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Rättö H, Kurko T, Pajunen P, Kastarinen H. Second-line pharmacotherapy intensification after metformin monotherapy in type 2 diabetes: a nationwide register study from Finland during 2011-2022. BMC Health Serv Res 2024; 24:944. [PMID: 39160557 PMCID: PMC11331595 DOI: 10.1186/s12913-024-11325-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND In this nationwide register study, we examined the initiation of a second-line antidiabetic medicine (ADM) among new patients receiving regular metformin monotherapy in Finland during 2011-2022. We also reflected the second-line treatment patterns on changes in the reimbursement policy, and the national type 2 diabetes (T2D) care guidelines. METHODS Using register data on all reimbursed ADM purchases during 2010-2022, we defined nine annual cohorts of patients initiating regular metformin monotherapy during 2011-2019, each with a three-year follow-up. Descriptive methods were used to study the patterns of metformin monotherapy and second-line intensification over time. Proportional hazards models were used to analyse the take-up of the second-line ADM. RESULTS The share of new patients initiating metformin use (11-13% of all metformin users) and regular metformin use (83-85% of all new metformin users) remained stable. In all cohorts, 16-19% of the patients took up a second-line ADM (median time to intensification 1.5 years). With the 2011 cohort as reference, the highest proportion of new regular metformin users taking up a second ADM (hazard ratio 1.12. 95% confidence interval 1.07 ; 1.16, P < .0001) was in the 2019 cohort. In the 2017 cohort, the proportion of patients initiating sodium-glucose cotransporter 2 inhibitors as second-line treatment surpassed those initiating dipeptidyl peptidase-4 inhibitors. The reimbursement policy restricted the use of GLP-1-analogues. CONCLUSIONS Second-line treatment intensification patterns over time paralleled the changes in the reimbursement system. Thus, our findings suggest that the reimbursement policy may influence the use of ADMs in Finland.
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Affiliation(s)
- Hanna Rättö
- Research Unit, The Social Insurance Institution of Finland, P.O. Box 450, Helsinki, 00056 KELA, Finland.
| | - Terhi Kurko
- Research Unit, The Social Insurance Institution of Finland, P.O. Box 450, Helsinki, 00056 KELA, Finland
| | - Pia Pajunen
- Medical Advisory Unit, The Social Insurance Institution of Finland, Helsinki, Finland
| | - Helena Kastarinen
- Medical Advisory Unit, The Social Insurance Institution of Finland, Kuopio, Finland
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Razzaq S, Nykänen I, Välimäki T, Koponen S, Savela RM, Schwab U, Suominen AL. Use of oral health care services by family caregivers and care recipients: the LENTO intervention. Acta Odontol Scand 2024; 83:317-326. [PMID: 38775632 PMCID: PMC11302500 DOI: 10.2340/aos.v83.40687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/22/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE We aimed to evaluate the impact of an individually tailored preventive oral health intervention on the use of oral health care services by older family caregivers (FCs) and their care recipients (CRs). MATERIAL AND METHODS A randomized controlled six and 12-month oral health intervention study included FCs and CRs aged ≥65 years living in Eastern Finland. The participants were randomly assigned to an intervention (FCs n = 53, CRs n = 47) and a control (FCs n = 39, CRs n = 35) group. Individually tailored oral health interventions for the FCs provided by a dental hygienist focused on oral hygiene and self-care. Generalized estimating equations were used to analyze the impact of intervention on the change in the use of oral health care services. RESULTS The intervention had no significant effect on the use of oral health care services by the FCs or their CRs. Traditional factors such as female gender, a higher number of teeth, toothache, no dental fear, and higher morbidity were significantly (p < 0.05) associated with an increased use of oral health care services in the FCs, but not among the CRs. CONCLUSIONS Individually tailored preventive oral health intervention showed no effect on the use of oral health care services. To promote oral health among the elderly, specific interventions focusing on use of oral health care services are needed. TRIAL REGISTRATION clinicaltrials.gov/study/NCT04003493.
