Chronic Disease Management Strategies Research Articles

Exploring Patient Preferences Related to Shared Decision-Making in Chronic Disease Management.

Background and objective Shared decision-making (SDM) in healthcare has transitioned from a paternalistic model to a collaborative approach, particularly significant in chronic disease management. This shift focuses on aligning healthcare decisions with patient preferences and values, thereby enhancing patient engagement and treatment adherence. However, patient preferences regarding involvement in SDM vary widely, influenced by demographic, disease-specific, psychological, cultural, and social factors. This study aimed to explore patient preferences related to SDM in chronic disease management in Saudi Arabia, by assessing attitudes towardSDM, the impact of decision aids, and the role of clinician communication in influencing these preferences. Methods A cross-sectional survey design was employed, involving 409 adult outpatients with chronic diseases attending four public hospitals in Saudi Arabia. Participants were selected using purposive and convenience sampling. The survey, translated into Arabic, collected demographic data and information on preferences and experiences in decision-making, communication, and information sharing. The data were analyzed using SPSS Statistics (IBM Corp., Armonk, NY) to identify patterns and correlations. Results Key findings indicated a strong preference among the participants for involvement in treatment decisions (n=303, 74.2%) and clear communication using layman's terms (n=338, 82.6%). Major barriers to active participation in SDM included lack of time during appointments (n=275, 67.2%), difficulty understanding medical terminology (n=220, 53.9%), and feeling intimidated to ask questions (297, 72.6%).Comfort in SDM was highest intheage group of 41-50 years[mean=4.16, standard deviation (SD)=28.44; F=2.3287, p=0.0739]. Patient satisfaction was significantly higher in the age group of 18-30 years(mean=3.42, SD=1.09; F=3.0503, p=0.0284). Conclusions Our findings highlightthe need for incorporating patient preferences into chronic disease management strategies to enhance engagement and satisfaction.

A Narrative Review of Alzheimer Dementia in African American and Hispanic Populations: The Health Care Provider's Role

African Americans and Hispanics, especially those of advanced age living with chronic diseases, have a higher risk of developing Alzheimer dementia (AD). Poor control of chronic diseases, such as diabetes, lack of awareness of increased risk factors by health care providers, or fragmented provider care can lead to missed opportunities to adopt early assessment strategies that can mitigate the effects or onset of AD. Nurse practitioners and other health care providers can play a crucial role in implementing chronic disease management strategies and educating patients who are at risk for AD among African Americans and Hispanics.

Daily Functionality of People with Low Vision: The Impact of Visual Acuity, Depression, and Life Orientation-A Cross-Sectional Study.

Low vision (LV) has a significant negative impact on the activities of daily life as well as on the psychological health of patients. The objective of this study is to investigate psychological, clinical, and demographic factors that may impact the daily functionality of patients with LV. A convenience sample of 53 patients, meeting the WHO criteria for LV, was recruited. Questionnaires on daily functionality, depression, and life orientation (in terms of optimism/pessimism) were administered along with a semistructured personal interview. Key Findings. The main results revealed a significant negative correlation between daily functionality and depression (r = -0.423, p < 0.001). Conversely, there is a positive correlation between daily functionality and visual acuity (r = 0.415, p < 0.001), while years since diagnosis were negatively correlated with depression (r = -0.345, p < 0.001). Depression seems to be a moderate predictor of a person's daily functionality (β = -0.389, p < 0.002), followed by visual acuity (β = -0.344, p = 0.006), explaining the 31.1% of the total variance. The study supports a correlation between daily functionality and both depression and visual acuity. Optimism as a personality characteristic did not factor into the prediction model for daily functionality, but it showed a strong correlation with lower levels of depressive symptoms. This highlights the potential for developing coping strategies for chronic disease management. Recommendations. The study could serve as a useful guide and may urge clinicians to pay attention to the psychological evaluation of these patients, supporting their unique emotional needs. Mental health professionals can use patients' positive resources to provide appropriate counseling and embrace the coping skills that encourage their engagement in activities of daily life.

