Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands.
BMC Health Serv Res. 2023 Feb 24;23(1):196. doi: 10.1186/s12913-023-09119-x.
The outbreak of COVID-19 had a significant impact on routines and continuity of professional care. As frequent users of this professional care, especially for people with chronic diseases this had consequences. Due to barriers in access to healthcare, an even greater appeal was made on the self-management behaviors of this group. In the present study, we aim to investigate the extent to which self-management changed during the recent pandemic, and which factors contributed to these changes.
The Dutch 'National Panel of people with Chronic Illness or Disability' was used to collect self-reported data of people with at least one chronic disease. Self-management was assessed with the Partners in Health questionnaire at two time points: before the crisis in 2018 and during the second wave of crisis in Autumn 2020. Paired t-tests were used to analyze changes in self-management. Potential associating factors on three levels - patient, organization and environment - were assessed in 2020 and their impact on self-management changes was tested with multinomial logistic regression.
Data from 345 panel members was available at two time points. In the majority of people, self-management behaviors were stable (70.7%). About one in seven experienced improved self-management (15.1%), and a similar proportion experienced deteriorated self-management (14.2%). Sex, physical disability, mental health and daily stressors due to COVID-19 (patient level), changes in healthcare access (organization level), and social support (environment level) were significantly associated with experienced changes in self-management.
People with chronic diseases experienced different trajectories of self-management changes during COVID-19. We need to be aware of people who seem to be more vulnerable to a healthcare crisis and report less stable self-management, such as those who experience mental health problems or daily stressors. Continuity of care and social support can buffer the impact of a healthcare crisis on self-management routines of people with chronic diseases.
COVID-19 的爆发对专业护理的常规和连续性产生了重大影响。由于经常使用这种专业护理，尤其是对于患有慢性病的人来说，这产生了后果。由于获得医疗保健的障碍，该人群对自我管理行为的需求更大。在本研究中，我们旨在调查在最近的大流行期间自我管理行为发生了多大程度的变化，以及哪些因素促成了这些变化。
使用荷兰“慢性疾病或残疾国家小组”收集至少患有一种慢性病的人群的自我报告数据。使用“健康伙伴关系问卷”在两个时间点评估自我管理：在危机前的 2018 年和 2020 年秋季危机的第二波期间。使用配对 t 检验分析自我管理的变化。在患者、组织和环境三个层面评估潜在的关联因素，并使用多项逻辑回归检验它们对自我管理变化的影响。
在两个时间点有 345 名小组成员的数据可用。在大多数人中，自我管理行为是稳定的（70.7%）。约有七分之一的人体验到自我管理行为的改善（15.1%），类似比例的人体验到自我管理行为的恶化（14.2%）。性别、身体残疾、心理健康和 COVID-19 导致的日常压力源（患者层面）、医疗保健获取的变化（组织层面）以及社会支持（环境层面）与自我管理变化的体验显著相关。
患有慢性病的人在 COVID-19 期间经历了不同的自我管理行为变化轨迹。我们需要注意那些似乎更容易受到医疗危机影响且自我管理行为不稳定的人，例如那些经历心理健康问题或日常压力源的人。医疗保健的连续性和社会支持可以缓冲医疗危机对慢性病患者自我管理常规的影响。
