CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland.
Int J Health Plann Manage. 2022 Dec;37 Suppl 1:129-143. doi: 10.1002/hpm.3536. Epub 2022 Jul 5.
The COVID-19 pandemic has negatively impacted health services, especially in low-and-middle-income countries, where care for chronic conditions such as diabetes was disrupted. Our study aims to describe the challenges faced by people living with Type 1 diabetes mellitus (T1DM) to access care during the COVID-19 pandemic in Peru.
A sequential explanatory mixed-method study was conducted between May and September 2020 including health professionals involved in T1DM care, people with T1DM and their caregivers. The study consisted of a quantitative strand to gather general information through electronic surveys and a qualitative strand that involved in-depth interviews.
For the quantitative study, we included 105 people with T1DM, 50 caregivers and 76 health professionals. The qualitative study included a total of 31 interviews; 16 people with T1DM, 14 health care professionals, and one representative from the Peruvian Ministry of Health (MoH). People with T1DM faced difficulties accessing consultations, insulin, monitoring devices and laboratory testing during the pandemic. Different phases of the Peruvian health system response were found. Firstly, an initial informal response to addressing T1DM care during the pandemic characterised by local initiatives to ensure continuity of care for people with T1DM. Following from this, a formal response was implemented by the MoH which focussed on reinforcing the primary level of care. Measures included teleconsultations and delivery of medicines, although these were not implemented in all health care establishments. Throughout the pandemic patient associations played an important role in organising and helping to counteract the impact of COVID-19 on people with T1DM.
The Peruvian health care system slowly adapted to the COVID-19 pandemic to provide care for people with T1DM. However, people with T1DM had difficulties to access care. Thus, reinforcement of interventions such as communication between levels of care, teleconsultations and delivery of medicines was urgently needed. Patient associations' capacity to respond should be considered by local authorities and civil society should be part of the health system response.
COVID-19 大流行对卫生服务产生了负面影响，尤其是在中低收入国家，这些国家的糖尿病等慢性病护理受到了干扰。我们的研究旨在描述 COVID-19 大流行期间秘鲁的 1 型糖尿病（T1DM）患者在获取护理方面面临的挑战。
这是一项在 2020 年 5 月至 9 月期间进行的顺序解释性混合方法研究，包括参与 T1DM 护理的卫生专业人员、T1DM 患者及其照顾者。该研究包括通过电子调查收集一般信息的定量部分和涉及深入访谈的定性部分。
对于定量研究，我们纳入了 105 名 T1DM 患者、50 名照顾者和 76 名卫生专业人员。定性研究共包括 31 次访谈；16 名 T1DM 患者、14 名医疗保健专业人员和 1 名秘鲁卫生部代表。T1DM 患者在大流行期间在就诊、胰岛素、监测设备和实验室检测方面遇到困难。发现了秘鲁卫生系统反应的不同阶段。首先，初步的非正式反应是在大流行期间解决 T1DM 护理问题，其特点是采取地方举措确保 T1DM 患者的护理连续性。随后，卫生部实施了正式的反应，侧重于加强初级保健。这些措施包括远程咨询和药物配送，但并非所有医疗保健机构都实施了这些措施。整个大流行期间，患者协会在组织和帮助减轻 COVID-19 对 T1DM 患者的影响方面发挥了重要作用。
秘鲁的卫生保健系统缓慢适应 COVID-19 大流行，为 T1DM 患者提供护理。然而，T1DM 患者在获得护理方面存在困难。因此，迫切需要加强干预措施，如各级医疗保健之间的沟通、远程咨询和药物配送。地方当局应考虑患者协会的应对能力，民间社会应成为卫生系统应对措施的一部分。
