Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals

Boost your health (Refuerza tu Salud): Design of a randomized controlled trial of a community health worker intervention to reduce inequities in COVID-19 and influenza vaccinations

INTRODUCTION

Low-income and underserved populations, especially racial and ethnic minorities, experience health disparities linked to social determinants. The COVID-19 pandemic amplified these disparities, necessitating effective strategies to address structural racism and related factors. Vaccination, crucial for mitigating infectious diseases, including COVID-19 and influenza, remains challenging among underserved populations. Community health worker (CHW) interventions show promise in addressing these disparities but have not undergone rigorous evaluation with a randomized controlled trial to increase vaccination uptake among underserved populations. This study develops and evaluates a CHW vaccination behavior (CHW-VB) intervention to increase COVID-19 and influenza vaccination among adult patients in primary care settings.

METHODS

Tailoring of the Boost Your Health (Refuerza tu Salud) intervention is grounded in behavior change theory and integrates input from a Community Advisory Board. The study employs a patient randomized controlled trial design to test the effectiveness the CHW-VB intervention compared with usual care across six Federally Qualified Health Centers (FQHCs) in New York. Patients are being screened for eligibility (vaccinated but not up to date with the COVID-19 vaccine and have at least one of seven common chronic illnesses) and 800 are assessed at baseline and three months. Outcomes include COVID-19 vaccine (primary) and influenza vaccine (secondary) uptake. The study also evaluates intervention implementation using the RE-AIM model.

CONCLUSION

Boost Your Health aims to increase COVID-19 and influenza vaccination among racially/ethnically diverse, underserved populations with chronic illness through the CHW-VB intervention, targeting critical gaps in vaccination uptake to reduce health disparities and increase health equity.

TRIAL REGISTRATION

(ClinicalTrials.govNCT06156254).

Social isolation and loneliness in non-communicable chronic diseases: Impact of COVID-19 pandemic, population aging and technological progress

AIMS

Social isolation and loneliness have increasingly emerged as closely linked to onset and progression of non-communicable chronic diseases (NCDs). The aim of this review is to highlight the importance of addressing social isolation in the prevention and management of NCDs such as obesity, type 2 diabetes, and cardiovascular diseases in order to hinder their development and improve their outcomes.

DATA SYNTHESIS

Social isolation and loneliness affect a significant portion of the older adult population, due to decrease in social interactions, chronic illnesses and sensory impairments. However, many other vulnerable populations may experience social isolation because of psychiatric or disabling health conditions, substances abuse, low socioeconomic status, unemployment and belonging to ethnic or marginalized minorities. The unprecedented COVID-19-related social distancing can be taken as a proof-of-concept of the detrimental role of poor interactions in NCDs prevention and management not only at individual level but also in a public health perspective. Indeed, social isolation has been linked to unhealthy lifestyle choices, disrupted sleep quality, low utilization of healthcare, preventive services and adherence to treatments. Underlying mechanisms like inflammation and stress responses may also play a role in the association between social isolation and worse NCDs outcomes.

CONCLUSIONS

Social isolation negatively impacts on the development, progression and management of NCDs. Effective interventions for social isolation should address both societal factors and healthcare-related needs. To counteract the detrimental effects of social distancing during COVID-19 pandemic, the use of telemedicine was implemented. However, telemedicine is not always available, and legislative and age-related barriers persist.

Determination of Emotions, Thoughts, Behaviors, and Quality of Life of Individuals in a COVID-19 Vaccine Clinic

OBJECTIVES

COVID-19 caused individual and social measures to be taken at the global level, and changed the social life, especially due to effects on interpersonal relations, the environment, and psychological and physical conditions. It was aimed to determine the feelings, thoughts, and behaviors related to the disease and the quality of life of people who applied to the COVID-19 vaccine unit of a state hospital.

METHODS

Descriptive and cross-sectional research was carried out with 360 individuals. Data collection tools were the Individual Information Form, Multidimensional COVID-19 Scale, and Impact of COVID-19 on Quality of Life Scale. Statistical analysis of the data was made using SPSS 20.0.

RESULTS

Multidimensional COVID-19 and Quality of Life Scale mean scores were found to be 80.50±18.14 and 3.16±1.00, respectively. A positive correlation was determined between the emotions, behavior, and thoughts related to COVID-19 and Quality of Life Scale.

CONCLUSIONS

Considering society's perceptions of COVID-19 and the impact of the pandemic process on quality of life, it was thought that the trainings carried out by nurses and other health professionals may affect the adaptaion of protective processes related to COVID-19.

Healthcare Resource Utilization and Costs in Individuals Who Discontinue Liraglutide and Who Switch from Liraglutide to Once-Weekly Injectable Semaglutide

INTRODUCTION

This study evaluated healthcare resource utilization (HCRU) and costs in the USA for people with type 2 diabetes (T2D) who discontinued the injectable glucagon-like peptide 1 receptor agonist (GLP-1 RA) once-daily liraglutide for T2D (with no other glucose-lowering agent added) or switched from liraglutide to the GLP-1 RA once-weekly semaglutide for T2D.

METHODS

In this observational cohort study, we utilized claims data (Merative MarketScan [Merative, Ann Arbor, MI, USA] Commercial and Medicare Database; January 1, 2017-March 31, 2021) to compare HCRU and costs between individuals who discontinued liraglutide ("discontinuers") and those who switched from liraglutide to semaglutide ("switchers"). Patients were indexed between January 1, 2018 and March 31, 2020. Outcomes were compared between discontinuers and switchers over the 360-day post-index period using stabilized inverse probability of treatment weighting.

RESULTS

Characteristics of the two cohorts were balanced after weighting. Switchers had significantly lower HCRU in inpatient and emergency department (ED) settings compared with discontinuers. Mean [standard deviation] total medical costs were significantly lower for switchers ($8513 [$18,931]) than for discontinuers ($13,585 [$52,011], p < 0.001), driven by reduced inpatient costs (2.6 times lower) and ED costs (1.6 times lower).

CONCLUSION

This analysis demonstrates that the cohort of people switching from liraglutide to semaglutide was associated with significantly lower HCRU and costs when compared with people discontinuing liraglutide only. These findings imply that switching to semaglutide could be a good option for people with T2D for whom liraglutide is no longer optimal.

The impact of COVID-19 pandemic on hospitalization rate, clinical impairment and mortality of cirrhotic patients

The COVID-19 pandemic caused widespread disruption to global healthcare systems, necessitating the reallocation of resources to address the immediate demands. This reorganization had significant repercussions on the management of chronic diseases, including cirrhosis. We sought to provide a comprehensive picture of the COVID-19 impact on monthly hospitalization rates of cirrhotic patients at Local Health Board 1 hospitals in the Abruzzo Region, Italy. Using the International Classification of Diseases, Ninth Revision, we identified cases of alcohol-related, nonalcohol-related, biliary, and decompensated cirrhosis. We analyzed 957 Hospital Discharge Records from January 1 to December 31, 2019 (pre-pandemic), and from January 1 to December 31, 2022 (post-pandemic). We evaluated patients' clinical impairment, length of stay, and mortality before and after the pandemic. We identified 494 hospitalizations for nonalcohol-related cirrhosis and 310 for alcohol-related cirrhosis. As key findings, hospitalizations for nonalcohol-related cirrhosis decreased (69% vs. 48%; p < .0001), while hospitalizations for alcohol-related cirrhosis increased (31% vs. 52%; p < .0001), in the post-pandemic period. Additionally, there was a significant rise in decompensated patients with alcohol-related cirrhosis post-COVID (77% vs. 65%; p = .0216). Mortality risk increased for both nonalcohol- (11% vs. 18.5%; p = .0176) and alcohol-related cirrhosis (7.7% vs. 18%; p = .0059) in the post-pandemic era. The increase in hospitalizations for alcohol-related cirrhosis is alarming and likely to have a prolonged impact on the natural history of liver diseases. There is an urgent need to reduce alcohol consumption at the population level. Continued awareness and personalized follow-up are essential for guaranteeing the standard of care during health emergencies.

Trajectories of sleep disturbance and self-management of chronic conditions during COVID-19 among middle-aged and older adults

The COVID-19 pandemic has had a widespread impact on sleep quality, yet little is known about the prevalence of sleep disturbance and its impact on self-management of chronic conditions during the ongoing pandemic. To evaluate trajectories of sleep disturbance and their associations with one's capacity to self-manage chronic conditions. A longitudinal cohort study linked to 3 active clinical trials and 2 cohort studies with 5 time points of sleep data collection (July 15, 2020-May 23, 2022). Adults living with chronic conditions who completed sleep questionnaires for two or more time points. Trajectories of self-reported sleep disturbance across 5 time points. Three self-reported measures of self-management capacity, including subjective cognitive decline, medication adherence, and self-efficacy for managing chronic disease. Five hundred and forty-nine adults aged 23 to 91 years were included in the analysis. Two-thirds had 3 or more chronic conditions; 42.4% of participants followed a trajectory of moderate or high likelihood of persistent sleep disturbance across the study period. Moderate or high likelihood of sleep disturbance was associated with age < 60 (RR 1.57, 95% CI 1.09, 2.26, P = 0.016), persistent stress (RR 1.54, 95% CI 1.16, 2.06, P = 0.003), poorer physical function (RR 1.57, 95% CI 1.17, 2.13, P = 0.003), greater anxiety (RR 1.40, 95% CI 1.04, 1.87, P = 0.03) and depression (RR 1.63, 95% CI 1.20, 2.22, P = 0.002). Moderate or high likelihood of sleep disturbance was also independently associated with subjective cognitive decline, poorer medication adherence, and worse self-efficacy for managing chronic diseases (all P < 0.001). Persistent sleep disturbance during the pandemic may be an important risk factor for inadequate chronic disease self-management and potentially poor health outcomes in adults living with chronic conditions. Public health and health system strategies might consider monitoring sleep quality in adults with chronic conditions to optimize health outcomes.

