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COVID-19 Pandemic Adversely Affects the Provision of Desired Newborn Circumcision: Perinatal Physician Perspectives
Lauren E Corona1,2, Ilina Rosoklija1, Ryan F Walton1
1Division of Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
Insights
The COVID-19 pandemic adversely affected newborn circumcision care, altering workflow, staffing, and settings. These changes may permanently impact policy and delivery systems for this common procedure.
Area of Science:
- Medical Practice
- Public Health
- Qualitative Research
Background:
- Newborn circumcision is common in the US, with optimal benefits and safety when performed in the neonatal period.
- The COVID-19 pandemic significantly disrupted healthcare delivery across various services.
- The pandemic's impact on newborn circumcision provision was largely unknown prior to this study.
Purpose of the Study:
- To explore physician perspectives on providing newborn circumcision care.
- To identify and analyze pandemic-related changes affecting newborn circumcision delivery.
- To understand the implications of these changes for future healthcare policy.
Main Methods:
- Qualitative study using semi-structured interviews with perinatal physicians.
- Interviews conducted between April 2020 and July 2020 in a large urban city.
- Verbatim transcription and qualitative coding of interview data.
Main Results:
- Nearly half of interviewed physicians reported pandemic-related impacts on newborn circumcision care.
- Eight pandemic-related sub-themes were identified, including workflow, staffing, and procedural settings.
- Most identified changes had adverse effects on the provision of newborn circumcisions.
Conclusions:
- The COVID-19 pandemic introduced significant, often negative, changes to newborn circumcision care delivery.
- Some pandemic-induced modifications may persist, necessitating policy adaptation.
- Healthcare systems and policymakers must redesign processes for delivering newborn circumcision care.
Abstract:
Over half of boys in the United States undergo circumcision, which has its greatest health benefits and lowest risks when performed during the newborn period under local anesthesia. The COVID-19 pandemic has affected delivery of patient care in many ways and likely also influenced the provision of newborn circumcisions. Prior to the pandemic, we planned to conduct a qualitative study to ascertain physician perspectives on providing newborn circumcision care. The interviews incidentally coincided with the onset of the pandemic and thus, pandemic-related changes emerged as a theme. We elected to analyze this theme in greater detail. Semi-structured interviews were conducted with perinatal physicians in a large urban city from 4/2020 to 7/2020. Physicians that perform or counsel regarding newborn circumcision and physicians with knowledge of or responsibility for hospital policies were eligible. Interviews were transcribed verbatim and qualitative coding was performed. Twenty-three physicians from 11 local hospitals participated. Despite no specific COVID-19 related questions in the interview guide, nearly half of physicians identified that the pandemic affected delivery of newborn circumcision care with 8 pandemic-related sub-themes. The commonest sub-themes included COVID-19 related changes in: (1) workflow processes, (2) staffing and availability of circumcision proceduralists, and (3) procedural settings. In summary, this qualitative study revealed unanticipated COVID-19 pandemic-related changes with primarily adverse effects on the provision of desired newborn circumcisions. Some of these changes may become permanent resulting in broad implications for policy makers that will likely need to adapt and redesign the processes and systems for the delivery of newborn circumcision care.
