Impact of COVID-19 primary healthcare service restrictions on patients with chronic obstructive pulmonary disease in Cape Town, South Africa

Abstract

Background. Patients with chronic obstructive pulmonary disease (COPD) typically experience multidimensional symptoms throughout the course of their disease, with burdensome physical symptoms, social isolation, and additional psychological suffering. COVID-19 lockdown resulted in restrictions on chronic care delivery at primary healthcare (PHC) facilities, and it is not known what the care experiences of patients with COPD were during this time.Objectives. To describe patient experiences of the impact of the lockdown on their needs and their experiences of the primary care received for their COPD.Methods. The data reported in this paper are from a cohort of 49 patients with COPD receiving primary care, recruited in February and March 2020, before recruitment was paused for COVID-19 lockdown, for a feasibility stepped-wedge hybrid type II design randomised controlled trial of integrated person-centred palliative care in primary care for patients with COPD in Cape Town, South Africa. Data are open-text responses from participants who responded to a single question on a validated measure of primary care consultation empathy (CARE), and describe patient experiences of the impact of the lockdown on the primary care received for their COPD, prior to crossover to trial intervention.Results. Thirty-two patients with COPD gave between 1 and 9 responses each to the open-ended question between March and December 2020. The average age of the participants was 58.6 years, and 53.1% (n=17) were female. Inductive analysis of the open-text data identified four main themes. Participants described decreased access to chronic care and a desire for more person-centred care in interactions with healthcare professionals. The socioeconomic ramifications of the COVID-19 lockdown added to the burden they experienced.Conclusion. The COVID-19 lockdown PHC service restrictions caused a disruption to the continuity of care for patients with COPD, with associated worry, anxiety and disappointment. Medication access was largely supported by the home delivery of chronic medication. We suggest that there are opportunities for providing more sustained support for patients with COPD through referrals to community health workers, and also through telephonic patient follow-up by primary care teams

Factors disrupting the continuity of care for patients with chronic disease during the pandemics: A systematic review

“…Patient-side factors Individual and social factors Age [22][23][24][25] Comorbidity [10,22] Insufficient knowledge [26][27][28] Disease-related factors Severity of chronic disease [23,29] The duration of the disease [24,30] Family history of the disease [25] psychological factors Negative emotions [22,23,26,[28][29][30][31][32][33][34][35] Medical and family support [26,29,35] Health system-side factors…”

Revisión bibliográfica sobre la Enfermedad Pulmonar Obstructiva Crónica en el desarrollo y pronóstico de COVID-19

“…Durante la pandemia su alto índice de mortalidad se relacionó con su gran impacto en los sistemas de salud, al déficit de inmunidad, falta de medicamentos y principalmente al desarrollo de neumonía e insuficiencia respiratoria aguda grave. (Fang et al, 2020;Farrant et al, 2022) La detección eficaz del virus se la realiza mediante una reacción en cadena polimerasa (PCR) o una muestra de exudado nasofaríngeo u orofarínge, la determinación sérica de anticuerpos no resulta útil en fases tempranas de la enfermedad ya que estos son positivos a partir del séptimo día. (Rai et al, 2021) El tratamiento de esta enfermedad no es específico, se debe utilizar oxigenoterapia invasiva o no invasiva según necesidad cuando la saturación de oxígeno es menor del 92%, la temperatura se controla generalmente con paracetamol, los corticoides sistémicos se pueden considerar en caso de síndrome de distrés respiratorio agudo, se recomienda el uso de heparina de bajo peso molecular como profilaxis para evitar la formación de trombos , ciertos medicamentos como la hidroxicloroquina, cloroquina, remdesivir, lopinavir/ ritonavir, tocilizumab, tienen propiedades antivirales y en ciertos ensayos han dado resultados positivos por lo que pueden ser considerados, sin embargo ninguno de estos medicamentos es específico para este tipo de infección.…”