Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Health Services and Systems Research, Duke-NUS Medical School, Singapore.
J Am Med Dir Assoc. 2022 Jan;23(1):7-14. doi: 10.1016/j.jamda.2021.11.004. Epub 2021 Nov 12.
Little empirical research exists on how key stakeholders involved in the provision of care for chronic conditions and policy planning perceive the indirect or "spillover" effects of the COVID-19 on non-COVID patients. This study aims to explore stakeholder experiences and perspectives of the impact of COVID-19 on the provision of care for chronic conditions, evolving modalities of care, and stakeholder suggestions for improving health system resilience to prepare for future pandemics.
Qualitative study design.
This study was conducted during and after the COVID-19 lockdown period in Singapore. We recruited a purposive sample of 51 stakeholders involved in care of non-COVID patients and/or policy planning for chronic disease management. They included health care professionals (micro-level), hospital management officers (meso-level), and government officials (macro-level).
In-depth semi-structured interviews were conducted. All interviews were digitally recorded, transcribed verbatim, and thematically analyzed.
Optimal provision of care for chronic diseases may be compromised through the following processes: lack of "direct" communication between colleagues on clinical cases resulting in rescheduling of patient visits; uncertainty in diagnostic decisions due to protocol revision and lab closure; and limited preparedness to handle non-COVID patients' emotional reactions. Although various digital innovations enhanced access to care, a digital divide exists due to uneven digital literacy and perceived data security risks, thereby hampering wider implementation. To build health system resilience, stakeholders suggested the need to integrate digital care into the information technology ecosystem, develop strategic public-private partnerships for chronic disease management, and give equal attention to the provision of holistic psychosocial and community support for vulnerable non-COVID patients.
Findings highlight that strategies to deliver quality chronic care for non-COVID patients in times of public health crisis should include innovative care practices and institutional reconfiguration within the broader health system context.
关于参与慢性病护理和政策规划的主要利益相关者如何感知 COVID-19 对非 COVID 患者的间接或“溢出”影响，实证研究较少。本研究旨在探讨利益相关者对 COVID-19 对慢性病护理提供、护理模式演变的影响的经验和观点，以及利益相关者对提高卫生系统应对未来大流行病的恢复力的建议。
定性研究设计。
本研究在新加坡 COVID-19 封锁期间和之后进行。我们招募了 51 名参与非 COVID 患者护理和/或慢性病管理政策规划的特定利益相关者。他们包括医疗保健专业人员（微观层面）、医院管理人员（中观层面）和政府官员（宏观层面）。
进行深入的半结构式访谈。所有访谈均进行数字记录、逐字转录和主题分析。
慢性病的最佳护理可能会通过以下过程受到影响：临床病例的同事之间缺乏“直接”沟通，导致患者就诊时间重新安排；由于方案修订和实验室关闭，诊断决策存在不确定性；以及处理非 COVID 患者情绪反应的准备有限。尽管各种数字创新增强了获取护理的机会，但由于数字素养参差不齐和感知的数据安全风险，存在数字鸿沟，从而阻碍了更广泛的实施。为了建立卫生系统的恢复力，利益相关者建议需要将数字护理纳入信息技术生态系统，为慢性病管理制定战略性公私合作伙伴关系，并平等关注为弱势非 COVID 患者提供全面的心理社会和社区支持。
研究结果表明，在公共卫生危机时期为非 COVID 患者提供优质慢性病护理的策略应包括创新的护理实践和更广泛的卫生系统背景下的机构配置。