Socio-structural and direct health challenges related to illness management among patients with type 2 diabetes in Kenya and Tanzania during the COVID-19 pandemic: A qualitative inquiry

During COVID-19, people with type 2 diabetes (T2D) experienced increased vulnerability, including severe COVID-19 complications, disruptions in diabetes management, and social isolation. These aspects were heightened in many sub-Saharan African countries, such as Kenya and Tanzania, where healthcare systems already face critical challenges in coping with increasing non-communicable diseases (NCDs). Little is known about how people with T2D in these countries managed their diabetes or how the different approaches to COVID-19 control (Kenya imposed lockdown and curfew, whereas Tanzania adopted less strict measures) impacted their T2D management. This qualitative study aimed to compare the accounts of T2D patients in both countries to examine similarities and differences in the illness management challenges they faced during the COVID-19 pandemic.Semi-structured interviews were conducted with 52 patients (Kenya, n=22; Tanzania, n=30), and the transcripts were analyzed thematically. Despite different COVID-19 control measures, patients in both countries faced similar direct health challenges, such as difficulties accessing diabetic consultations and treatment, but they also experienced distinct socio-structural challenges. Direct health challenges included difficulties in accessing diabetic consultations and treatment, limited availability of diabetic medicine at health facilities and mental health distress. These were exacerbated by socio-structural challenges, many of which pre-dated COVID-19 but intensified during the pandemic. These included closure of diabetic clinics in Dar es Salaam, business instability, financial difficulties, health insurance challenges, higher food prices impacting patients' adherence to T2D dietary recommendations (in both countries), and price inflation of diabetic medicine and test kits (in Kenya). Together, these challenges led to patients practicing self-medication, missing doses and resulted in poor blood sugar control. People with T2D in Kenya and Tanzania have described similar illness management challenges. In both countries, future contingency planning is essential to ensure adequate routine management of T2D and to improve access to care in emergency situations. Affordable comprehensive health insurance, economic support, and psychosocial services are required to increase patient resilience and support the health and wellbeing of people with T2D.

The influence of COVID-19 on health seeking behaviors among students attending a minority-serving institution in the U.S

Objective: The goal of this research was to examine the effects of COVID-19 on health seeking behaviors among students attending a minority-serving institution (MSI). Participants: Students [N = 580, Mage (SD) = 27.7 ± 9.1 years] from a midsized university in the U.S. Methods: Cross-sectional survey, distributed between February-March 2021, assessing visits with a healthcare professional before and during the pandemic. Comparison by time and between groups using McNemar's test and ordinal logistic regression. Results: In-person medical care decreased during the pandemic (p = 0.096). Higher frequency of doctor visits pre-pandemic resulted in less contact with students' healthcare providers during the pandemic (p < 0.001). Those that indicated their health status as Excellent were mostly likely to visit their healthcare provider in-person during the pandemic (p = 0.026). Virtual contacts with their healthcare provider increased during the pandemic (p < 0.001). Conclusions: The COVID-19 pandemic has changed health seeking behaviors among students attending an MSI.

Diabetes disparities in diabetes health care access and outcomes during the COVID-19 pandemic in the United States

OBJECTIVES

To investigate the impact of COVID-19 on hospitalization and consequent diabetes-related complications in patients with type 2 diabetes mellitus (diabetes).

METHODS

We conducted a retrospective cohort study of patients with diabetes. Interrupted time series analysis (ITS) was used to analyze the monthly trends in diabetes-related hospitalization rates, including short- and long-term complications, 1-year before and after onset of COVID-19.

RESULTS

Persons with diabetes experienced a significant (p < 0.001) rapid drop in monthly hospital admission rates at onset of COVID-19, then rose significantly (p = 0.003) to higher than pre-COVID-19 levels. Older age, lower education, and income levels were associated with higher base-level monthly hospital admission rates and a greater rate reduction at COVID-19 onset. ITS analysis showed monthly hospital admission rates from short-term complications surged to higher level 6 months after COVID-19 onset. Hospital admissions due to long-term complications decreased immediately post-COVID-19, but rose significantly (p < 0.001) to higher than pre-COVID levels, with patients experiencing higher nephropathy, angiography, and dermatological complications post-COVID-19.

CONCLUSION

COVID-19 had a negative impact on diabetes-related hospitalization access, resulting in increased short- and long-term complications. Long-term effects of deferred care due to COVID-19 on diabetes-related complications may persist, emphasizing the need for continued education toward improved diabetes self-management.

Impact of the COVID-19 Pandemic and Control Measures on Screening and Diagnoses of Type 2 Diabetes in British Columbia

INTRODUCTION

In British Columbia (BC), Canada, COVID-19 and associated control measures impacted routine care for patients with diabetes. Some of these measures may have impacted timely screening and diagnosis of type 2 diabetes. We assessed the impact of control measures on screening and diagnosis of type 2 diabetes in BC.

METHODS

We used data from the BC COVID-19 Cohort, which includes COVID-19 and healthcare administrative data on all residents of BC. We assessed and compared screening (≥40 yrs) and diagnosis (≥18 yrs) of diabetes among the adult population during the pandemic period (1 April 2020-31 December 2022), with 1 January 2016-31 March 2020 used as a historical reference period. We used interrupted time series with generalized additive models to evaluate the impact of policy measures on screening and diagnoses trends.

RESULTS

We observed an initial decline in the mean number of screenings and diagnoses. In the third post-policy phase (January 2022-December 2022), there was a 4.8% (-5.1, 15.4) increase in screenings while after an initial reduction in diabetes diagnoses, we observed a significant increase of 31.6% (17.8, 46.6) in the third post-policy phase. Further stratification by age and sex showed the entire increase in diagnoses trends was driven by younger females with a 56.4% (25.1, 92.9) and 58.7% (38.2, 81.3) increment in diagnoses in the 18-29 and 40-49 age groups, respectively.

CONCLUSIONS

The initial reduced number of screenings and diagnoses followed by the significant upward trend in diabetes diagnoses in the later post-policy phase have important clinical and public health implications. Further research is needed to understand the post-pandemic increase in diabetes among females.

What can be learned from the impact of the COVID-19 crisis on work participation among people with work disabilities? A qualitative practice & policy perspective approach

BACKGROUND

Previous studies among people with work disabilities (WD) showed that during the COVID-19 pandemic they were at risk for negative outcomes on work participation and health. These studies focused on people's own accounts of their difficulties to work and did not include the policy and practice perspective. The aim of the present study was to explore the policy and practice perspective on what can be learned from the impact of the COVID-19 crisis, and what is needed to enhance work participation among people with WD, in times of crisis and beyond.

METHODS

We used a multi-stakeholder perspective qualitative approach. Between March 2021 and September 2022, twenty-five semi-structured in-depth online interviews were conducted with occupational health professionals (13), employers (7) and policymakers (5). Participants were asked to share their experiences about employees or job seekers with work disabilities on (re)gaining and maintaining paid employment, barriers and facilitators for work participation during the Covid-19 crisis and what is needed to enhance work participation among people with WD in times of crisis and beyond. Data were analysed using thematic content analysis.

RESULTS

The results indicated that, although employers rapidly implemented new working arrangements, people with WD had a vulnerable labour market position during the COVID-19 crisis, especially those with temporary contracts. Job loss and detrimental effects on mental health were identified. Other barriers to work participation included hampered collaboration between stakeholders during lockdowns and fewer job opportunities due to workplace shutdowns. Nevertheless, employers and occupational health professionals noticed that some employees were surprisingly flexible and capable with regard to performing alternative work tasks. We also identified ways to improve work participation for people with WD, including simplifying legislation and establishing sustainable policies on employment, investing in career development, creating an inclusive organizational culture and increasing accessibility to information and support assistance.

CONCLUSIONS

People with WD had a vulnerable labour market position during the COVID-19 crisis. The introduction of new working arrangements became widespread during the COVID-19 crisis, which had both positive and negative consequences for people with WD. Our results showed that improving work participation for people with WD requires a multifaceted approach, which can be achieved by the practical and policy recommendations offered by this study.

Association between nap time, nighttime sleep, and multimorbidity in Chinese older adults: a cross-sectional study

OBJECTIVE

This study aims to explore the relationship between sleep duration and multimorbidity among elderly Chinese and to determine the optimal sleep duration for preventing multimorbidity.

METHODS

This study is based on data from the 2020 China Health and Elderly Care Longitudinal Survey (CHARLS), which collected detailed information from 5,761elderly individuals, including demographic characteristics, sleep duration, health status, and lifestyle information. Logistic regression models were used to investigate the relationship between sleep duration and multimorbidity, and restricted cubic spline analysis was employed to analyze the dose-response relationship between sleep duration and multimorbidity.

