COVID-19 大流行期间，患者衰弱状况、多种并存疾病以及人口统计学特征与慢性病初级保健变化之间的关联：一项前后研究。

The association between patients' frailty status, multimorbidity, and demographic characteristics and changes in primary care for chronic conditions during the COVID-19 pandemic: a pre-post study.

机构信息

Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.

Department of Family Medicine, McMaster University, Hamilton, Canada.

出版信息

Fam Pract. 2023 Nov 23;40(4):523-530. doi: 10.1093/fampra/cmad089.

DOI:10.1093/fampra/cmad089

PMID:37624946

Abstract

BACKGROUND

The purpose of this study was to assess the impact of SARS-COV-2 (Severe acute respiratory syndrome coronavirus 2) pandemic on primary care management (frequency of monitoring activities, regular prescriptions, and test results) of older adults with common chronic conditions (diabetes, hypertension, and chronic kidney disease) and to examine whether any changes were associated with age, sex, neighbourhood income, multimorbidity, and frailty.

METHODS

A research database from a sub-set of McMaster University Sentinel and Information Collaboration family practices was used to identify patients ≥65 years of age with a frailty assessment and 1 or more of the conditions. Patient demographics, chronic conditions, and chronic disease management information were retrieved. Changes from 14 months pre to 14 months since the pandemic were described and associations between patient characteristics and changes in monitoring, prescriptions, and test results were analysed using regression models.

RESULTS

The mean age of the 658 patients was 75 years. While the frequency of monitoring activities and prescriptions related to chronic conditions decreased overall, there were no clear trends across sub-groups of age, sex, frailty level, neighbourhood income, or number of conditions. The mean values of disease monitoring parameters (e.g. blood pressure) did not considerably change. The only significant regression model demonstrated that when controlling for all other variables, patients with 2 chronic conditions and those with 4 or more conditions were twice as likely to have reduced numbers of eGFR (Estimated glomerular filtration rate) measures compared to those with only 1 condition ((OR (odds ratio) = 2.40, 95% CI [1.19, 4.87]); (OR = 2.19, 95% CI [1.12, 4.25]), respectively).

CONCLUSION

In the first 14 months of the pandemic, the frequency of common elements of chronic condition care did not notably change overall or among higher-risk patients.

摘要

背景

本研究旨在评估 SARS-COV-2（严重急性呼吸系统综合症冠状病毒 2）大流行对患有常见慢性病（糖尿病、高血压和慢性肾病）的老年患者的初级保健管理（监测活动、常规处方和检验结果的频率）的影响，并探讨这些变化是否与年龄、性别、社区收入、多重疾病和虚弱有关。

方法

利用麦克马斯特大学监测和信息合作家庭实践的一个研究数据库，确定了≥65 岁且进行了虚弱评估和有 1 种或多种疾病的患者。检索患者的人口统计学特征、慢性疾病和慢性疾病管理信息。描述大流行前 14 个月至大流行后 14 个月的变化，并使用回归模型分析患者特征与监测、处方和检验结果变化之间的关系。

结果

658 名患者的平均年龄为 75 岁。虽然与慢性疾病相关的监测活动和处方的频率总体上有所下降，但在年龄、性别、虚弱程度、社区收入或疾病数量的亚组中没有明显的趋势。疾病监测参数（如血压）的平均值没有明显变化。唯一具有统计学意义的回归模型表明，在控制所有其他变量的情况下，患有 2 种慢性病和患有 4 种或更多种慢性病的患者的 eGFR（估计肾小球滤过率）测量值减少的可能性是仅患有 1 种疾病的患者的两倍((OR（比值比）=2.40，95%CI [1.19, 4.87]）；（OR=2.19，95%CI [1.12, 4.25]）。