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

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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.