RESULTS

After adjusting for potential confounders, a U-shaped association was found between nighttime sleep duration and the likelihood of multimorbidity among the elderly. Specifically, elderly individuals with a nighttime sleep duration of 7 h had the lowest incidence of multimorbidity. Compared to those with 6-8 h of nighttime sleep, elderly individuals with less than 6 h (OR = 1.24, 95% CI: 1.05-1.48) or more than 8 h (OR = 1.79, 95% CI: 1.37-2.34) of nighttime sleep had a 24% and 79% increased likelihood of multimorbidity, respectively. The restricted cubic spline analysis further confirmed this U-shaped relationship, showing that the likelihood of multimorbidity gradually decreased as sleep duration increased from 6 to 7 h, but gradually increased as sleep duration exceeded 7 h. Additionally, a positive correlation was found between napping habits and the likelihood of multimorbidity, with elderly individuals without napping habits having a lower likelihood of multimorbidity compared to those with napping habits. Subgroup analysis indicated no significant differences in the impact of 6-8 h of nighttime sleep on multimorbidity among male and female elderly individuals and different age groups.

CONCLUSION

Appropriate nighttime sleep duration may be an important factor in preventing multimorbidity among the elderly, while increased napping duration may increase the likelihood of multimorbidity. These findings provide scientific evidence for sleep health management among the elderly, suggesting the promotion of appropriate sleep duration to reduce the likelihood of multimorbidity in this population.

Prescription for change: Unveiling burnout perspectives among pharmacy leaders

Background

Burnout among pharmacists is increasingly pertinent, with growing demand for effective interventions. Burnout can lead to reduced productivity, increased job turnover, medical errors, poor patient satisfaction, and other negative outcomes for patients and providers. Growing attention to burnout in the pharmacy profession highlights the need for personal, organizational, and systemic solutions. However, the uptake and relative efficacy of different approaches remain unclear, particularly within community pharmacy practice. This study sought the viewpoint of community pharmacy leaders (i.e., community pharmacy managers, district managers, franchisees, owners, and executives from various pharmacy organizations) to characterize burnout from their perspectives.

Methods

This qualitative study followed a grounded theory approach. Community pharmacy leaders were interviewed using a semistructured format to gather in-depth insights into their experiences and perspectives on burnout and engagement.

Results

Sixteen people were interviewed; interviews lasted 30 to 65 minutes, averaging 51 minutes long. Six themes were identified: perceived disconnection between front-line staff and pharmacy decision-makers, overwhelming work demands, cautious optimism toward the expanding scope of pharmacy practice, the importance of employee recognition and appreciation, appropriateness and use of existing work resources, and multimodal, systemic responsibility and solutions to burnout.

Conclusion

Addressing burnout requires a multifaceted approach involving personal, organizational, and systemic interventions. Evidence from this study provides valuable insights into the feasibility and efficacy of specific interventions, informing future strategies to enhance workplace well-being and engagement. The study highlights the importance of managing job demands and maximizing resources, emphasizing that personal approaches alone are insufficient and that organizational and systemic interventions are crucial.

Sickness presenteeism, job burnout, social support and health-related productivity loss among nurses in the Chinese nurses' health cohort study (TARGET): A cross-sectional survey

BACKGROUND

Sickness presenteeism has potential negative impacts on job burnout and health-related productivity loss among clinical nurses, whereas social support has been identified as a potential mitigating factor for such impacts. However, there is limited evidence regarding the relationships and mechanisms between sickness presenteeism, job burnout, social support, and health-related productivity loss.

OBJECTIVE

To explore the role of job burnout and social support in the association between sickness presenteeism and health-related productivity loss among female nurses.

DESIGN

A cross-sectional study.

SETTING(S)

105 hospitals conveniently selected from 36 cities in 15 provinces in China.

PARTICIPANTS

50,653 registered female nurses.

METHODS

This study utilizes the cross-sectional data from the baseline survey of the Chinese nurses' health cohort study (Towards A Revolution in GETting nurses' health ticked, TARGET), conducted from December 2020 to February 2024. Variables were measured using the Sickness Presenteeism Questionnaire, Stanford Presenteeism Scale, Maslach Burnout Inventory, and Perceived Social Support Scale. Data analyses were performed using independent sample t-tests, Pearson correlation analysis, one-way analysis of variance, multivariate linear regression analysis, and the Process 4.0 macro plug-in method.

RESULTS

A total of 42,843 valid questionnaires were collected with an 85% response rate. The incidence of sickness presenteeism among female nurses was 62 %. Sickness presenteeism was positively correlated with job burnout and health-related productivity loss, and job burnout was also positively correlated with health-related productivity loss. Conversely, social support was negatively associated with sickness presenteeism, job burnout and health-related productivity loss. The findings showed that the association between sickness presenteeism and health-related productivity loss was partially mediated by job burnout. Moreover, the direct and indirect effects within the mediation model were moderated by social support. When levels of social support were high, the impact of sickness presenteeism on job burnout and health-related productivity loss was weaker, as was the impact of job burnout on health-related productivity loss.

CONCLUSIONS

Hospital administrators and nurses themselves can mitigate the adverse effects of sickness presenteeism on health-related productivity loss by alleviating job burnout and increasing levels of social support. By addressing these significant challenges, they can more effectively manage the consequences of sickness presenteeism and job burnout among nurses.

REGISTRATION

The protocol of TARGET was registered in the China Clinical Trial Registry (ChiCTR2100043202).

TWEETABLE ABSTRACT

The study analyses TARGET data to explore the mechanisms between sickness presenteeism and health-related productivity loss.

Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania

BACKGROUND

The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services.

OBJECTIVES

We investigated the pandemic's impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania.

METHODS

A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February-April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access.

RESULTS

We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p < 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05-2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22-0.58]; p < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33-0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14-2.88]; p = 0.011).

CONCLUSIONS

COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.

The profound impact of COVID-19 on the control and care of diabetic patients: a comprehensive retrospective cohort study

BACKGROUND

The COVID-19 pandemic has led to a significant shift in healthcare services, focusing on pandemic response and emergency preparedness. The Oman Ministry of Health implemented various measures to combat and control COVID-19. However, this shift disrupted routine outpatient appointments, particularly for chronic diseases such as diabetes mellitus (DM) and hypertension (HTN). This study aims to assess the pandemic's effect on diabetes control, by examining glycated haemoglobin (HbA1c), blood pressure (BP), lipid values (particularly low-density lipoprotein (LDL), body weight/ body mass index (BMI), and comparing these measures to pre-pandemic levels.

METHODS

A retrospective cohort study of 223 people with diabetes (PwD), aged 20-95 years who underwent a blood workup in 2019 and 2020 and were registered in Al-Khuwair Health Centre from March to December 2020. Data was extracted from the Al Shifa 3plus System and National Diabetic Register (NDR), and analyzed using SPSS.

RESULTS

Out of 260 PwD identified, 223 met the inclusion criteria, while 37 were excluded due to recent diagnoses or missing follow-up in 2019. Significant changes were observed in HbA1C, systolic blood pressure (SBP), and BMI from 2019 to 2020. Mean HbA1c increased from 6.9% in 2019 to 7.2% in 2020. Mean SBP rose from 131.22 mmHg in 2019 to 134.84 mmHg in 2020, while mean BMI increased from 30.49 to 30.80. No significant changes were found in LDL levels or diastolic BP.

CONCLUSION

The COVID-19 pandemic disrupted healthcare systems globally, and the consequences on health and mortality were not only due to the direct impact of the virus, but also to the modifications in priorities. These interruptions in inconsistent care, had consequences for non-communicable diseases (NCDs) like diabetes. Future strategic plans should be prepared and implemented to manage NCD cases in case of pandemics.

Impacts of the COVID-19 pandemic on patients with chronic conditions in Vietnam: A cross-sectional study

OBJECTIVES

We assess the impact of the COVID-19 pandemic on health, treatment adherence and expectations of patients with chronic diseases in Vietnam.

METHODS

We conducted a national cross-sectional study using a questionnaire survey, distributed through social networks and presented on Google Forms. The survey was performed during two months of the most stringent social distancing in Vietnam (between 21 July and 21 September 2021).

RESULTS

Most of the participants said that the COVID-19 epidemic had affected their daily activities (91.9%), health (53.6%), sleep behavior (52.3%), and mental health (79.8%). During social distancing in Vietnam, three-quarter could not go to hospitals for periodic health examination; nearly half of respondents did not do daily physical activity; a quarter of respondents did not adhere to recommended diet plan. Factors associated with the effect of the COVID-19 epidemic on patient's health included those living in Ho Chi Minh City (p = 0.015), lived alone (p = 0.027), uncontrolled chronic conditions (p < 0.001), treatment dissatisfaction or experienced anxiety/stress (p < 0.001). Factors associated with medication adherence included the elderly (p = 0.015), having periodic health examination (p = 0.012), direct consultation (p = 0.003), and telemedicine (p = 0.007).

CONCLUSION

This study highlights the urgent need for better chronic management strategies for the new post-COVID era in the future.