Barriers and facilitators of lifestyle management among adult South Asian migrants living with chronic diseases: A mixed-methods systematic review

Background and aimSouth Asian migrants have a higher prevalence of chronic diseases than Caucasians. Despite much literature that has explored challenges in chronic disease management amongst the South Asian population in the past decades, their chronic disease management is still suboptimal. Understanding their determinants of disease management behaviour using the Theoretical Domains Framework will inform the development of a culturally sensitive intervention relevant to consumer-end-users. This study aimed to synthesise qualitative and quantitative studies on chronic disease management among adult South Asian immigrants. MethodsA mixed-methods systematic review was conducted using electronic databases. The Mixed Methods Appraisal Tool assessed the quality of the included studies. Quantitative data were transformed into qualitative data and analysed thematically. Subthemes were mapped in the Theoretical Domains Framework presenting barriers and facilitators under each theme. Results18293 studies were identified, of which 37 studies were included. The barriers and facilitators identified were categorised into four overarching themes: patient-provider interaction and relationship (e.g., complex language use by health professionals), the impact of migration (e.g., weather conditions had an impact on engagement with physical activity), heritage-based practices (e.g., an obligation to consume energy-dense food in social gatherings), and chronic disease management strategies (e.g., lack understanding of appropriate disease management strategies). ConclusionThis review provides a comprehensive understanding of the complexity of chronic disease management among South Asian migrants and insights into developing multifaceted interventions to address barriers to chronic disease management, guiding the healthcare professionals in helping overcome South Asians perceived barriers to managing chronic disease in the host countries.

A Qualitative Investigation on Chronic Disease Management and Prevention Among Older Adults During the COVID-19 Pandemic.

To qualitatively describe experiences of chronic disease management and prevention in older adults (age ≥65 years) during COVID-19. Qualitative descriptive approach. Data collected online via telephone and video-conferencing technologies to participants located in various cities in British Columbia, Canada. Data analyzed by researchers in the cities of Vancouver and Kelowna in British Columbia. Twenty-four community-living older adults (n = 24) age ≥65 years. Each participant was invited to complete a 30-to-45-minute virtual, semi-structured, one-on-one interview with a trained interviewer. Interview questions focused on experiences managing health prior to COVID-19 and transitioning experiences of practicing health management and prevention strategies during COVID-19. Audio recordings of interviews were transcribed verbatim and analyzed thematically. The sample's mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions (12.5% none, 12.5% one). Three themes described participants' strategies for chronic disease management and prevention: (1) having a purpose to optimize health (i.e., managing health challenges and maintaining independence); (2) internal self-control strategies (i.e., self-accountability and adaptability); and (3) external support strategies (i.e., informational support, motivational support, and emotional support). Helping older adults identify purposes for their own health management, developing internal control strategies, and optimizing social support opportunities may be important person-centred strategies for chronic disease management and prevention during unprecedented times like COVID-19.

Transformation of chronic disease management: Before and after the COVID-19 outbreak.

Adults with chronic diseases often experience a decline in their quality of life along with frequent exacerbations. These diseases can cause anxiety and impose a significant economic burden. Self-management is a crucial aspect of treatment outside of the hospital and can improve quality of life and reduce the financial burden resulting from unexpected hospitalizations. With the COVID-19 pandemic, telehealth has become a vital tool for both medical professionals and patients; many in-person appointments have been canceled due to the pandemic, leading to increased reliance on online resources. This article aimed to discuss various methods of chronic disease management, both traditional self-management and modern telehealth strategies, comparing before and after the COVID-19 outbreak and highlighting challenges that have emerged.

"Mind the Gap" - An overview of the role of the Extensions Community Healthcare Outcomes (ECHO) model in enhancing value in health care delivery.