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Affiliation(s)
- Shanza Razzaq
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.
| | - Irma Nykänen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sohvi Koponen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland; Oral Health Teaching Unit, Kuopio University Hospital, Kuopio, Finland
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Niemenoja O, Ämmälä AJ, Riihijärvi S, Lillrank P, Bono P, Taimela S. The impact of COVID-19 on healthcare booking and cancellation patterns: time series analysis of private healthcare service utilisation in Finland. BMC Health Serv Res 2024; 24:483. [PMID: 38637794 PMCID: PMC11027366 DOI: 10.1186/s12913-024-10987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND COVID-19 has had wide-reaching effects on healthcare services beyond the direct treatment of the pandemic. Most current studies have reported changes in realised service usage, but the dynamics of how patients engage with healthcare services are less well understood. We analysed the effects of COVID-19 on healthcare bookings and cancellations for various service channels between January 2020 and July 2021. METHODS Our data includes 7.3 million bookings, 11.0 million available appointments, and 405.1 thousand cancellations by 900.6 thousand individual patients between the ages of 18 and 65 years. The data were collected from electronic health record data, including laboratory and imaging services as well as inpatient stays, between January 2017 and July 2021. The patients were Finnish private and occupational healthcare customers in the capital region of Finland. We fitted an autoregressive moving average (ARIMA) model on data between 2017 and 2019 to predict the expected numbers of bookings, available appointments, and cancellations, which were compared to observed time series data between 2020 and 2021. RESULTS Utilisation of physical, in-person primary care physician appointments decreased by up to 50% during the first 18 months of the pandemic. At the same time, digital care channels experienced a rapid, multi-fold increase in service usage. Simultaneously, the number of bookings for laboratory and imaging services decreased by 50% below the pre-pandemic projections. The number of specialist and hospital service bookings remained at the predicted level during the study period. Cancellations for most health services increased sharply by up to three times the pre-COVID levels during the first weeks of the pandemic but returned to the pre-pandemic levels for the rest of the study period. CONCLUSIONS The reduction in in-person appointments and the increase in the utilisation of digital services was likely a contributing factor in the decrease of the utilisation of diagnostic and imaging services throughout the study period. Utilisation of specialist care and hospital services were not affected. Cancellations contributed to the changes in service utilisation only during the first weeks of the pandemic.
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Affiliation(s)
- Oskar Niemenoja
- Terveystalo Plc, Helsinki, Finland.
- Aalto University, Espoo, Finland.
| | | | | | | | - Petri Bono
- Terveystalo Plc, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Simo Taimela
- Terveystalo Plc, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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Cuevas Fernández FJ, Delgado Estévez JL, Hernández Lorenzo M, Segovia Martínez CM, Cabrera León A, Aguirre-Jaime A. [Diabetes control and visits to the family doctor during the COVID-19 pandemic: a multicenter study in primary care]. Aten Primaria 2024; 56:102815. [PMID: 38043174 PMCID: PMC10703598 DOI: 10.1016/j.aprim.2023.102815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVES To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. DESIGN Multicentric study of retrospective follow-up. SETTING Seven health centers in Tenerife, Spain. PARTICIPANTS 3543 patients with DM2. MAIN MEASUREMENTS Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. RESULTS 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. CONCLUSIONS The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.
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Affiliation(s)
- Francisco Javier Cuevas Fernández
- Gerencia de Atención primaria de Tenerife, Santa Cruz de Tenerife, España; Área de Medina Preventiva y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, España
| | - Juan Luis Delgado Estévez
- Gerencia de Atención primaria de Tenerife, Santa Cruz de Tenerife, España; Área de Medina Preventiva y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, España
| | | | - Cristóbal Manuel Segovia Martínez
- Gerencia de Atención primaria de Tenerife, Santa Cruz de Tenerife, España; Área de Medina Preventiva y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, España
| | - Antonio Cabrera León
- Área de Medina Preventiva y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, España; Unidad de Investigación de la Gerencia de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
| | - Armando Aguirre-Jaime
- Servicio de Apoyo a la Investigación en Cuidados del Colegio de Enfermer@s de Santa Cruz de Tenerife, España
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Ye M, Vena JE, Shen-Tu G, Johnson JA, Eurich DT. Reduced incidence of diabetes during the COVID-19 pandemic in Alberta: A time-segmented longitudinal study of Alberta's Tomorrow Project. Diabetes Obes Metab 2024; 26:1244-1251. [PMID: 38131246 DOI: 10.1111/dom.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
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.
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Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Inglin L, Wikström K, Lamidi ML, Laatikainen T. Consistent service use before the COVID-19 pandemic predicted the continuity of face-to-face appointments during the lockdown among type 2 diabetes patients. Prim Care Diabetes 2024; 18:230-237. [PMID: 38185577 DOI: 10.1016/j.pcd.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION The COVID-19 pandemic affected diabetes care among type 2 diabetes (T2D) patients. However, it is not known whether the observed changes in care concern all T2D patients equally. We examined the changes in health service usage and treatment outcomes among T2D patients according to the pre-pandemic follow-up activity. METHODS We analysed electronic health records of 11 083 T2D patients in North Karelia, Finland (March 2017-March 2021), categorizing them by pre-pandemic T2D-related in-person contact frequency. We focused on HbA1c and LDL measurement activity and treatment targets as care indicators. RESULTS Overall, health service usage and recording rates for HbA1c and LDL decreased during the pandemic. They decreased most but stayed at the highest level among patients with the most consistent pre-pandemic face-to-face service use, characterised by the highest proportion of comorbidities and elevated HbA1c. Their treatment outcomes were not negatively affected. In contrast, service usage and measurement activities increased among those with no pre-pandemic contact. CONCLUSION Those with consistent pre-pandemic service use and greater service needs were more likely to seek face-to-face care despite the lockdown, and no negative effect on treatment outcomes was seen.
