The Impact of the COVID-19 Pandemic on Self-Reported Management of Chronic Conditions

Inability to get needed health care during the COVID-19 pandemic among a nationally representative, diverse population of U.S. adults with and without chronic conditions

BACKGROUND

Delays in health care have been observed in the U.S. during the COVID-19 pandemic; however, the prevalence of inability to get needed care and potential disparities in health care access have yet to be assessed.

METHODS

We conducted a nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults between 12/2020-2/2021 (baseline) and 8/16/2021-9/9/2021 (6-month follow-up). Participants were asked "Since the start of the pandemic, was there any time when you did not get medical care that you needed?" Those who responded "Yes" were asked about the type of care and the reason for not receiving care. Poisson regression was used to estimate the association between sociodemographics and inability to receive needed care; all analyses were stratified by chronic condition status. Chronic conditions included: chronic obstructive pulmonary disease (COPD), heart conditions, type 2 diabetes, chronic kidney disease or on dialysis, sickle cell disease, cancer, and immunocompromised state (weakened immune system).

RESULTS

Overall, 20.0% of participants at baseline and 22.7% at follow-up reported not getting needed care. The most common reasons for being unable to get needed care included fear of COVID-19 (baseline: 44.1%; follow-up: 47.2%) and doctors canceled appointment (baseline: 25.3%; follow-up: 14.1%). Routine care (baseline: 59.9%; follow-up: 62.6%) and chronic care management (baseline: 31.5%; follow-up: 30.1%) were the most often reported types of delayed care. Fair/poor self-reported physical health was significantly associated with being unable to get needed care despite chronic condition status (≥ 1 chronic condition: aPR = 1.36, 95%CI = 1.04-1.78); no chronic conditions: aPR = 1.52, 95% CI = 1.28-1.80). The likelihood of inability to get needed care differed in some instances by race/ethnicity, age, and insurance status. For example, uninsured adults were more likely to not get needed care (≥ 1 chronic condition: aPR = 1.76, 95%CI = 1.17-2.66); no chronic conditions: aPR = 1.25, 95% CI = 1.00-1.56).

CONCLUSIONS

Overall, about one fifth of participants reported being unable to receive needed care at baseline and follow-up. Delays in receiving needed medical care may exacerbate existing conditions and perpetuate existing health disparities among vulnerable populations who were more likely to have not received needed health care during the pandemic.

Mental well-being and patient activation during the first eight months of the COVID-19 pandemic in Denmark - a cohort study among 710 Danish adults with chronic conditions

BACKGROUND

COVID-19 has highlighted the importance of patient activation in managing chronic conditions and promoting resilience during times of crisis. Patient activation refers to an individual's knowledge, skills, and confidence in managing their own health and healthcare. Previous research has shown that people with higher levels of patient activation are better prepared to navigate the challenges of chronic illness and are more likely to engage in healthy behaviors. However, the impact of patient activation on COVID-19-related concerns and mental well-being among people with chronic conditions during the pandemic remains unclear. This study aims to investigate the possible role of patient activation in shaping COVID-19-related concerns and to describe changes in mental well-being among Danish adults with one or more chronic conditions during the early months of the pandemic.

METHODS

Danish adults with chronic conditions (e.g. diabetes, coronary heart disease, obstructive pulmonary lung disease, cancer) who had participated in a municipal health education program prior to the COVID-19 outbreak were asked to participate in this prospective questionnaire study in May 2020 and November 2020. Sociodemographic (sex, age, living status, educational attainment, employment status) and disease-related information (diagnosis, one or more chronic conditions) along with the Patient Activation Measure were collected before the outbreak and were obtained from a clinical database used for monitoring and evaluation of municipal health education programs. In contrast, the two questionnaires collected six months apart consisted of single items related to concerns about COVID-19 and the WHO-5 well-being index.

RESULTS

A total of 710 people with chronic conditions (mean age 60.9 years; 55.8% female) participated at both time points. In bivariate analyses, patient activation was associated with COVID-19-related concern and well-being. At follow-up, participants experienced a significant decrease in well-being. The decrease was associated with poorer well-being measured six months earlier, a greater perception that it had become more challenging to take care of one's health due to the pandemic, and finally, feeling lonely. The association between patient activation and well-being ceased to be significant in the multivariate regression model.

CONCLUSIONS

A considerable proportion of people with chronic conditions participating in this study have been mentally burdened during COVID-19. Although lower levels of patient activation were associated with greater COVID-19-related concerns, it did not have a significant impact on mental well-being over time.

The Patient Activation Measure (PAM) and the pandemic: Predictors of patient activation among Australian health consumers during the COVID-19 pandemic

BACKGROUND

Preventative healthcare is crucial for improving individual patient outcomes and is integral to sustainable health systems. The effectiveness of prevention programs is enhanced by activated populations who are capable of managing their own health and are proactive to keep themselves well. However, little is known about the level of activation among people drawn from general populations. We used the Patient Activation Measure (PAM) to address this knowledge gap.

METHODS

A representative, population-based survey of Australian adults was conducted in October 2021 during the Delta strain outbreak of the COVID-19 pandemic. Comprehensive demographic information was collected, and the participants completed the Kessler-6 psychological distress scale (K6) and PAM. Multinomial and binomial logistic regression analyses were performed to determine the effect of demographic factors on PAM scores, which are categorised into four levels: 1-participants disengaged with their health; 2-becoming aware of how to manage their health; 3-acting on their health; and 4-engaging with preventative healthcare and advocating for themselves.

