Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA 94063, USA.
Department of Internal Medicine, San Francisco VA Health Care System, San Francisco, CA 94133, USA.
Mil Med. 2023 Jul 22;188(7-8):e2615-e2620. doi: 10.1093/milmed/usac277.
The abrupt change in care delivery caused by the coronavirus disease 2019 pandemic may have left some patients, particularly those with chronic conditions, unable to receive timely and appropriate routine care. Understanding the effect of the pandemic and the switch to virtual care for patients with chronic conditions requires in-depth qualitative feedback from providers who care for these patients.
We interviewed 13 primary care providers and clinical pharmacists from the Veterans Health Administration. Interviews elicited experiences managing patients with chronic conditions, specifically diabetes and hypertension, during the coronavirus disease 2019 pandemic. We employed a rapid analytic approach for data analysis.
In general, interview participants maintained that most patients' chronic conditions could be managed remotely without significant disruption. However, patients who lack familiarity with technology and/or reliable broadband access, patients not compliant with recommended self-assessments, and older patients with hearing loss or cognitive disorders may be more difficult to manage virtually. Although providers reported minimal disruptions to care because of the pandemic, they did note that the closure of labs and experiences of social isolation may have negatively impacted patients. Providers suggested optimizing virtual management through more robust patient instruction on virtual care technology, increased use of Veterans Affairs home health services, and removing institutional barriers that may de-incentivize virtual care modalities.
For many patients with chronic conditions, virtual care is a promising approach to provide ongoing management in primary care. However, more tailored strategies may be needed to care for sicker, more vulnerable patients.
由于 2019 年冠状病毒病大流行导致医疗服务的突然变化，一些患者，尤其是那些患有慢性病的患者，可能无法及时获得适当的常规护理。了解大流行对慢性病患者的影响以及向虚拟护理的转变，需要深入了解照顾这些患者的提供者的反馈。
我们采访了退伍军人事务部的 13 名初级保健提供者和临床药师。访谈内容包括在 2019 年冠状病毒病大流行期间管理慢性病患者（特别是糖尿病和高血压患者）的经验。我们采用了快速分析方法进行数据分析。
总的来说，访谈参与者认为，大多数患者的慢性病可以在没有重大干扰的情况下远程管理。然而，那些不熟悉技术和/或可靠的宽带接入、不遵守推荐的自我评估的患者，以及有听力或认知障碍的老年患者，可能更难进行虚拟管理。尽管提供者报告说由于大流行，护理几乎没有中断，但他们确实指出，实验室关闭和社会隔离的经历可能对患者产生了负面影响。提供者建议通过对虚拟护理技术进行更全面的患者指导、增加退伍军人事务部家庭健康服务的使用以及消除可能不利于虚拟护理模式的机构障碍来优化虚拟管理。
对于许多患有慢性病的患者来说，虚拟护理是一种有前途的方法，可以在初级保健中提供持续的管理。然而，对于病情较重、更脆弱的患者，可能需要更有针对性的策略。
