Ministry of Health, Al Khuwair, Muscat, Oman.
J Prim Care Community Health. 2021 Jan-Dec;12:21501327211051930. doi: 10.1177/21501327211051930.
COVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients' and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients' glycemic outcome in Oman.
To explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients' glycemic outcome.
Before and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients' glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients' HbA1c and mode of consultation was measured using multivariable regression analysis.
A total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), . With multivariable linear regression, the mean difference in HbA1c was -0.3 (-2.3 to 1.5), for telephone consultation alone, -0.5 (-2.4 to 1.4), , and -0.5 (-2.4 to 1.3), , compared to those who did not receive any formal consultation.
Despite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.
COVID-19 大流行导致医疗服务发生变化，并暂时中断了初级保健中为糖尿病患者提供的常规护理。这样做是为了最大限度地减少门诊就诊次数，允许保持身体距离，并确保患者和医疗保健提供者的安全。目前尚无证据表明 COVID-19 大流行对阿曼糖尿病服务和患者血糖控制结果产生了影响。
在宣布 COVID-19 大流行后，探索初级保健中糖尿病服务的可及性，并衡量患者的血糖控制结果。
这是一项在初级保健中使用 Al-Shifa 医疗保健数据库进行的前后回顾性队列研究。2019 年在大流行宣布前，随机选择了 1000 名成年糖尿病患者参加糖尿病诊所，并对他们进行随访，直至 2020 年底。纳入年龄≥18 岁且 2019 年至少就诊 2 次的患者。通过接受治疗的患者人数、就诊频率、就诊方式和给予患者的干预类型来确定糖尿病服务的可及性。确定 2020 年大流行宣布后患者的糖化血红蛋白（HbA1c）和其他血糖参数，并与 2019 年大流行前的相同参数进行比较。使用多变量回归分析测量患者的 HbA1c 与就诊方式之间的关联。
共有 937 名患者在大流行宣布后继续接受糖尿病护理。中位数就诊次数为 2 次，四分位间距（IQR）：3-2.57。47.4%的患者仅接受面对面咨询，32.4%的患者同时接受面对面和电话咨询，10%的患者仅接受电话咨询。大流行宣布前后 HbA1c（%）的平均差异为 0.2±1.4（95%CI：0.1 至 0.3），多变量线性回归显示，单独接受电话咨询的平均差异为-0.3（-2.3 至 1.5），单独接受电话咨询的平均差异为-0.5（-2.4 至 1.4），单独接受电话咨询的平均差异为-0.5（-2.4 至 1.3）。
尽管 COVID-19 大流行后初级保健中的服务发生了变化，全面护理也中断，但由于大多数患者仍在接受随访，糖尿病服务仍然可以获得。糖化血红蛋白总体呈上升趋势，但上升幅度不足 1 个单位。在调整了多变量后，与未接受任何正式咨询的患者相比，接受包括电话咨询在内的咨询的患者的糖化血红蛋白有所下降，但证据不太令人信服。