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Affiliation(s)
- Laura Inglin
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Katja Wikström
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland.
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland; Joint Municipal Authority for North Karelia Social and Health Services, Tikkamäentie 16, FI-80210 Joensuu, Finland
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Amsah N, Md Isa Z, Ahmad N, Abdul Manaf MR. Impact of COVID-19 Pandemic on Healthcare Utilization among Patients with Type 2 Diabetes Mellitus: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4577. [PMID: 36901588 PMCID: PMC10002238 DOI: 10.3390/ijerph20054577] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
As the COVID-19 pandemic continues, healthcare services have been grossly overwhelmed by the pandemic. Due to this circumstance, routine care for individuals with type 2 diabetes mellitus (T2DM) has been temporarily disrupted. The purpose of this systematic review was to summarize the evidence regarding the impact of the COVID-19 pandemic on healthcare utilization among patients with T2DM. A systematic search was conducted in the Web of Science, Scopus, and PubMed databases. The process of identifying the final articles followed the PRISMA guidelines. The inclusion criteria were articles published between 2020 and 2022, written in English, and studies focusing on the research question. Any proceedings and books were excluded. A total of fourteen articles relevant to the research question were extracted. Following that, the included articles were critically appraised using the Mixed Method Appraisal Tool (MMAT) and the Joanna Briggs Institute Critical Appraisal Tool to assess the quality of the studies. The findings were further classified into three themes: reduced healthcare utilization among T2DM patients in routine healthcare services, a surge of telemedicine usage, and delay in the delivery of healthcare services. The key messages include demands for monitoring the long-term effects of the missed care and that better preparedness is crucial for any pandemic in the future. A tight diagnostic workup at the community level and regular follow-ups are crucial in managing the impact of the pandemic among T2DM patients. Telemedicine should be on the agenda of the health system to maintain and complement healthcare services. Future research is warranted to determine effective strategies to deal with the impact of the pandemic on healthcare utilization and delivery among T2DM patients. A clear policy is essential and should be established.
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Lavikainen P, Lamidi ML, Repo T, Inglin L, Martikainen J, Laatikainen T. Effects of COVID-19 Pandemic and Lockdown on Monitoring and Treatment Balance of Finnish Coronary Heart Disease and Type 2 Diabetes Patients. Clin Epidemiol 2022; 14:1363-1373. [PMID: 36387927 PMCID: PMC9664920 DOI: 10.2147/clep.s387461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/27/2022] [Indexed: 02/17/2024] Open
Abstract
PURPOSE We aimed to examine the effect of the COVID-19 pandemic and lockdown on monitoring and treatment balance of Finnish coronary heart disease (CHD) and type 2 diabetes (T2D) patients. PATIENTS AND METHODS We used data from the electronic health records on 1604 CHD and 10,136 T2D patients aged 18‒85 years in Eastern Finland. Measurement and levels of low-density lipoprotein cholesterol (LDL) of CHD patients and glycated haemoglobin (HbA1c) of T2D patients were assessed monthly during January 2019-June 2021. Interrupted time-series analysis design was utilized to examine the effect of the lockdown on proportion of patients monitored and treatment balance. RESULTS Reductions in frequencies of LDL testing of CHD and HbA1c testing of T2D patients were observed during the national lockdown. Downward trend in average LDL was observed from January 2019 until June 2021. Average HbA1c values increased from January 2019 to March 2020 with an additional increase by 2.04 mmol/mol (0.80 to 3.29) in April 2020. However, there was a downward trend in monthly average HbA1c during the lockdown until June 2021 with an additional change in level by 0.61 mmol/mol (95% CI 0.06 to 1.16) in July 2020. CONCLUSION The lockdown decreased the frequency of monitoring among both CHD and T2D patients. Meanwhile, monthly average LDL had a steadily improving pattern in CHD patients during the follow-up while temporary worsening in HbA1c in patients with T2D was observed at the time of the lockdown. The lockdown may have introduced selection in patients who had their treatment outcomes monitored. Better self-management of risk factors among patients is also possible.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Teppo Repo
- Department of Geographical and Historical Studies, University of Eastern Finland, Joensuu, Finland
| | - Laura Inglin
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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