The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review.
The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review.
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DOI：
10.2147/rmhp.s293471
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发表时间：
2021
影响因子：
3.5
通讯作者：
Kendall CE
中科院分区：
文献类型：
--
作者：
Kendzerska T;Zhu DT;Gershon AS;Edwards JD;Peixoto C;Robillard R;Kendall CE
慢性病患者需要持续的疾病管理，以降低不良健康结果的风险。在COVID-19疫情期间，由于重新分配资源用于COVID-19患者的紧急护理，非COVID-19病例的医疗保健受到影响，导致对慢性病的持续护理不足。在PubMed、Google Scholar、Science Direct和Scopus中对2020年1月至2021年1月期间发表的英语文章进行了关键词检索。于2019冠状病毒病大流行期间，由于政府限制选择性及非紧急医疗就诊、对亲临就诊期间潜在的2019冠状病毒病风险的恐惧加深，以及与2019冠状病毒病前相比远程医疗的使用率较高，慢性病患者的亲临护理有所减少。在大流行期间，虚拟护理框架的潜在好处包括更有效的常规疾病监测，提高患者满意度，提高治疗依从性和随访率。然而，还需要做更多的工作，以确保及时和有效地获得远程医疗，特别是对数字素养较低的个人。在2019冠状病毒病大流行期间，按人头付费的初级保健模式被认为是一种比按服务收费的初级保健模式更具财务稳健性的方法;然而，人们对不同初级保健模式与健康结果之间的相互作用仍然知之甚少，需要进一步调查。由于全球供应链中断，在COVID-19大流行开始时也观察到用于管理慢性病的药物短缺。最后，慢性病患者的生活方式因COVID-19大流行而受到干扰，特别是在体力活动、睡眠、压力和心理健康方面，这些问题需要得到更好的解决。总体而言，本次审查阐明了慢性病患者在COVID-19大流行期间面临的初级和专科护理障碍不成比例地增加，并强调迫切需要更好的慢性病管理策略。
Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions. A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021. During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed. Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.