The ECHO (Extensions Community Healthcare Outcomes) model of healthcare delivery has grown rapidly since its establishment and increased in popularity in recent years. This expansion has developed alongside the growing incidence of chronic diseases and the need to better manage them. The increasing uptake in ECHO has presented a requirement to assess its true value as healthcare costs are increasing globally, resulting in a growing demand by governments and policy makers to ensure chronic disease management strategies provide true value. Therefore, the aim of this review is to examine the impact that ECHO has on clinical practice and how such impacts are measured or evaluated. A narrative literature review is carried out to examine the outcomes assessed in ECHO-related studies. Three key academic databases were utilised for the literature search: Web of Science, PubMed, and Medline. Keywords relating to the review were chosen and searched for. Papers were screened using specified inclusion and exclusion criteria relating to years of publication (2000-2020), type of publication (original research, review papers and meta-analyses) and language requirements (English language only). This review found that while the ECHO model is expanding, and improving the so-called "knowledge gap" between specialists and primary care physicians, there is also a gap in the ways value is examined within ECHO. Most studies on ECHO lack an examination of patient reported health outcomes and appropriate, comparative costing methods. Current ECHO-related studies lack vital components that demonstrate the value of the model. Such components include patient reported health outcomes and detailed costing comparisons between the ECHO model and the traditional care pathway it is replacing.

The Concept of Healthy Behaviours in Obesity May Have Unintended Consequences.

Obesity has become a global epidemic, representing a major health crisis, with a significant impact both in human and financial terms. Obesity was originally seen as a condition, not a disease, which was considered self-inflicted. Thus, it was understandable that a simplistic approach, such as eat less and move more was proposed to manage obesity. Over the last 25 years, the perception of obesity has been gradually changing and the awareness has risen that it is a disease in its own right and not just a precipitating factor for type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), etc. Creation of a comprehensive algorithm for the management of obesity needs to be informed by an in-depth understanding of the issues impacting the provision of treatment. Promotion of healthy behaviours is essential to help the population become healthier, but these are not obesity treatment strategies. Twenty percent of patients with obesity may respond to approaches based on healthy behaviour, but the 80% who do not respond should not be stigmatised but rather their treatment should be escalated. The unintended consequences of promoting healthy behaviours to patients with obesity can be mitigated by understanding that obesity is likely to be a subset of complex diseases, that require chronic disease management. Once the biology of the disease has been addressed, then healthy behaviours may play an invaluable role in optimising self-care within a chronic disease management strategy.

Association between the metabolic score for insulin resistance (METS-IR) and estimated glomerular filtration rate (eGFR) among health check-up population in Japan: A retrospective cross-sectional study.

This study aimed to investigate the relationship between a new metric-metabolic score for insulin resistance (METS-IR)-and estimated glomerular filtration rate (eGFR) among Japanese participants who underwent health check-ups. We conducted a cross-sectional study that involved participants in a medical health screening program, which was conducted at the Medical Health Check-up Center in Japan. This retrospective study examined the relationship between METS-IR and eGFR among 881 individuals that joined the program between March 1, 2004, and December 31, 2012. Covariates consisted of serum laboratory tests and lifestyle questionnaires. Multivariate linear regression analysis was used to explore the association between METS-IR and eGFR. In addition, subgroup and interaction analyses were done based on age, sex, body mass index (BMI), alcohol use, smoking status, and hyperuricemia. A total of 881 individuals participated in this study. High METS-IR was highly linked with reduced eGFR (adjusted β = -5.04, 95% confidence interval (CI): -7.65 to -2.43), while METS-IR was utilized as a categorical variable inside the multiple regression analysis. A decrease in eGFR of 2.54 units was reported for every 10-unit rise in METS-IR (adjusted β = -2.54, 95% CI: -4.04 to -1.05, P-value = 0.001). Stratified analysis suggested no marked interaction between METS-IR and eGFR across age, sex, BMI, and alcohol consumption groups. However, there was an indication of interaction between METS-IR level, smoking status (P-value = 0.001), and uric level (P-value = 0.011) on eGFR decrease. METS-IR is remarkably associated with eGFR among the participants who underwent health check-ups in Gifu, Japan. Although more studies are required to prove it, METS-IR could be applied as a monitoring index for early screening, primary prevention, and diagnostic and treatment management strategies for chronic kidney disease.

