The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium

Abstract

Background The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.

Health, psychosocial, and economic impacts of the COVID-19 pandemic on people with chronic conditions in India: a mixed methods study

“…People with diabetes and hypertension were worst affected due to their difficulty in accessing health care and experienced worsening symptoms or uncontrolled BP or FBS during the lockdowns, which might lead to poor health outcomes and avoidable micro- and macrovascular complications. People with chronic conditions are known to be most vulnerable to the complications of COVID-19 as highlighted in the WHO global survey and several published reports [ 8 , 9 , 23 , 38 – 40 ]. It is unclear how the dual impact of COVID-19 and the health care disruptions affect these individuals in the long-term.…”

“…Measures to address coronavirus spread including lockdowns may have serious economic consequences and unintended effect of exacerbating rather than mitigating health disparities [ 8 , 9 , 23 , 24 ]. However, to date, few data document the impact of the COVID-19 pandemic on disparities in chronic disease management in India.…”

Magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Ethiopia during the COVID-19 pandemic

“…The COVID-19 pandemic has severely affected health systems in general and follow-up service to chronic illnesses in particular [ 28 – 30 ]. Its impact in Sub-Saharan Africa is more pronounced as this region is often characterized by low health system infrastructure coupled with a growing burden of non-communicable diseases [ 31 ].…”

Family Physicians’ Standpoint and Mental Health Assessment in the Light of COVID-19 Pandemic—A Nationwide Survey Study

“…Moreover, with all the COVID-19 related changes in the healthcare system, and even more workload put on FPs, it is possible that the quality and continuity of primary healthcare is severely obstructed for other patients with non-communicable diseases (NCDs) in need of chronic care [ 25 , 26 ]. However, attitudes from the FP perspective on this aspect of the pandemic have not been studied yet, to the best of our knowledge.…”