, 0.05）和缺乏身体活动（0.05 EPH/月）月；95% CI 0.01，0.09）尚未恢复到大流行前的水平。同样，戒烟转介仍然较低（0.01 EPH/月；95% CI -0.01, 0.09），过量饮酒转介恢复到类似水平（0.0005 EPH/月；95% CI 0.0002, 0.0008），而肥胖转介（0.14 EPH）每月；95% CI 0.10，0.19）和缺乏身体活动（0.01 EPH/月；95% CI 0.01，0.02）相对于大流行前的比率有所增加。对吸烟的建议和支持，以及对体重、过量饮酒和缺乏身体活动的建议尚未恢复到大流行前的水平。临床医生和政策制定者应在 COVID-19 康复计划中优先考虑预防性护理。