Impact of the COVID-19 pandemic on health care for patients with chronic diseases

新冠肺炎大流行导致国家卫生系统内的优先事项和资源重新分配发生了巨大变化。手术被推迟，全科医生(GP)诊所暂时关闭，甚至据报道急诊患者数量下降。初步数据显示，门诊部门也受到了很大影响。因此，该项目旨在调查新冠肺炎疫情对慢性病患者医疗保健的影响，重点是2型糖尿病(T2D)、冠心病(CHD)和癌症患者。在流行病学、普通医学和卫生经济学之间的跨学科方法中，我们从多个角度研究了大流行对T2D、CHD和癌症患者的影响。我们描述了与参照期(2010年至2019年)相比，在第一波大流行期间(2020年3月至5月)诊断、疾病管理、预防和获得卫生保健的情况。该项目回答了以下主要研究问题：在大流行期间，新诊断的慢性病的发病率和死亡率是如何发展的？在大流行期间，患者特征和地区指标对患者护理的连续性有何影响？是否有任何迹象表明慢性病患者初级保健的变化与健康结果的变化有关？我们将使用由巴伐利亚法定健康保险医生协会(KVB)提供的约1100万人的健康索赔数据，以及T2D和CHD患者的KVB处方数据和KVB疾病管理数据。此外，癌症发病率的数据来自巴伐利亚州癌症登记处，医院DRG和死亡率统计数据来自巴伐利亚州统计局。该项目包括四个单元(流行病学、疾病管理、预防和卫生经济学)，图1描述了针对疾病的研究问题。这两个单元的相关证据由两个工作方案(WP1和WP2)共同生成，项目说明中进一步概述了这两个工作方案。该项目是一项描述性次级数据分析，旨在显示在大流行期间如何发展对慢性病患者的护理，以及是否可以观察到时间序列中断或群体差异的模式。通过使用覆盖超过85%的巴伐利亚州人口的可靠常规数据，我们将能够对大流行和封锁措施对德国最大和受影响最严重地区的慢性病医疗保健的影响产生重要的见解。我们相信，该项目将有助于通过更密切地调查特定的患者队列来揭示慢性病护理方面的潜在缺陷，从而产生与患者、政策制定者和其他研究人员相关的证据，以便更好地为未来的大流行做准备。

The COVID-19 pandemic caused a tremendous change in priorities and reallocation of resources within national health systems. Surgeries were delayed, general practitioner (GP) practices temporarily closed and even a decline in number of emergency patients was reported. Preliminary data have shown that also the outpatient sector has been greatly affected. This project therefore aims to investigate the impact of the COVID-19 pandemic on health care for patients with chronic diseases focussing on patients with type 2 diabetes (T2D), coronary heart disease (CHD) and cancer. In an interdisciplinary approach between Epidemiology, General Medicine and Health Economics, we examine the impact of the pandemic on T2D, CHD and cancer patients from multiple perspectives. We describe how diagnosis, disease management, prevention and access to health care and have developed during the first wave of the pandemic (March to May 2020) in comparison to the reference period (2010 to 2019). The project answers the following overarching research questions: How did incidence of newly diagnosed chronic diseases and mortality develop during the pandemic? How do patient characteristics and area indicators impact upon the continuity of care for patients during the pandemic? Is there any indication that changes in primary care for patients with chronic diseases are associated with changes in health outcomes?We will use health claims data of approximately 11 million people, provided by the Bavarian Association of Statutory Health Insurance Physicians (KVB) as well as KVB prescription data and KVB disease management data for T2D and CHD patients. Further, data on cancer incidence is obtained from the Bavarian Cancer Registry, and hospital DRG and mortality statistics from the Bavarian State Office for Statistics. This project consists of four modules (Epidemiology, Disease Management, Prevention and Health Economics) for which disease-specific research questions are depicted in Figure 1. Relevant evidence for the modules is jointly generated by both work programmes (WP1 and WP2) that are further outlined in the project description. This project is a descriptive secondary data analysis designed to show how care of chronic diseases patients developed during the pandemic and whether patterns of time-series disruption or group-differences are observable. By using reliable routine data that covers over 85% of the Bavarian population, we will be able to generate important insights into the effects of the pandemic and lockdown measures on health care for chronic diseases in the largest and most affected German region. We believe that the project will help to reveal potential deficits in chronic diseases care by investigating specific patient cohorts more closely and thus generate evidence relevant for patients, policy-makers and other researchers to better prepare for future pandemics.