Cushing's syndrome and COVID-19

PURPOSE

This review aims to present current data on the course of COVID-19 in patients with Cushing syndrome (CS) and discuss treatment for CS during to the pandemic.

METHODS

Literature review using PubMed (pubmed.ncbi.nlm.nih.gov). The search included the following terms: "COVID19" in combination with "Cushing syndrome", "Hypercortisolism" and "Glucocorticoid".

RESULTS

Chronic hypercortisolism has been reported to increase infectious risk and worsens prognostic of patients with COVID-19 potentially due to its direct impact on the immune system: lymphopenia, impairment of monocytes and neutrophils activity, diminution of complement activation. Main metabolic complications of CS - i.e. diabetes, hypertension and obesity - have been recognized as COVID-19 complications risk factors. Patients with CS treated with steroidogenesis inhibitors might experience adrenal insufficiency during COVID-19. Special attention should be paid to patients with CS and COVID-19. The pandemic has impacted - and delayed - care of chronic illnesses including CS. Specific recommendations had been provided during the pandemic: favor telemedicine consultations, limit in-hospital explorations and postpone surgery when feasible.

CONCLUSION

There are enough evidence for an increased prevalence and severity of COVID-19 to recommend a specific attention and caution in patients with CS.

Developing a machine learning model with enhanced performance for predicting COVID-19 from patients presenting to the emergency room with acute respiratory symptoms

Artificial Intelligence is playing a crucial role in healthcare by enhancing decision-making and data analysis, particularly during the COVID-19 pandemic. This virus affects individuals across all age groups, but its impact is more severe on the elderly and those with underlying health issues like chronic diseases. This study aimed to develop a machine learning model to improve the prediction of COVID-19 in patients with acute respiratory symptoms. Data from 915 patients in two hospitals in Saudi Arabia were used, categorized into four groups based on chronic lung conditions and COVID-19 status. Four supervised machine learning algorithms-Random Forest, Bagging classifier, Decision Tree, and Logistic Regression-were employed to predict COVID-19. Feature selection identified 12 key variables for prediction, including CXR abnormalities, smoking status, and WBC count. The Random Forest model showed the highest accuracy at 99.07%, followed by Decision Tree, Bagging classifier, and Logistic Regression. The study concluded that machine learning algorithms, particularly Random Forest, can effectively predict and classify COVID-19 cases, supporting the development of computer-assisted diagnostic tools in healthcare.

The impact of COVID-19 on referrals among general practitioners and specialists in Shanghai, China

BACKGROUND

The COVID-19 pandemic has impacted patient's visits to general practitioners (GPs). However, it is unclear what the impact of COVID-19 has been on the interaction among the local primary care clinics, the GP Department within the hospital and specialists.

METHODS

The interaction among GPs referring to hospital-based specialists and specialists to local doctors was determined, comparing pre-pandemic 2019 and 2020 during the pandemic.

RESULTS

Reduced referrals from GPs to specialists were consistent with the reduction in specialist referrals back to the local doctors, which dropped by approximately 50% in 2020, particularly in the two most common chronic conditions (hypertension and diabetes mellitus).

DISCUSSION

Reduced referral of patients from local clinics to Tongren Hospital is probably due to the extensive online training provided to the local GPs to become more competent in handling local patients via telehealth. Our data provide some insight to assist in combatting the pandemic of COVID-19, offering objective evidence of the impact of COVID-19 on patient management by GPs.

Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review

BACKGROUND

Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge.

OBJECTIVE

We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies.

METHODS

We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included "Asia," "chronic disease," "app," "application," "survey," "experiment," "questionnaire," "group," "medical adherence," "medication adherence," "case-control," "cohort study," "randomized controlled trial," "clinical trial," "observational study," "qualitative research," "mixed methods," and "analysis," combined using logical operators "OR" and "AND." The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use.

RESULTS

The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction.

CONCLUSIONS

This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence.

Self-care practices and associated factors among hypertensive patients at public hospitals in North Shewa zone, Ethiopia

Background

Hypertension significantly contributes to premature mortality worldwide, highlighting the need for effective self-care to manage its complications. However, there is limited research on self-care practices among hypertensive patients in Ethiopia. This study assessed self-care practices and associated factors in hypertensive patients at public hospitals in North Shewa zone, Amhara Region, Ethiopia.

Methods

A hospital-based cross-sectional study was conducted with 450 participants using multi-stage sampling and interviewer-administered questionnaires. Data were processed with Epi-Data 4.6.0.6 and analyzed using SPSS 23. Descriptive statistics summarized the results, while bivariable and multivariable logistic regression identified factors associated with self-care practices. Crude and adjusted odds ratios with 95% confidence intervals were calculated, with significance at p < 0.05.

Results

Out of 450 participants, 231 (51.3, 95% CI: 46.4-55.6%) exhibited poor hypertension self-care practices. Factors associated with poor self-care included having a college-level education (AOR = 0.27, 95% CI: 0.07-0.95), university-level education (AOR = 0.36, 95% CI: 0.13-0.98), being widowed/widower (AOR = 5.30, 95% CI: 1.05-27.2), poor knowledge of hypertension (AOR = 4.51, 95% CI: 2.44-8.59), inadequate stress management (AOR = 3.10, 95% CI: 1.64-5.74), and first diagnosis during a check-up (AOR = 7.72, 95% CI: 4.22-13.8).

Conclusion

This study highlights inadequate self-care among hypertensive individuals, affected by factors such as education, marital status, knowledge, stress management, and diagnostic practices. Personalized interventions focusing on health education, stress management, and proactive screening are essential for improving health outcomes. Additionally, psychological support enhances emotional well-being and self-care engagement in hypertension patients, leading to better health outcomes and quality of life.

Association Between Social Determinants of Health, COVID-19 Stressors, and Mental Health Among New York Residents Early in the Pandemic

OBJECTIVE

The COVID-19 pandemic is a disaster event. Exposure to stressors during and after disaster events is associated with negative mental health symptoms. To inform targeted COVID-19 recovery efforts, data are needed to understand which stressors play a key role in this relationship.

METHODS

Cross-sectional survey data (demographics, impacts of COVID-19, social determinants of health, depression, and anxiety) were collected online from adults living in New York state between May and June 2020. Differences in the proportion of stressors (COVID-19 and social determinants) experienced by race/ethnicity were assessed using chi-square analyses. Logistic regression was used to assess which factors were associated with increased odds of depression and anxiety.

RESULTS

A majority (n = 258, 62.2%) of the 415 respondents reported being directly impacted by the pandemic. Non-white respondents reported a significantly larger proportion of stressors compared to white respondents. Under half of respondents reported depression (n = 171, 41.2%) and anxiety (n = 164, 39.5%). Healthcare and food concerns were associated with increased odds of depression and anxiety, and economic concerns were associated with increased odds of anxiety.

CONCLUSIONS

Findings underscore the need to respond to the COVID-19 mental health crisis by addressing social determinants of health.

Impact of COVID-19 Pandemic on Healthcare Utilization in People with Diabetes: A Time-Segmented Longitudinal Study of Alberta's Tomorrow Project

OBJECTIVE

The objective is to characterize the impact of COVID-19 on major healthcare for diabetes, including hospitalization, emergency department (ED) visits and primary care visits in Alberta, Canada.

METHODS

Participants from Alberta's Tomorrow Project (ATP) with pre-existing diabetes prior to 1 April 2018 were included and followed up to 31 March 2021. A time-segmented regression model was used to characterize the impact of COVID-19 on healthcare utilization after adjusting for seasonality, socio-demographic factors, lifestyle behaviors and comorbidity profile of patients.

RESULTS

Among 6099 participants (53.5% females, age at diagnosis 56.1 ± 9.9 y), the overall rate of hospitalization, ED visits and primary care visits was 151.5, 525.9 and 8826.9 per 1000 person-year during the COVID-19 pandemic (up to 31 March 2021), which means they reduced by 12% and 22% and increased by 6%, compared to pre-pandemic rates, respectively. Specifically, the first COVID-19 state of emergency (first wave of the outbreak) was associated with reduced rates of hospitalization, ED visits and primary care visits, by 79.4% (95% CI: 61.3-89.0%), 93.2% (95% CI: 74.6-98.2%) and 65.7% (95% CI: 47.3-77.7%), respectively. During the second state of emergency, healthcare utilization continued to decrease; however, a rebound (increase) of ED visits was observed during the period when the public health state of emergency was relaxed.

CONCLUSION

The declared COVID-19 states of emergency had a negative impact on healthcare utilization for people with diabetes, especially for hospital and ED services, which suggests the importance of enhancing the capacity of these two healthcare sectors during future COVID-19-like public health emergencies.

COVID-19-related morbidity and mortality in people with multiple long-term conditions: a systematic review and meta-analysis of over 4 million people

OBJECTIVES

To describe the direct impact of coronavirus disease 2019 (COVID-19) infection on morbidity and mortality in people with multiple long-term conditions (MLTCs).

DESIGN

A systematic review and meta-analysis including observational studies.

SETTING

Studies conducted between 1 January 2020 and 4 May 2023 across 51 countries were identified from five databases.

PARTICIPANTS

A total of 4,084,469 patients with confirmed COVID-19 infection.

