Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India.
Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, India.
Front Public Health. 2021 Feb 1;8:584408. doi: 10.3389/fpubh.2020.584408. eCollection 2020.
While most of the studies to date demonstrate the deleterious effect of multiple chronic diseases on COVID-19 risk and outcome, there is sparse information available on the effect of the pandemic on multimorbidity management, with no reports yet from India. We sought to explore the effect of COVID-19 pandemic on routine and emergency care for multimorbidity among community-dwelling adults in Odisha, India. A community-based cross-sectional study was undertaken pandemic lockdown, in Khurda district of Odisha, India. Around 600 individuals having at least one chronic disease residing in rural, urban residential and slums were interviewed using a specifically developed questionnaire MAQ COVID-19. The association of socio-demographic characteristics and multimorbidity with pandemic-related care challenges was examined by multiple logistic regression. Principal Component Analysis was employed to minimize the dimensionality of factors related to multimorbidity care. Multimorbidity was highly prevalent in younger age group (46-60 years) with cardio-metabolic clusters being dominant. Individuals with multimorbidity experienced significantly higher care challenges than those with single condition (AOR = 1.48, 95% CI = 1.01-2.05) with notable disruption in treatment and routine check-up. Most frequently cited concerns were-physician consultation (43%), diagnostic-services (26%), transport (33%), and mobility restrictions (21%). Multivariate analysis revealed older adults living alone in urban residence to have higher challenges than their rural counterparts. Patient activation for self-care, multimorbidity literacy, and technology-enabled tele-consultation could be explored as potential interventions. Future studies should qualitatively explore the challenges of physicians as well as garner an in-depth understanding of multimorbidity management in the vulnerable subgroups.
虽然迄今为止的大多数研究表明，多种慢性疾病会对 COVID-19 的风险和结果产生有害影响，但关于大流行对多种疾病管理的影响的信息很少，印度尚无相关报告。我们旨在探讨 COVID-19 大流行对印度奥里萨邦社区居住成年人多种疾病常规和紧急护理的影响。在印度奥里萨邦库尔达区进行了一项基于社区的横断面研究，该研究在大流行封锁期间进行。使用专门开发的 MAQ COVID-19 问卷对至少患有一种慢性病的 600 名居住在农村、城市住宅和贫民窟的个体进行了访谈。采用多因素逻辑回归分析了社会人口统计学特征和多种疾病与大流行相关的护理挑战之间的关联。采用主成分分析来最小化与多种疾病护理相关因素的维度。结果发现，年轻年龄组（46-60 岁）的多种疾病患病率较高，以心血管代谢疾病为主。与单病种患者相比，多种疾病患者经历了更高的护理挑战（OR = 1.48，95%CI = 1.01-2.05），治疗和常规检查明显中断。最常提到的问题是医生咨询（43%）、诊断服务（26%）、交通（33%）和行动限制（21%）。多变量分析显示，居住在城市的独居老年人比农村老年人面临更大的挑战。可以探索患者自我护理的积极性、多种疾病知识和基于技术的远程咨询等潜在干预措施。未来的研究应定性探讨医生面临的挑战，并深入了解弱势群体的多种疾病管理。
