Abstract
BackgroundThe COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic.MethodsA qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM).ResultsThree 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 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.ConclusionOur findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.
Highlights
The COVID-19 pandemic affects the processes of routine care for chronic patients
Changes in the health care delivery system and team approach The providers all observed a general drop in consultations for chronic care
This study examined how primary care practices in a highly affected area in Belgium organized services for chronic conditions like diabetes and hypertension during the COVID-19 pandemic
Summary
The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for waves of the pandemic. The unprecedented scale of this pandemic provided a significant challenge to modern medical care, requiring a collective shift towards the acute care for COVID-19 patients with severe presentation in hospitals, as well as the optimisation of infection control in the community This comprehensive effort to contain the pandemic and minimize the subsequent morbidity and mortality has affected both the continuity and quality of care for patients with chronic diseases [4]. Patients have less options for community-based support and care This leads to a serious concern about the indirect health footprint of COVID-19, especially on chronic diseases with increased complications and accelerated progression due to delayed and diminished access to secondary care and to a disruption in follow-up at primary care level
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