Non-communicable disease management in vulnerable patients during Covid-19.
Non-communicable disease management in vulnerable patients during Covid-19.
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DOI：
10.20529/ijme.2020.041
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发表时间：
2020-04-01
影响因子：
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通讯作者：
Basu, Saurav
中科院分区：
文献类型：
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作者：
Basu, Saurav
现已明确，糖尿病、高血压、呼吸系统疾病和心脏病等非传染性疾病 (NCD)，尤其是老年人，会增加对 COVID-19 疾病的易感性。 60%-90% 的 COVID-19 病例的死亡归因于其中一种或多种合并症。然而，控制 COVID-19 的医疗保健管理涉及公共卫生和政策决策，可能会严重损害最脆弱的非传染性疾病患者的现有健康需求。一些二级和三级医院的门诊医疗机构暂时关闭，导致数百万非传染性疾病患者无法正常用药和诊断健康需求。大多数州缺乏强大的初级医疗保健设施，并且由于基础设施不足而未能保持身体距离规范也存在问题。在缺乏有效的公共卫生干预措施的情况下，社会经济弱势患者可能会变得不依从，从而增加了疾病并发症的风险。在这种背景下，在职能政府卫生机构为慢性非传染性疾病配发比平常更长的药物补充、基本药物送货上门、在初级保健中心开设专门的非传染性疾病诊所以及利用远程医疗机会为患者提供护理和支持的可行性值得积极探索。关键词：Covid-19、非传染性疾病、医学伦理、流行病、印度。
It is now well established that non-communicable diseases (NCD), like diabetes mellitus, hypertension,, respiratory and heart disease, particularly among the elderly, increase the susceptibility to COVID-19 disease. Mortality in 60%-90% of the COVID-19 cases is attributed to either one or more of these comorbidities. However, healthcare management for control of COVID-19 involves public health and policy decisions that may critically undermine the existing health needs of the most vulnerable NCD patients. Temporary closure of outpatient health facilities in some secondary and tertiary care hospitals have deprived millions of NCD patients of their regular medication and diagnostic health needs. The lack of robust primary healthcare facilities in most states, and the failure to maintain physical distancing norms due to inadequate infrastructure is also problematic. In the absence of effective public health interventions, socioeconomically vulnerable patients are likely to become non-adherent increasing manifold their risk of disease complications. In this context, the feasibility of dispensing longer than usual drug refills for chronic NCD conditions at functional government health facilities, home delivery of essential drugs, running dedicated NCD clinics at PHCs, and utilisation of telemedicine opportunities for care and support to patients warrant aggressive exploration. Keywords: Covid-19, NCDs, Medical ethics, epidemic, India.