MAIN OUTCOME MEASURES

Pooled risk ratios (RRs) for mortality, hospitalisation, severe disease, intensive care unit (ICU) admission and mechanical ventilation were estimated with random effect meta-analysis models.

RESULTS

A total of 38,356 studies were identified and 111 included. In most (74%) of the studies, MLTCs referred to having two or more long-term conditions. Others described MLTCs by high weighted indices: the Charlson Comorbidity Index in 11% and the Clinical Frailty Score in 7%. Using the National Institutes of Health quality assessment tool for observational studies, the risk of bias was judged as low and moderate in 86 and 25 studies, respectively. Having MLTCs was associated with increased mortality (RR: 2.61 [95% CI: 2.27 to 3.0]); hospitalisation (2.4 [1.92 to 2.99]); severe disease (2.61 [1.92 to 3.54]); ICU admission (1.22 [1.07 to 1.39]) and mechanical ventilation (1.83 [1.18 to 2.84]) compared with those with no MLTCs. Pooled RRs for adverse outcomes were higher in children and young people compared with all age groups. In meta-regression analyses, men were more likely to need ICU admission (p = 0.013) and mechanical ventilation (p = 0.002).

CONCLUSIONS

Public health policies, clinical and preventative interventions should prioritise people with MLTCs to minimise direct adverse outcomes from COVID-19 disease.

Spillover health losses of COVID-19 in China: evidence from non-COVID-19-related mortality

OBJECTIVES

With the seeming end of the COVID-19 epidemic, international focus is rethinking its spillover consequences, such as on the routine provision and usage of healthcare. This study uses China's national death records to estimate the potential spillover effects of the COVID-19 pandemic on the mortality of non-COVID diseases in China, such as chronic diseases and mental disorders.

STUDY DESIGN

A longitudinal study.

METHODS

Using the difference-in-difference strategy, our results showed a sizeable increase in total non-COVID deaths and mortality from cardiovascular diseases, chronic kidney disease, diabetes, mental diseases, and suicide.

RESULTS

Notably, the deaths from diabetes and suicide increased by 4.60% and 7.08%, respectively, relative to the regions without pandemic cases in the first outbreak and escalated by 3.57% and 5.00%, respectively, when the control group switched to the same period in 2019.

CONCLUSIONS

These results documented adverse spillover effects of COVID-19 on mortality of non-COVID diseases, suggesting inadequate provision and utilization of regular healthcare. The government and healthcare industry should adopt expedient policies for non-epidemic diseases and reallocate health resources to mitigate future pandemics like COVID-19.

Persistent disparities in insulin pump uptake despite a universal pump programme for type 1 diabetes in Ontario, Canada

AIM

To evaluate associations between social disadvantage and insulin pump use among adults with type 1 diabetes (T1D) in the context of a universal publicly funded insulin pump programme in Ontario, Canada, and to ascertain whether social disparities in insulin pump programme enrolment have decreased over time.

METHODS

Population-based cross-sectional studies were conducted using administrative healthcare data in Ontario, Canada. First, among adults aged older than 18 years diagnosed with T1D before 31 March 2021, logistic regression was used to assess the association between neighbourhood social disadvantage (Ontario marginalization index quintiles) and insulin pump use. Second, among all paediatric and adult applicants to the insulin pump programme from 1 September 2006 to 31 March 2022, ordinal logistic regression was used to evaluate associations between year of insulin pump initiation and social disadvantage.

RESULTS

Among 27 453 adults with T1D, 60% used insulin pumps. Greater social disadvantage was associated with lower odds of insulin pump use (adjusted odds ratio [OR] 0.44 [95% confidence interval {CI} 0.39-0.48] for greatest vs. lowest social disadvantage quintile). Among 21 002 paediatric and adult applicants to the insulin pump programme, social disparities in pump use decreased in the first 3 years of the programme, plateaued until 2020, then increased from 2020 to 2022, with no change in the odds of being in a higher social deprivation quintile for 2022 relative to 2007 (OR 1.09 [95% CI 0.83-1.44]).

CONCLUSIONS

Despite a universal pump programme for individuals with T1D, disparities by social disadvantage persist. Residual financial and non-financial barriers must be addressed to promote equitable insulin pump uptake.

The impact of COVID-19 on people with epilepsy: Global results from the coronavirus and epilepsy study

OBJECTIVE

To characterize the experience of people with epilepsy and aligned healthcare workers (HCWs) during the first 18 months of the COVID-19 pandemic and compare experiences in high-income countries (HICs) with non-HICs.

METHODS

Separate surveys for people with epilepsy and HCWs were distributed online in April 2020. Responses were collected to September 2021. Data were collected for COVID-19 infections, the effect of COVID-related restrictions, access to specialist help for epilepsy (people with epilepsy), and the impact of the pandemic on work productivity (HCWs). The frequency of responses for non-HICs and HICs were compared using non-parametric Chi-square tests.

RESULTS

Two thousand one hundred and  five individuals with epilepsy from 53 countries and 392 HCWs from 26 countries provided data. The same proportion of people with epilepsy in non-HICs and HICs reported COVID-19 infection (7%). Those in HICs were more likely to report that COVID-19 measures had affected their health (32% vs. 23%; p < 0.001). There was no difference between non-HICs and HICs in the proportion who reported difficulty in obtaining help for epilepsy. HCWs in non-HICs were more likely to report COVID-19 infection than those in HICs (18% vs 6%; p = 0.001) and that their clinical work had been affected by concerns about contracting COVID-19, lack of personal protective equipment, and the impact of the pandemic on mental health (all p < 0.001). Compared to pre-pandemic practices, there was a significant shift to remote consultations in both non-HICs and HICs (p < 0.001).

SIGNIFICANCE

While the frequency of COVID-19 infection was relatively low in these data from early in the pandemic, our findings suggest broader health consequences and an increased psychosocial burden, particularly among HCWs in non-HICs. Planning for future pandemics should prioritize mental healthcare alongside ensuring access to essential epilepsy services and expanding and enhancing access to remote consultations.

PLAIN LANGUAGE SUMMARY

We asked people with epilepsy about the effects of COVID-19 on their health and healthcare. We wanted to compare responses from people in high-income countries and other countries. We found that people in high-income countries and other countries had similar levels of difficulty in getting help for their epilepsy. People in high-income countries were more likely to say that their general health had been affected. Healthcare workers in non-high-income settings were more likely to have contracted COVID-19 and have the care they deliver affected by the pandemic. Across all settings, COVID-19 associated with a large shift to remote consultations.

Having any mental health condition before the COVID-19 pandemic as a risk factor of COVID-19 contagion during the first year of pandemic: A Spanish adult cohort

Numerous studies suggest that subjects suffering from a mental health condition before the COVID-19 pandemic were at higher risk of contagion, but mostly are cross-sectional or retrospective. The BIOVAL-D-COVID-19 is a longitudinal cohort study design with 922 subjects who full filled two evaluations from an online survey of Spanish residents before and during the pandemic. Mental health conditions assessed were: Major Depressive Episode (MDE), Generalised Anxiety Disorder (GAD), Suicidal Thoughts and Behaviours (STB) and subthreshold of panic and bipolar disorder (BD). Mental health screening instruments used were: the Spanish version of the Composite International Diagnostic Interview (CIDI) version 3.0 for the evaluation of MDE, the GAD-7 scale to evaluate GAD; STB was evaluated with four items from the CIDI questionnaire. Panic Disorder and BD were screened from a modified and self-reported version of the CIDI. A bivariate plus five logistic regression models were developed for each mental health condition adjusted by socio-demographic variables; employment status; general and physical health; comorbidity; and including all previous variables and the other mental health conditions. We found in bivariate model that MDE; GAD and STB were statistically significant risk factors of contagion of COVID-19. The logistic regression models developed reveal that having a previous GAD (aOR 3.30 1.31-8.31) or STB (aOR 2.16 CI 95% 1.01-4.62) was statistically significant associated with COVID-19 contagion, independently of all variables included. MDE was not a risk factor of contagion when it was adjusted by comorbidity (aOR 0.99 CI 95% 0.47-2.09). It is recommended to detect those subjects with previous GAD or STB as vulnerable groups of infection to reduce contagion rates.

[Adherence to chest physiotherapy in adults with cystic fibrosis]

INTRODUCTION

Chest-physiotherapy is a key element in treatment of cystic fibrosis and patient adherence is a major issue in global cystic fibrosis care. This study aims to assess adherence to chest physiotherapy in adults with cystic fibrosis who not treated with tritherapy and to analyze the impact of certain factors on adherence.

METHODS

Thus is a cross-sectional study, conducted using a questionnaire and a physiotherapy evaluation. Adherence to this treatment was measured in terms of quantitative and qualitative aspects. The impact on adherence of 15 factors was then assessed.

RESULTS

Only 47% of patients could be considered as adherent, with a significant disparity between a quantitative and qualitative assessment. Gender, working time, pathology severity, the fact of being regularly followed by a physiotherapist, the perceived benefit of the sessions and their replacement by physical activity, seem associated with adherence to this treatment.

CONCLUSIONS

Taking into account the qualitative aspect of the sessions, our study reveals a low rate, in our cohort, of adherence to respiratory physiotherapy, and highlights six factors likely to predominate. Regular follow-up by a physiotherapist seems to be a determining factor in adherence to this treatment.

