Impact of COVID-19 Pandemic on Adherence to Chronic Therapies: A Systematic Review

Abstract

The spread of the coronavirus disease 2019 (COVID-19) pandemic caused a sudden and significant disruption in healthcare services, especially for patients suffering from chronic diseases. We aimed at evaluating the impact of the pandemic on adherence to chronic therapies through a systematic review of available studies. PubMed, EMBASE, and Web of Science were searched since inception to June 2022. Inclusion criteria were: (1) observational studies or surveys; (2) studies on patients with chronic diseases; (3) reporting the effects of COVID-19 pandemic on adherence to chronic pharmacological treatment, as a comparison of adherence during the pandemic period vs. pre-pandemic period (primary outcome) or as rate of treatment discontinuation/delay specifically due to factors linked to COVID-19 (secondary outcome). Findings from 12 (primary outcome) and 24 (secondary outcome) studies showed that many chronic treatments were interrupted or affected by a reduced adherence in the pandemic period, and that fear of infection, difficulty in reaching physicians or healthcare facilities, and unavailability of medication were often reported as reasons for discontinuation or modification of chronic therapies. For other therapies where the patient was not required to attend the clinic, continuity of treatment was sometimes ensured through the use of telemedicine, and the adherence was guaranteed with drug stockpiling. While the effects of the possible worsening of chronic disease management need to be monitored over time, positive strategies should be acknowledged, such as the implementation of e-health tools and the expanded role of community pharmacists, and may play an important role in preserving continuity of care for people with chronic diseases.

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

“… 37 , 38 A systematic review by Olmastroni et al assessed the impact of COVID-19 on medication adherence of many chronic conditions such as inflammatory bowel disease, COPD, osteoporosis, psoriasis and others. 39 Overall, they showed that adherence to the chronic therapies were reduced during COVID-19; some examples included biologics, controller inhalers and denosumab injections. Reasons for decreased adherence were difficulty in reaching physicians, fear of infection and unavailability of medications.…”

“…Reasons for decreased adherence were difficulty in reaching physicians, fear of infection and unavailability of medications. 39 They also showed that for some therapies, where patients were not required to attend the clinic, the use of telemedicine was crucial to ensure continuity of treatment. 39 More research on medication adherence during COVID-19 is warranted across other chronic medical conditions.…”

The Significance of Community Pharmacies' Services Beyond Dispensing Separation: A Rapid Scoping Review

“…Generally, community pharmacists who conducted medication reviews and provided educational counseling were the most common in the 9 included literature searches [16-24]. These are followed by specialized care services for speci c diseases or illnesses being offered by community pharmacists, as underlined in 9 included studies; these services include the management of anticoagulation, minor ailments, epilepsy care, chronic pain intervention, obesity, weight services, medicine and alcohol consultation, and other chronic disease care such as diabetes and hypertension [16,20,[25][26][27][28][29][30][31] Among the included studies, 3 highlighted the expansion of community pharmacists' services and their responsibilities in preserving the continuity of care for society during public health emergencies [32][33][34]. Community pharmacists also contributed to chronic disease management during the COVID-19 pandemic, maintaining the drug supply to the public, serving as vaccinators and screeners, and performing COVID-19 diagnostic tests.…”

“…Community pharmacists also played a role in preserving continuity of care for people with chronic diseases during the COVID-19 pandemic. Nonadherence has been widely reported for many chronic treatments for diseases, in ammatory diseases, and osteoporosis; these treatments are interrupted and subsequently reduced in adherence and therapy discontinuation due to di culties reaching healthcare facilities and the unavailability of medications [33]. Due to being highly accessible at any time during the outbreak, more than 50% of the vulnerable population with chronic diseases relied on community pharmacists for chronic disease management care, including medication [56].…”

“…Due to being highly accessible at any time during the outbreak, more than 50% of the vulnerable population with chronic diseases relied on community pharmacists for chronic disease management care, including medication [56]. Therefore, community pharmacists providing telemedicine consultation via telephone or other electronic channels, particularly for patients who were not required to attend the clinic, and speci cally for patients who required renewal of established therapy, have improved patients' adherence to chronic therapies during the pandemic period [33]. Other services offered by community pharmacists to preserve the continuity of medical supplies to vulnerable people who are at high risk of COVID-19 infection, such as elderly, people and patients with AIDS, asthma, tuberculosis, diabetes, hypertension, and COPD, include medication home delivery services [57].…”