RESULTS

Of 5100 participants, 7.8% scored at PAM level 1; 13.7% level 2, 45.3% level 3, and 33.2% level 4. The mean score was 66.1, corresponding to PAM level 3. More than half of the participants (59.2%) reported having one or more chronic conditions. Respondents aged 18 to 24 years old were twice as likely to score PAM level 1 compared with people aged 25-44 (p < .001) or people aged over 65 years (p < .05). Speaking a language other than English at home was significantly associated with having low PAM (p < .05). Greater psychological distress scores (K6) were significantly predictive of low PAM scores (p < .001).

CONCLUSION

Overall, Australian adults showed high levels of patient activation in 2021. People with lower incomes, of younger age, and those experiencing psychological distress were more likely to have low activation. Understanding the level of activation enables targeting sociodemographic groups for extra support to increase the capacity to engage in prevention activities. Conducted during the COVID-19 pandemic, our study provides a baseline for comparison as we move out of the pandemic and associated restrictions and lockdowns.

PATIENT OR PUBLIC CONTRIBUTION

The study and survey questions were co-designed with consumer researchers from the Consumers Health Forum of Australia (CHF) as equal partners. Researchers from CHF were involved in the analysis of data and production of all publications using data from the consumer sentiment survey.

Clinical characterization and factors associated with quality of life in Long COVID patients: Secondary data analysis from a randomized clinical trial

BACKGROUND

Long COVID patients suffer a negative impact on their quality of life, as well as their functioning, productivity or socialization. There is a need to better understand the individual experience and circumstances surrounding these patients.

OBJECTIVE

To characterize clinical picture of Long COVID patients and to identify factors associated with quality of life.

METHODS

A secondary data analysis from a randomized clinical trial (RCT) was carried out with 100 Long COVID patients treated by Primary Health Care and residents in the territory of Aragon (northeast of Spain). The main variable of the study was quality of life, evaluated using the SF-36 Questionnaire, in relation to socio-demographic and clinical variables. In addition, ten validated scales were used that contemplated their cognitive, affective, functional and social status, as well as personal constructs. Correlation statistics and linear regression model were calculated.

RESULTS

Long COVID patients suffer a decrease in their levels of physical and mental health. On the one hand, the higher number of persistent symptoms (b = -0.900, p = 0.008), worse physical functioning (b = 1.587, p = 0.002) and sleep quality (b = -0.538, p = 0.035) are predictors of worse quality of life, physical subscale. On the other hand, higher educational level (b = 13.167, p = 0.017), lower number of persistent symptoms (b = -0.621, p = 0.057) and higher affective affectation (b = -1.402, p<0.001) are predictors of worse quality of life, mental subscale.

CONCLUSION

It is necessary to design rehabilitation programs that consider both the physical and mental health of these patients, thus obtaining an improvement in their quality of life.

Neuroticism and fear of COVID-19 during the COVID-19 pandemic: Testing the mediating role of intolerance of uncertainty and sense of control among Chinese high school students

Since the COVID-19 pandemic broke out in 2019, neuroticism has been proven a predictor of fear of COVID-19 infection. However, only few studies have been conducted on the factors affecting the relationship between neuroticism and this kind of fear. The present study is aimed at analyzing the role intolerance of uncertainty (IU) and sense of control (SOC) play in relation to neuroticism and the fear of COVID-19. We conducted a cross-sectional study in Guangdong and Guangxi provinces, China, and we collected complete datasets from 792 high school students. The main results can be described as follows: (a) individuals with high neuroticism tended to have higher intolerance of uncertainty (IU) and a lower sense of control (SOC); (b) IU and SOC played a mediating role between neuroticism and fear of COVID-19, and a serial mediation effect was found between these factors; (c) after controlling for both IU and SOC, the effect of neuroticism on fear was no longer significant. The results suggested a critical role of IU and sense of control in the causal relationship between neuroticism and fear.

Fear of COVID-19 and Its Association With Health Literacy in Elderly Patients

One of the groups most negatively affected by the epidemic process has been the elderly patients. In this process, it is of great importance to determine the fear levels of the patients and to evaluate the factors that may be related. With this approach, this study aimed to examine the relationship between the fear of COVID-19 and health literacy scores of elderly patients living in Kahramanmaraş City, Turkey. Another aim of the study was to investigate whether the participants' COVID-19 fear change according to various socio-demographic characteristics. The convenience sampling method were used and 266 of valid samples were collected. Descriptive statistics, t-test, ANOVA, Pearson correlation analysis, simple and multiple linear regression analysis techniques were used. The results obtained from the study showed that COVID-19 fear status of the participants were moderate while the health literacy scores were low. Higher health literacy was associated with lower fear of COVID-19. In addition, it was determined that the fear of COVID-19 showed statistically significant differences according to education level, insurance status, smoking status, follow the news status and marital status. As a result, it has been observed that the level of health literacy can be effective in protecting elderly patients from fear. Longitudinal studies have been proposed to determine whether this relationship is causal or not.

Changes in Care Provision During COVID-19 Impact Patient Well-Being

The fast onset and extensive impact of COVID-19 necessitated strict public health measures and temporary diversion of personnel and resources from other types of medical care. This study examined the prevalence of such disruptions and their impacts on patient-perceived well-being using an untargeted survey. The majority of surveyed patients experienced changes in their routine medical care. Of those whose appointments were postponed or canceled, most patients indicated an overall negative impact on their emotional and physical well-being. We highlighted the impact of disruptions in nonurgent medical care during a large-scale public health emergency.