Beyond Infection: Unmasking the Impact of COVID-19 on Diabetes Emergency Trends

Introduction The relationship between COVID-19 and diabetes has been demonstrated in many studies. However, it is thought that the psycho-socioeconomic effects of the pandemic led to a worsening of glycemic control and an increase in diabetes-associated clinical emergencies in diabetic patients without a diagnosis of COVID-19. Objectives We aimed to reveal the change in the frequency of diabetes-related clinical emergencies before and during the COVID-19 pandemic. Patients and methods The data of the patients requiring endocrinology consultations in Manisa Celal Bayar University Faculty of Medicine Emergency Service between March 2018 and March 2022 were included. In total, 269 consultations were analyzed. The March 2018 - March 2020 period was considered as pre-COVID, and March 2020 - March 2022 as the COVID-19 period. The frequency of diabetes-related conditions between these two periods was compared. Results Compared to the pre-COVID period, there was a significant increase in the frequency of admissions with diabetic ketosis, hyperglycemic hyperosmolar state, hypoglycemia, and hyperglycemia in the COVID-19 period (p=0.022, p=0.037, p=0.044, and p=0.004 respectively). Although an increase was observed in the frequency of diabetic ketoacidosis (DKA) cases, no statistical significance was found. When the mortality data of the patients was evaluated, the total number of deaths was seen to increase significantly in the COVID-19 period (p=0.01). It was observed that the ratio of type 2 diabetes mellitus (DM)/type 1 DM among DKA patients increased significantly in the COVID-19 period (p=0.001). Conclusions It can be concluded that the increasing trend in diabetic emergencies that started even before the pandemic is exacerbated by COVID-19, especially in patients with poor glycemic control.

The relationship between healthcare access and change in health-related quality-of-life among the general population of five countries during the COVID-19 pandemic

PURPOSE

To determine whether (1) healthcare access at onset of the pandemic and (2) age, gender, socioeconomic status (SES), and pre-existing health status were associated with change in health-related quality-of-life (HRQoL) during the COVID-19 pandemic. The study includes a general population sample of five countries.

METHODS

An online questionnaire was administered to respondents from Greece, Italy, the Netherlands, the UK, and the US at the onset of the COVID-19 pandemic between April 22nd and May 5th of 2020, and 1 year later between May 23rd and June 29th of 2021. The questionnaire included questions on demographic background, health status, and HRQoL. The primary outcome was change in HRQoL as measured by the EQ-5D-5L instrument. Specifically, the EQ-5D-5L index and EQ VAS were used. Healthcare access was quantified with regard to the respondent's ease of getting an appointment, waiting time, and opportunity to contact the provider and during analysis dichotomized into "sufficient" versus "insufficient". Linear regression analysis was performed with change in HRQoL as dependent variable and background variables as independent variables.

RESULTS

In total, 6,765 respondents completed the second questionnaire. 19.8% of total respondents reported insufficient healthcare access. Respondents with insufficient healthcare had both more improved and deteriorated HRQoL compared to respondents with sufficient healthcare, whose HRQoL remained unchanged. We did not find significant interactions between age, gender, SES and/or chronic disease status with healthcare access at onset of the COVID-19 pandemic.

CONCLUSION

Healthcare access was not associated with cumulative differences in change in HRQoL over a 1-year period in strata of age, gender, SES, and chronic disease status.

Effects of the COVID-19 Pandemic on the Medical Use of Elderly Patients with Hypertension: A Nationwide Cohort Study in Korea

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services, including chronic disease management, for vulnerable groups, such as older individuals with hypertension. This study aimed to evaluate hypertension management in South Korea's elderly population during the pandemic using treatment consistency indices such as the continuity of care (COC), modified, modified continuity index (MMCI), and most frequent provider continuity (MFPC).

METHODS

This study used the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service between 2017 and 2021. The research included a total of 4,097,299 hypertensive patients aged 65 years or older. We defined 2018 and 2019 as the baseline period before the COVID-19 pandemic and 2020 and 2021 as the COVID-19 period and calculated the indices of medical continuity (number of visits, COC, MMCI, and MFPC) on a yearly basis.

RESULTS

The number of visits decreased during the COVID-19 period compared to the baseline period (59.64±52.75 vs. 50.49±50.33, P<0.001). However, COC, MMCI, and MFPC were not decreased in the baseline period compared to the COVID-19 period (0.71±0.21 vs. 0.71±0.22, P<0.001; 0.97±0.05 vs. 0.96±0.05, P<0.001; 0.8±0.17 vs. 0.8±0.17, P<0.001, respectively).

CONCLUSION

COVID-19 had no significant impact on the continuity of care but affected the frequency of outpatient visits for older patients with hypertension. However, this study highlights the importance of addressing healthcare inequalities, especially in older patients with hypertension, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.

Characteristics and influencing factors of caregivers' healthcare preferences for young children under COVID-19 lockdown: a cross-sectional study in Shanghai, China

BACKGROUND

Missed or delayed child healthcare caused by the COVID-19 lockdown has threatened young children's health and has had an unpredictable influence on caregivers' child healthcare preferences. This study investigated caregivers' child healthcare preferences and the factors that influence them among families with young children (0-3 years) during the lockdown in Shanghai.

METHODS

Participants in this cross-sectional study were enrolled through random encounter sampling. Questionnaires were distributed online from June 1 to November 10, 2022, in Shanghai. A total of 477 valid questionnaires were received. The demographics of caregivers and their families, children's characteristics, COVID-19-related information, and caregivers' healthcare preferences were analyzed. The statistical analyses included frequency and percentage, chi-square tests, and multinomial logistic regression.

RESULTS

Caregivers preferred child healthcare professionals in the community health service system (CHS; 47.6%) followed by hospital pediatricians (40.0%) during lockdown. Caregivers with the following characteristics preferred CHS: those with an annual household income of CNY 200,000-300,000, those whose youngest children were aged 8-12 months, and those who experienced early childhood physical development issues. Caregivers preferred hospitals if they had experienced healthcare-seeking-related difficulties in accessing professional guidance from hospital pediatricians.

CONCLUSIONS

During pandemic lockdowns, policymakers should allocate more resources to CHS to meet caregivers' childcare demands. Moreover, special attention should be given to the healthcare needs for CHS among families with specific demographics.

TRIAL REGISTRATION

Approval was obtained from the Ethics Committee of Shanghai Jiao Tong University School of Medicine School of Public Health (SJUPN-202,109; June 1, 2022).

The Impact of COVID-19 Health Measures on Adults With Multiple Chemical Sensitivity: Cross-Sectional Study

BACKGROUND

Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition.

OBJECTIVE

This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic.

METHODS

An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network.

RESULTS

In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6%, n=103) and highly educated, with 57.1% (n=68) having a university degree. Slightly more than half (57.1%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before ("prepandemic period") and after ("postpandemic period") March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=-3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=-2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=-2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001).

CONCLUSIONS

During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures.

Mental health status among chronic disease patients in Bangladesh during the COVID-19 Pandemic: Findings from a cross-sectional study

Context

The COVID-19 epidemic has had a substantial influence on the mental health of chronic disease patients. However, there is a scarcity of research on them in Bangladesh.

Aims

This study aims to explore the prevalence of and identify the risk factors for depression, anxiety, and stress symptoms during the COVID-19 pandemic among people with chronic diseases in Bangladesh.

Materials and Methods

This cross-sectional study involving face-to-face and telephone interviews was carried out among Bangladeshi people diagnosed with chronic diseases between September and November 2020. The total sample size was 878, and a convenient sampling technique was used. Logistic regression analysis was performed to investigate potential influencing factors for depression, anxiety, and stress.

Results

The mean age of respondents was 50.10 years. Among them, 35.0%, 36.0%, and 29.0% suffered from depression, anxiety, and stress symptoms, respectively. In multivariable logistic regression, depression had a significant positive association with higher age (≥60 years), lower income, rural residency, and loss of close family members due to COVID-19. Anxiety had a significant positive association with higher age (≥40 years), lower education, lower income, rural residency, and loss of close family members due to COVID-19. Stress had a significant positive association with higher age (≥40 years), no income, rural residency, and loss of close family members due to COVID-19.

Conclusion

It is urgent to consider the risk of developing mental health distress among chronic disease patients, especially aged people, by health service providers and generate effective programs for emergency situations.

Evaluating adherence to American Diabetes Association standards of care in diabetes and impacts of social determinants of health on patients at two nurse practitioner-owned clinics

BACKGROUND

The COVID-19 pandemic created barriers in the management of type 2 diabetes mellitus (T2DM) and worsened social determinants of health (SDOH). A New Hampshire primary care office worked to adhere to T2DM standards of care and began screening for SDOH. This project assessed adherence to quality metrics, hemoglobin A1C, and SDOH screening as telehealth utilization decreased.

LOCAL PROBLEM

A1C values have increased at the practice, especially since COVID-19. The practice also began screening for SDOH at every visit, but there was need to assess how needs were being documented and if/how they were addressed.

METHODS

A retrospective chart review of patients with T2DM was performed. Demographic data and T2DM metrics were collected and compared with previous years and compared new versus established patients. Charts were reviewed to evaluate documentation of SDOH and appropriate referral.