Implementation, not hesitation, for SGLT2 inhibition as foundational therapy for chronic kidney disease.

Despite the increasing burden of ill health attributable to chronic kidney disease, appropriate pharmacotherapy has been inadequate. Based on trials in the 1990s and 2000s,1 guidelines recommend renin angiotensin system (RAS) inhibition to reduce progression of chronic kidney disease and its associated cardiovascular risk. However, the global burden of chronic kidney disease continues to increase.1 Furthermore, data from the US CURE-CKD registry highlights that uptake of chronic kidney disease management strategies is low, with only around 21% of patients prescribed RAS inhibitors between 2006 and 2017.

Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA-CKD.

BackgroundIn participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized.Methods and ResultsIn ISCHEMIA‐CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease), 777 participants with advanced CKD and moderate or severe ischemia were randomized to either an initial invasive or conservative management strategy. Herein, we compare the proportion of randomized participants with non–dialysis‐requiring CKD at baseline (n=362) who initiated dialysis and compare the time to dialysis initiation between invasive versus conservative management arms. Using multivariable Cox regression analysis, we also sought to identify the effect of invasive versus conservative chronic coronary disease management strategies on dialysis initiation. At a median follow‐up of 23 months (25th–75th interquartile range, 14–32 months), dialysis was initiated in 18.9% of participants (36/190) in the invasive strategy and 16.9% of participants (29/172) in the conservative strategy (P=0.22). The median time to dialysis initiation was 6.0 months (interquartile range, 3.0–16.0 months) in the invasive group and 18.2 months (interquartile range, 12.2–25.0 months) in the conservative group (P=0.004), with no difference in procedural acute kidney injury rates between the groups (7.8% versus 5.4%; P=0.26). Baseline clinical factors associated with earlier dialysis initiation were lower baseline estimated glomerular filtration rate (hazard ratio [HR] associated with 5‐unit decrease, 2.08 [95% CI, 1.72–2.56]; P<0.001), diabetes (HR, 2.30 [95% CI, 1.28–4.13]; P=0.005), hypertension (HR, 7.97 [95% CI, 1.09–58.21]; P=0.041), and Hispanic ethnicity (HR, 2.34 [95% CI, 1.22–4.47]; P=0.010).ConclusionsIn participants with non–dialysis‐requiring CKD in ISCHEMIA‐CKD, randomization to an invasive chronic coronary disease management strategy (relative to a conservative chronic coronary disease management strategy) is associated with an accelerated time to initiation of maintenance dialysis for kidney failure.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT01985360.

Rising Healthcare Costs and Utilization among Young Adults with Cirrhosis in Ontario: A Population-Based Study.

Objectives Chronic diseases account for the majority of healthcare spending. Cirrhosis is a chronic disease whose burden is rising, especially in young adults. This study aimed at describing the direct healthcare costs and utilization in young adults with cirrhosis compared to other chronic diseases common to this age group. Methods Retrospective population-based study of routinely collected healthcare data from Ontario for the fiscal years 2007–2016 and housed at ICES. Young adults (aged 18–40 years) with cirrhosis, inflammatory bowel disease (IBD), and asthma were identified based on validated case definitions. Total and annual direct healthcare costs and utilization were calculated per individual across multiple healthcare settings and compared based on the type of chronic disease. For cirrhosis, the results were further stratified by etiology and decompensation status. Results Total direct healthcare spending from 2007 to 2016 increased by 84% for cirrhosis, 50% for IBD, and 41% for asthma. On a per-patient basis, annual costs were the highest for cirrhosis ($6,581/year) compared to IBD ($5,260/year), and asthma ($2,934/year) driven by acute care in cirrhosis and asthma, and drug costs in IBD. Annual costs were four-fold higher in patients with decompensated versus compensated cirrhosis ($20,651/year vs. $5,280/year). Patients with cirrhosis had greater use of both ICU and mental health services. Conclusion Healthcare costs in young adults with cirrhosis are rising and driven by the use of acute care. Strategies to prevent the development of cirrhosis and to coordinate healthcare in this population through the development of chronic disease prevention and management strategies are urgently needed.

