De impact van Covid-19 op chronische zorg volgens zorgverleners: een kwalitatieve studie bij eerstelijnspraktijken in België

Abstract

The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase the resilience of the health system and to prepare it adequately for next waves of the pandemic. A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Using semi-structured video interviews, 21 people (doctors, nurses, dieticians) were interrogated. A thematic analysis was performed using the domains of the chronic care model (CCM). Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care and a reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. The findings in this article show a disruption of the delivery of chronic care in the Belgian primary care context. In such contexts, the establishment of the CCM can facilitate the continuity of care in times of a crisis. Short-term actions should be directed to facilitate the identification of high-risk patients and to develop a practice organization plan to organize chronic care and to use digital channels for support, especially with regard to vulnerable patients, during next waves of the epidemic.