Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, South Africa.
Cicely Saunders Institute, King's College, London, UK.
S Afr Med J. 2022 Aug 30;112(9):760-764. doi: 10.7196/SAMJ.2022.v112i9.16385.
Patients with chronic obstructive pulmonary disease (COPD) typically experience multidimensional symptoms throughout the course of their disease, with burdensome physical symptoms, social isolation, and additional psychological suffering. COVID-19 lockdown resulted in restrictions on chronic care delivery at primary healthcare (PHC) facilities, and it is not known what the care experiences of patients with COPD were during this time.
To describe patient experiences of the impact of the lockdown on their needs and their experiences of the primary care received for their COPD.
The data reported in this paper are from a cohort of 49 patients with COPD receiving primary care, recruited in February and March 2020, before recruitment was paused for COVID-19 lockdown, for a feasibility stepped-wedge hybrid type II design randomised controlled trial of integrated person-centred palliative care in primary care for patients with COPD in Cape Town, South Africa. Data are open-text responses from participants who responded to a single question on a validated measure of primary care consultation empathy (CARE), and describe patient experiences of the impact of the lockdown on the primary care received for their COPD, prior to crossover to trial intervention.
Thirty-two patients with COPD gave between 1 and 9 responses each to the open-ended question between March and December 2020. The average age of the participants was 58.6 years, and 53.1% (n=17) were female. Inductive analysis of the open-text data identified four main themes. Participants described decreased access to chronic care and a desire for more person-centred care in interactions with healthcare professionals. The socioeconomic ramifications of the COVID-19 lockdown added to the burden they experienced.
The COVID-19 lockdown PHC service restrictions caused a disruption to the continuity of care for patients with COPD, with associated worry, anxiety and disappointment. Medication access was largely supported by the home delivery of chronic medication. We suggest that there are opportunities for providing more sustained support for patients with COPD through referrals to community health workers, and also through telephonic patient follow-up by primary care teams.
慢性阻塞性肺疾病（COPD）患者在疾病过程中通常会经历多维度的症状，包括身体症状负担重、社会隔离以及额外的心理痛苦。COVID-19 封锁导致初级保健（PHC）设施对慢性疾病护理的限制，目前尚不清楚在此期间 COPD 患者的护理体验如何。
描述患者在封锁期间对其需求的影响的体验，以及他们接受 COPD 初级保健的体验。
本文报告的数据来自于在南非开普敦进行的一项 COPD 患者接受初级保健的可行性分步楔形混合 II 期随机对照试验的队列研究，该研究纳入了 49 名接受初级保健的 COPD 患者，招募时间为 2020 年 2 月和 3 月，在此之前因 COVID-19 封锁而暂停招募，该研究旨在评估在初级保健中整合以患者为中心的姑息治疗对 COPD 患者的影响。数据来自于参与者对一项经过验证的初级保健咨询同理心（CARE）量表的单一问题的开放性文本回复，描述了患者在封锁期间接受 COPD 初级保健的体验，在此之前交叉到试验干预。
在 2020 年 3 月至 12 月期间，32 名 COPD 患者对开放式问题的回复次数为 1 至 9 次。参与者的平均年龄为 58.6 岁，53.1%（n=17）为女性。对开放性文本数据进行的归纳分析确定了四个主要主题。参与者描述了他们在与医疗保健专业人员互动时，慢性护理的获取减少以及对更以患者为中心的护理的需求。COVID-19 封锁的社会经济影响增加了他们所经历的负担。
COVID-19 封锁期间 PHC 服务限制导致 COPD 患者的连续护理中断，由此带来了担忧、焦虑和失望。慢性病药物的获取主要通过慢性病药物的家庭配送得到支持。我们建议，通过向社区卫生工作者转介，以及通过初级保健团队的电话随访，为 COPD 患者提供更持续的支持。
