The Impact of COVID-19 Lockdown on Service Utilization Among Chronic Disease Patients in South Africa.
The Impact of COVID-19 Lockdown on Service Utilization Among Chronic Disease Patients in South Africa.
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DOI：
10.1177/11786329231215040
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发表时间：
2023
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
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在全球范围内，COVID-19大流行给医疗服务提供带来了许多干扰。有证据表明，这一流行病对孕产妇和儿童保健服务等常规保健服务的利用产生了负面影响，但在南非，关于这一流行病对非传染性疾病影响的文献很少。这些干扰可能对患者的健康和经济产生长期影响。使用行政数据估计COVID-19封锁对南非慢性病患者服务利用率的影响。我们使用2018年11月至2021年10月的慢性药物集中分配和分发（CCMDD）计划数据库的月度数据，研究了COVID-19封锁对仅接受抗逆转录病毒治疗（ART）药物治疗（仅ART）的患者、同时接受ART和NCD药物治疗（ART + NCD）的患者以及仅接受NCD药物治疗（仅NCD）的患者的使用情况的影响。我们采用分段中断时间序列的方法来研究变化。我们根据社会经济地位对分析进行了分层。我们发现，总体而言，封锁与CCMDD服务利用率增加相关，仅ART患者增加10.8%（95% CI：3.3%-19%），仅NCD患者增加10.3%（95% CI：3.3%-17.7%）。使用率的增加在不同的社会经济群体中没有差异。对于接受ART + NCD药物治疗的患者，使用率下降了56.6%（95% CI：47.6%-64.1%），并且在低SES地区出现了更高的下降。应教育患者在大流行期间及以后继续利用疾病项目的必要性。需要做出更多努力来改善患有多种疾病的患者对服务的使用。
Globally, the COVID-19 pandemic has brought many disruptions in health service delivery. Evidence show that the pandemic has negatively affected routine healthcare utilization such as maternal and child health services, but the literature on the effect on non-communicable diseases (NCDs) is scant in South Africa. These disruptions can have long-term health and economic implications for patients. To estimate the impact of COVID-19 lockdown on service utilization among chronic disease patients in South Africa using administrative data. Using monthly data from the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program database covering November 2018 to October 2021, we examined the effects of COVID-19 lockdown on utilization among patients receiving antiretroviral therapy (ART) medication only (ART-only), patients receiving both ART and NCD medication (ART + NCD), and patients receiving NCD medications only (NCD-only). We employed segmented interrupted time series approach to examine the changes. We stratified the analysis by socioeconomic status. We found that, overall, the lockdown was associated with increased utilization of CCMDD services by 10.8% (95% CI: 3.3%-19%) for ART-only and 10.3% (95% CI: 3.3%-17.7%) for NCD-only patients. The increase in utilization was not different across socioeconomic groups. For patients receiving ART + NCD medications, utilization declined by 56.6% (95% CI: 47.6%-64.1%), and higher reductions occurred in low SES districts. Patients should be educated about the need to continue with utilization of disease programs during a pandemic and beyond. More efforts are needed to improve service use among patients with multi-morbidities.