INTERVENTIONS

The practice transitioned from an increased utliization of telehealth back to prioritizing in-office visits. The practice also began routinely screening for SDOH in 2020; however, this process had not been standardized or evaluated.

RESULTS

Adherence to nearly all quality metrics improved. Glycemic control improved after a year of nurse practitioner (NP) care, especially in new patients. All patients were screened for SDOH, but documentation varied, and affected patients had higher A1Cs, despite receiving comparable care.

CONCLUSION

Nurse practitioners at this practice are adhering to American Diabetes Association guidelines, and A1C values improve under their care. Social determinants of health continue to act as unique barriers that keep patients from improving glycemic control, highlighting the need for individualized treatment of SDOH in T2DM care.

The effect of COVID-19 on utilization of chronic diseases services

OBJECTIVES

The aim of the present study is to evaluate the impact of Covid-19 on utilization of chronic diseases services.

METHODS

Interrupted time-series design was used to examine the utilization of chronic diseases services before and during the Covid-19 pandemic among hospitals in Iran. Chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, heart failure, and chemotherapy were selected as a proxy to indicate the impact of Covid-19 on utilization of chronic diseases services. Data were collected in 24 sites from 12 months before the onset of Covid-19 (from March 2019 to February 2020) to 12 months during the Covid-19 pandemic (February 2020 to March 2021).

RESULTS

A total of 7,039,378 services were provided, of which 51.92% were provided for women and 62.73% for >65 age group. A sudden decrease was observed in monthly utilization of services during the Covid-19 pandemic; ranging from 13.91 (95% CI = -21.73, 6.10, P = 0.001) for chemotherapy to 606.39 (95% CI = -1040.72, 172.06, P = 0.009) for heart failure services per 100 thousand population. A decrease was observed in COPD services; 15.28 services compared with the period before Covid-19. Subsequently, the monthly utilization trends of asthma, type 2 diabetes, and chemotherapy services increased significantly (P < 0.05).

DISCUSSION

Although chronic diseases are a factor in more severe form of Covid-19, their failure to seek diagnostic, prevention and treatment services has somewhat complicated the issue.

Indirect effects of the COVID-19 pandemic on diagnosing, monitoring, and prescribing in people with diabetes and strategies for diabetes service recovery internationally

The COVID-19 pandemic has caused major disruptions in clinical services for people with chronic long-term conditions. In this narrative review, we assess the indirect impacts of the COVID-19 pandemic on diabetes services globally and the resulting adverse effects on rates of diagnosing, monitoring, and prescribing in people with type 2 diabetes. We summarise potential practical approaches that could address these issues and improve clinical services and outcomes for people living with diabetes during the recovery phase of the pandemic.

Understanding health service utilisation patterns for care home residents during the COVID-19 pandemic using routinely collected healthcare data

BACKGROUND

Healthcare in care homes during the COVID-19 pandemic required a balance, providing treatment while minimising exposure risk. Policy for how residents should receive care changed rapidly throughout the pandemic. A lack of accessible data on care home residents over this time meant policy decisions were difficult to make and verify. This study investigates common patterns of healthcare utilisation for care home residents in relation to COVID-19 testing events, and associations between utilisation patterns and resident characteristics.

METHODS

Datasets from County Durham and Darlington NHS Foundation Trust including secondary care, community care and a care home telehealth app are linked by NHS number used to define daily healthcare utilisation sequences for care home residents. We derive four 10-day sets of sequences related to Pillar 1 COVID-19 testing; before [1] and after [2] a resident's first positive test and before [3] and after [4] a resident's first test. These sequences are clustered, grouping residents with similar healthcare patterns in each set. Association of individual characteristics (e.g. health conditions such as diabetes and dementia) with healthcare patterns are investigated.

RESULTS

We demonstrate how routinely collected health data can be used to produce longitudinal descriptions of patient care. Clustered sequences [1,2,3,4] are produced for 3,471 care home residents tested between 01/03/2020-01/09/2021. Clusters characterised by higher levels of utilisation were significantly associated with higher prevalence of diabetes. Dementia is associated with higher levels of care after a testing event and appears to be correlated with a hospital discharge after a first test. Residents discharged from inpatient care within 10 days of their first test had the same mortality rate as those who stayed in hospital.

CONCLUSION

We provide longitudinal, resident-level data on care home resident healthcare during the COVID-19 pandemic. We find that vulnerable residents were associated with higher levels of healthcare usage despite the additional risks. Implications of findings are limited by the challenges of routinely collected data. However, this study demonstrates the potential for further research into healthcare pathways using linked, routinely collected datasets.

Structural vulnerabilities and PrEP awareness among Boston heterosexuals and people who inject drugs at risk for HIV: findings from 2018 to 2019 cycles from the Boston, MA site of the NHBS

Little is known about biopsychosocial factors relating to pre-exposure prophylaxis (PrEP) awareness among people with either heterosexual or injection drug use HIV risk behaviors. Participants engaged in vaginal/anal sex with a person of the opposite sex (N = 515) or were people who injected drugs (PWID; N = 451) in the past 12 months from 2018-2019 in Boston, MA. We examined associations between PrEP awareness and: homelessness; perceived HIV-related stigma; country of birth; bacterial STDs, chlamydia, and/or gonorrhea in the past 12 months, lifetime hepatitis C virus (HCV) infection, sexual orientation, and poverty. More PWID (36.8%) were aware of PrEP than people with heterosexual HIV risk (28%; p = .001). Among people with heterosexual risk, homelessness (aOR = 1.99, p = .003), and among PWID: homelessness (aOR = 2.11, p = .032); bacterial STD (aOR = 2.96, p = .012); chlamydia (aOR = 6.14, p = .008); and HCV (aOR = 2.40, p < .001) were associated with increased likelihood of PrEP awareness. In the combined sample: homelessness (aOR = 2.25, p < .001); HCV (aOR = 2.18, p < .001); identifying as homosexual (aOR = 3.71, p = .036); and bisexual (aOR = 1.55, p = .016) were each associated with PrEP awareness. Although having an STD, HCV, identifying as homosexual or bisexual, and experiencing homelessness were associated with increased PrEP awareness, most participants were unaware of PrEP. Efforts to increase PrEP awareness could engage PWID and heterosexual HIV risk behavior.

Understanding the experiences of PHC nurses in caring for older patients in the post-fifth wave of the COVID-19 pandemic: an exploratory qualitative study

Objective

To ensure the best possible care, the perspective of PHC nurse work experience during the COVID-19 pandemic should be considered when developing nursing care protocols for older patients who receive PHC services.

Method

This exploratory qualitative study was conducted with 18 nurses working continuously in PHC between the first and fifth waves of the pandemic. Semi-structured thematic interviews were undertaken. Qualitative thematic content analysis was conducted to identify and group the themes that emerged from the discourse. Interviews were transcribed and analyzed using thematic analysis.

Results

The first topic describes the nurses' experiences of physical and mental suffering in caring for older patients in response to the pandemic. The second topic covers the experience of reorganizing PHC work. The third topic focuses on the difficulties of caring for older patients. The final topic includes issues of support needs for nurses in PHC work.

Conclusion

The experience and understanding of PHC nurses in caring for older people during the COVID pandemic should lead to significant changes in the system of nursing care for geriatric patients and in the cooperative role within geriatric care specialist teams. Drawing on the experience of COVID-19, it is necessary to work on the weak points of PHC exposed by the pandemic in order to improve the quality of care and life for geriatric patients.

Reduced incidence of diabetes during the COVID-19 pandemic in Alberta: A time-segmented longitudinal study of Alberta's Tomorrow Project

AIM

To characterize the impact of the COVID-19 pandemic on diabetes diagnosis using data from Alberta's Tomorrow Project (ATP), a population-based cohort study of chronic diseases in Alberta, Canada.

MATERIALS AND METHODS

The ATP participants who were free of diabetes on 1 April 2018 were included in the study. A time-segmented regression model was used to compare incidence rates of diabetes before the COVID-19 pandemic, during the first two COVID-19 states of emergency, and in the period when the state of emergency was relaxed, after adjusting for seasonality, sociodemographic factors, socioeconomic status, and lifestyle behaviours.

RESULTS

Among 43 705 ATP participants free of diabetes (65.5% females, age 60.4 ± 9.5 years in 2018), the rate of diabetes was 4.75 per 1000 person-year (PY) during the COVID-19 pandemic (up to 31 March 2021), which was 32% lower (95% confidence interval [CI] 21%, 42%; p < 0.001) than pre-pandemic (6.98 per 1000 PY for the period 1 April 2018 to 16 March 2020). In multivariable regression analysis, the first COVID-19 state of emergency (first wave) was associated with an 87.3% (95% CI -98.6%, 13.9%; p = 0.07) reduction in diabetes diagnosis; this decreasing trend was sustained to the second COVID-19 state of emergency and no substantial rebound (increase) was observed when the COVID-19 state of emergency was relaxed.

CONCLUSIONS

The COVID-19 public health emergencies had a negative impact on diabetes diagnosis in Alberta. The reduction in diabetes diagnosis was likely due to province-wide health service disruptions during the COVID-19 pandemic. Systematic plans to close the post-COVID-19 diagnostic gap are required in diabetes to avoid substantial downstream sequelae of undiagnosed disease.

