Kendzerska Tetyana, Zhu David T, Gershon Andrea S, Edwards Jodi D, Peixoto Cayden, Robillard Rebecca, Kendall Claire E
Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Risk Manag Healthc Policy. 2021 Feb 15;14:575-584. doi: 10.2147/RMHP.S293471. eCollection 2021.
Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions.
A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021.
During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed.
Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.
患有慢性病的个体需要持续的疾病管理以降低不良健康后果的风险。在新冠疫情期间，由于资源重新分配用于新冠患者的紧急护理，非新冠病例的医疗保健受到影响，导致慢性病的持续护理不足。
在PubMed、谷歌学术、科学Direct和Scopus中进行关键词搜索，以查找2020年1月至2021年1月期间发表的英文文章。
在新冠疫情期间，由于政府限制选择性和非紧急医疗就诊、在面对面就诊期间对潜在新冠病毒暴露的更大恐惧以及与新冠疫情前相比更高的远程医疗利用率，慢性病患者的面对面护理减少。疫情期间虚拟护理框架的潜在好处包括更有效的常规疾病监测、提高患者满意度以及提高治疗依从性和随访率。然而，需要做更多工作以确保及时有效地获得远程医疗服务，特别是对于数字素养较低的个体。与按服务收费的初级保健模式相比，人头费初级保健模式在新冠疫情期间被提议作为一种更具财务稳健性的方法；然而，不同初级模式与健康结果之间的相互作用仍知之甚少，值得进一步研究。在新冠疫情开始时，由于全球供应链中断，还观察到用于管理慢性病的药物短缺。最后，慢性病患者因新冠疫情面临生活方式的干扰，特别是在身体活动、睡眠、压力和心理健康方面，这些需要得到更好的解决。
总体而言，本综述阐明了慢性病患者在新冠疫情期间在初级和专科护理方面面临的不成比例的更大障碍，并强调迫切需要制定更好的慢性病管理策略。