Abstract EP55: Qualitative Evaluation Of Older Adult Participants Of A Community Outreach Telehealth Program For Covid Education And Health Promotion (Coach)

Background: Chronic diseases are prevalent in Canada’s aging population (≥65 years). Positive health behaviours (e.g., physical activity, healthy diet) are critical for the management of chronic diseases (e.g., stroke, heart disease). However, novel coronavirus (COVID-19) prevention strategies of quarantining, social isolation, and physical distancing may compromise one's ability to manage health and engage in daily activities, possibly increasing risk of adverse health events. The Community Outreach teleheAlth program for Covid education and Health promotion (COACH) program has demonstrated an increase in health promoting behaviours, but little is known about participants’ experiences in participating in the program. The program entailed six telehealth sessions over two months that focused on health coaching, behaviour change, and COVID education. The objectives of this study were to describe: (1) chronic disease prevention and management strategies of older adults (≥65 years of age) during COVID-19; and (2) participants’ experience in COACH sessions delivered by medical students at the University of British Columbia. Methods: Twenty-four COACH participants participated in semi-structured interviews that were conducted through Zoom videoconferencing. Interview questions focused on how participants managed their own health before and during COVID-19. Qualitative description was the guiding methodological framework. Interviews were transcribed verbatim and analyzed thematically. Findings: Participants’ mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions (e.g., stroke, heart disease, coronary artery disease, diabetes, heart attack). Three themes described participants’ prevention and management strategies, including: i) having a purpose for optimizing health; ii) using internal self-control strategies; and iii) leveraging external support strategies. COACH further supported participants during COVID-19, as represented through coach interactions as well as knowledge and skill development. Conclusion: Findings suggest that older adults engage in internal self-control strategies and external support means to manage current chronic conditions and promote health and well-being. Health professional program students have a potential role in health promotion and in assuming the role of coach in telehealth promotion programs for older adults.

Assessment of Chronic Disease Management Strategies Among Health Care Practices in Medically Underserved South Carolina Counties.

Diabetes and heart disease are among the leading causes of death and disability in the United States, and these conditions are especially prevalent in the South. South Carolina's persistent racial and socioeconomic disparities in chronic disease outcomes are well-documented, yet little is known about how health care practices in medically underserved areas are addressing these challenges. Data were collected through a cross-sectional survey as part of two complementary 5-year cooperative agreements between the Centers for Disease Control and Prevention and the Division of Diabetes and Heart Disease Management (the Division) at the South Carolina Department of Health and Environmental Control. The Division fielded a survey to (a) assist in determining which Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were best poised to implement specific strategies as part of these cooperative agreements and (b) provide data to establish the baseline for performance measures. FQHCs and RHCs in the top 25% of counties with the highest diabetes and heart disease burden were surveyed about eight domains: staffing/services, electronic health records, team-based care policies, lifestyle change programs, medication therapy management, telehealth, quality improvement collaboratives, and patient demographics. Data representing 71 practices revealed contrasts between RHCs and FQHCs and opportunities for improvement. For example, while most practices reported they were not implementing evidence-based lifestyle change programs (e.g., the National Diabetes Prevention Program), most RHCs and FQHCs expressed interest in starting such programs. Findings are being used to guide efforts to improve diabetes and heart disease prevention and management in South Carolina.