Telehealth for Chronic Disease Management Among Vulnerable Populations

Chronic diseases disproportionately affect patients in low-income minority groups who traditionally use in-person healthcare services. COVID-19 disrupted their routines and limited options for people to receive care; this could exacerbate health inequities. The study examined telehealth chronic disease management among low-income minority groups. We used Florida Medicaid claims data from March to December 2020 and the American Consumer Survey to examine the study objectives. Data were analyzed using Linear and Logistic Regression. We retrieved claim records of 52,904 unique patients; 31,999 were female and 49% of the sample had at least one telehealth visit. Medicaid patients were 8% less likely to use telehealth and 21% more likely to have audio visits when compared to Medicare patients. The analyses suggest that Non-Hispanic Black patients and individuals with a lack of education experience significant health inequities. People with chronic obstructive pulmonary disease (5%) and heart failure (14%) were less likely to use telehealth than patients with diabetes. Telehealth will continue to be a health delivery option; thus we recommend that strategies are enacted to educate, and resources are provided to promote equity among Non-Hispanic Black patients. Without priority attention to people among low-income minority populations, health inequities will continue to plague this community.

Knowledge of non-communicable diseases and access to healthcare services among adults before and during COVID-19 pandemic in rural Tanzania

Background

The COVID-19 pandemic significantly affected access to healthcare services, particularly among individuals living with Non-Communicable Diseases (NCDs) who require regular healthcare visits. Studies suggest that knowledge about a specific disease is closely linked to the ability to access services for that condition. In preparation for the future, we conducted the study to assess knowledge of NCDs and access to healthcare services among adults residing in rural areas before and during the COVID-19 pandemic.

Methods

We conducted a community-based cross-sectional study in rural Tanzania in October 2022, a few months after the end of the third wave of the COVID-19 pandemic. A total of 689 community residents participated in the study. The level of knowledge of NCDs was assessed using an 11-item Likert questionnaire, which was later dichotomized into adequate and inadequate levels of knowledge. In addition, access to healthcare was assessed before and during the pandemic. We summarized the results using descriptive statistics and logistic regression was applied to determine factors associated with adequate levels of knowledge of NCDs. All statistical tests were two-sided; a p-value <0.05 was considered statistically significant. All data analyses were performed using SPSS.

Results

Among 689 participants, more than half 369 (55%) had adequate knowledge of whether a disease is NCD or not; specifically, 495 (73.8%), 465 (69.3%), and 349 (52%) knew that hypertension, diabetes mellitus, and stroke are NCDs while 424 (63.2%) know that UTI is not NCD. Of the interviewed participants, 75 (11.2%) had at least one NCD. During the COVID-19 pandemic the majority 57 (72.2%) accessed healthcare services from nearby health facilities followed by traditional healers 10 (12.7%) and community drug outlets 8 (10.1%). Residence and education level were found to be significantly associated with knowledge of NCDs among participants.

Conclusion

The study revealed that the community has a moderate level of knowledge of NCDs, and during the COVID-19 pandemic outbreaks, people living with NCD (s) relied on nearby health facilities to obtain healthcare services. Health system preparedness and response to pandemics should take into account empowering the community members to understand that NCD care is continuously needed even during pandemic times. We further advocate for a qualitative study to explore contextual factors influencing the knowledge of NCDs and access to healthcare services beyond the big domains of education and residence.

Policies for type 2 diabetes and non-communicable disease management during the COVID-19 pandemic in Kenya and Tanzania: a desk review and views of decision-makers

BACKGROUND

The COVID-19 pandemic caused disruptions in care that adversely affected the management of non-communicable diseases (NCDs) globally. Countries have responded in various ways to support people with NCDs during the pandemic. This study aimed to identify policy gaps, if any, in the management of NCDs, particularly diabetes, during COVID-19 in Kenya and Tanzania to inform recommendations for priority actions for NCD management during any future similar crises.

METHODS

We undertook a desk review of pre-existing and newly developed national frameworks, policy models and guidelines for addressing NCDs including type 2 diabetes. This was followed by 13 key informant interviews with stakeholders involved in NCD decision-making: six in Kenya and seven in Tanzania. Thematic analysis was used to analyse the documents.

RESULTS

Seventeen guidance documents were identified (Kenya=10; Tanzania=7). These included pre-existing and/or updated policies/strategic plans, guidelines, a letter, a policy brief and a report. Neither country had comprehensive policies/guidelines to ensure continuity of NCD care before the COVID-19 pandemic. However, efforts were made to update pre-existing documents and several more were developed during the pandemic to guide NCD care. Some measures were put in place during the COVID-19 period to ensure continuity of care for patients with NCDs such as longer supply of medicines. Inadequate attention was given to monitoring and evaluation and implementation issues.

CONCLUSION

Kenya and Tanzania developed and updated some policies/guidelines to include continuity of care in emergencies. However, there were gaps in the documents and between policy/guideline documents and practice. Health systems need to establish disaster preparedness plans that integrate attention to NCD care to enable them to better handle severe disruptions caused by emergencies such as pandemics. Such guidance needs to include contingency planning to enable adequate resources for NCD care and must also address evaluation of implementation effectiveness.

Effects of the COVID-19 Pandemic on the Implementation of NCD Care at the Primary Care Level in the Philippines: A Qualitative Inquiry

Background and Objective

The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients' disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines.

Methods

Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting physicians, nurses, midwives, and community health workers from various facilities - community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals - located within two provinces in the Philippines. All interviews were video-recorded upon participants' consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes.

Results

The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen.

Conclusion

Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients' health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.

Expert Insight Into the Use of eHealth Interventions to Aid Medication Adherence During COVID-19

Background and Aim

The COVID-19 pandemic has transformed the way healthcare is delivered by the increased utilisation of eHealth tools to deliver remote patient consultations. These eHealth tools served various functions during COVID-19 including monitoring and surveillance of patients. Therefore, assessment of digital health interventions for monitoring medication adherence is crucial to maximise the potential benefits of eHealth. The aim of this study is to understand the perspectives of experts in medication adherence around eHealth interventions used to aid adherence during COVID-19.

Methods

The study was exploratory and utilized a mixed-method approach. Data was gathered from a survey distributed by the International society for Medication Adherence, and from arranging subsequent structured interviews. Purposive sampling was used to collect data from individuals who were rich in knowledge about the field of medication adherence. Template analysis was used to analyse the collected data.

Results

Twenty-one participants responded to the survey and 6 completed the interviews. Results showed that eHealth tools reduced barriers to medication adherence by improving health literacy of patients. The main strengths of eHealth technology used in COVID-19 highlighted by participants were convenience and user empowerment. Moreover, weaknesses and barriers included lack of cooperation between technology providers, lack of awareness of doctors about eHealth and patient's digital health literacy.

Conclusion and Future Directions

The increased utility of eHealth tools during COVID-19 highlighted their vital role in aiding medication adherence of patients. These technologies have both decreased and increased barriers to medication adherence through numerous ways. Future directions should focus on gaining the perspectives of patients on the use of eHealth interventions and its role in aiding medication adherence.

Sex-specific Impact of the first COVID-19 Lockdown on Age Structure and Case Acuity at Admission in a Patient Population in southwestern Germany: a retrospective comparative Study in Neuroradiology

OBJECTIVES

A hard lockdown was presumed to lead to delayed diagnosis and treatment of serious diseases, resulting in higher acuity at admission. This should be elaborated based on the estimated acuity of the cases, changes in findings during hospitalisation, age structure and biological sex.

DESIGN

Retrospective monocentric cross-sectional study.

SETTING

German Neuroradiology Department at a .

PARTICIPANTS

In 2019, n=1158 patients were admitted in contrast to n=884 during the first hard lockdown in 2020 (11th-13th week).

MAIN OUTCOME MEASURES

Three radiologists evaluated the initial case acuity, classified them into three groups (not acute, subacute and acute), and evaluated if there was a relevant clinical deterioration. The data analysis was conducted using non-parametric methods and multivariate regression analysis.

RESULTS

A 24% decrease in the number of examinations from 2019 to 2020 (p=0.025) was revealed. In women, the case acuity increased by 21% during the lockdown period (p=0.002). A 30% decrease in acute cases in men was observable (in women 5% decrease). Not acute cases decreased in both women and men (47%; 24%), while the subacute cases remained stable in men (0%) and decreased in women (28%). Regression analysis revealed the higher the age, the higher the acuity (p<0.001 in both sexes), particularly among women admitted during the lockdown period (p=0.006).

CONCLUSION

The lockdown led to a decrease in neuroradiological consultations, with delays in seeking medical care. In women, the number of most severe cases remained stable, whereas the mean case acuity and age increased. This could be due to greater pandemic-related anxiety among women, however, with severe symptoms they were seeking for medical help. In contrast in men, the absolute number of most severe cases decreased, whereas the mean acuity and age remained nearly unaffected. This could be attributable to a reduced willingness to seek for medical consultation.

Health Outcomes for Older Patients with Chronic Diseases During the First Pandemic Year

Background

Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain.

Methods

A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization.

Results

We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported.

Conclusion

Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.