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

Authors Kendzerska T, Zhu DT, Gershon AS, Edwards JD, Peixoto C, Robillard R, Kendall CE

Received 23 November 2020

Accepted for publication 18 January 2021

Published 15 February 2021 Volume 2021:14 Pages 575—584


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Professor Marco Carotenuto

Tetyana Kendzerska,1– 3 David T Zhu,1,4 Andrea S Gershon,5 Jodi D Edwards,3,6 Cayden Peixoto,7 Rebecca Robillard,8 Claire E Kendall1,7,9,10

1Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada; 2Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 3School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; 4Faculty of Science, Western University, London, Ontario, Canada; 5Department of Medicine, Sunnybrook Health Sciences Centre/University of Toronto, Toronto, Ontario, Canada; 6University of Ottawa Heart Institute, Ottawa, Ontario, Canada; 7The Institut Du Savoir Montfort, Ottawa, Ontario, Canada; 8The Royal’s Institute of Mental Health Research/University of Ottawa, Ottawa, Ontario, Canada; 9C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Ontario, Canada; 10Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada

Correspondence: Tetyana Kendzerska
The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
Tel +1 613-761-4636

Background: Individuals 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.
Methods: A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021.
Findings: During 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.
Interpretation: Overall, 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.

Keywords: narrative review, chronic disease, COVID-19 pandemic, primary care, specialist care

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