Modelling management strategies for chronic disease in wildlife: Predictions for the control of respiratory disease in bighorn sheep

Abstract Controlling persistent infectious disease in wildlife populations is an ongoing challenge for wildlife managers and conservationists worldwide, and chronic diseases in particular remain a pernicious problem. Here, we develop a dynamic pathogen transmission model capturing key features of Mycoplasma ovipneumoniae infection, a major cause of population declines in North American bighorn sheep Ovis canadensis. We explore the effects of model assumptions and parameter values on disease dynamics, including density‐ versus frequency‐dependent transmission, the inclusion of a carrier class versus a longer infectious period, host survival rates, disease‐induced mortality and recovery rates and the epidemic growth rate. Along the way, we estimate the basic reproductive ratio, R0, for M. ovipneumoniae in bighorn sheep to fall between approximately 1.36 and 1.74. We apply the model to compare efficacies across a suite of management actions following an epidemic, including test‐and‐remove, depopulation‐and‐reintroduction, range expansion, herd augmentation and density reduction. Our results suggest that test‐and‐remove, depopulation‐and‐reintroduction and range expansion could help persistently infected bighorn sheep herds recovery following an epidemic. By contrast, augmentation could lead to worse outcomes than those expected in the absence of management. Other management actions that improve host survival or reduce disease‐induced mortality are also likely to improve population size and persistence of chronically infected herds. Synthesis and applications. Dynamic transmission models like the one employed here offer a structured, logical approach for exploring hypotheses, planning field experiments and designing adaptive management. We find that management strategies that removed infected animals or isolated them within a structured metapopulation were most successful at facilitating herd recovery from a low‐prevalence, chronic pathogen. Ideally, models like ours should operate iteratively with field experiments to triangulate on better approaches for managing wildlife diseases.

Virtual Group Visits: Hope for Improving Chronic Disease Management in Primary Care During and After the COVID-19 Pandemic.

As health care systems respond to the COVID-19 pandemic, new virtual care approaches are emerging for health promotion and chronic disease management. Virtual group visits (VGVs) supporting a healthy lifestyle, adapted from the well-established shared medical appointment (SMA) model, hold promise as a primary care delivery tool for preventing and managing chronic disease. In order to establish VGVs as standard of care, evidence for clinical effectiveness, financial sustainability, and access for vulnerable populations is needed. In the future, VGVs could improve the quality and reach of chronic disease prevention and management strategies.

Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India.

Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.

Clinician certainty with the evidence: In practice, it's complicated

Clinician certainty with the evidence: In practice, it's complicated

The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review.

BackgroundIndividuals 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.MethodsA keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021.FindingsDuring 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.InterpretationOverall, 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.

Temporal dynamics, patterns and correlates of single and multimorbidity in India, 1994-2018.

ObjectiveAs a consequence of the epidemiological transition, multimorbidity has been identified as a critical public health challenge in India. The majority of the studies in the domain are grounded on hospital-based data or are based on small sample size, findings from which can only be generalized to a specific sub-group. These studies recommend exploring multimorbidity holistically at a national level to ensure adequate healthcare management in the country. Therefore, the present study examines the pattern and correlates of single and multimorbidity over the past two decades in India.MethodsThe study utilized data on 397901, 257519, and 399705 individuals from 52nd (1994–1995), 60th (2004–2005), and 75th (2018) rounds of cross-sectional data from the National Sample Survey (NSS). Univariate, bivariate, and multivariable statistical methods were applied to draw inferences from the data. The findings depict an increase in single and multimorbidity burden over individuals’ age and NSS rounds.ResultsHypertension and diabetes were the fastest-growing morbidities over time. Higher education, urban residence, and belonging to an affluent class were significantly associated with both single and multimorbidity occurrence over time.ConclusionThe burden of single and multimorbidity increases over time among India’s older adults. Therefore, there is an urgent need to recuperate chronic disease management strategies for older adults in the Indian healthcare infrastructure.