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      Repercusiones en pacientes crónicos de una Zona Básica de Salud de Toledo en la Pandemia COVID-19 Translated title: Impact on chronic patients in a basic health zone of Toledo in the COVID-19 pandemic

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          Abstract

          RESUMEN: Introducción: Las personas con enfermedades crónicas son población vulnerable a la interrupción de la atención y al estrés producido con la pandemia por COVID-19. Se necesita reevaluar su riesgo cardiovascular postconfinamiento. Objetivo: Evaluar el impacto del confinamiento y modificaciones en sistema de atención sanitaria en la salud de personas con enfermedades crónicas de una Zona Básica de Salud de Toledo durante la pandemia COVID-19. Métodos: Estudio analítico, observacional, longitudinal, retrospectivo. Pacientes con patologías crónicas. Muestra aleatoria 420. Revisión historias clínicas para recogida parámetros clínicos/metabólicos antes y después confinamiento; N.º y tipo visitas enfermería e ingresos hospitalarios antes, durante y después confinamiento. Resultados Se evaluaron 349 historias. Edad media 65,36 y el 52,7% fueron hombres. Se encontró que tras el confinamiento hubo una disminución significativa de peso (p=0,046) y aumento de presión arterial diastólica (p=0,018) en toda la muestra. La disminución de peso fue mayor en mujeres, mayores de 65, hipertensos y personas con hiperlipidemias. En cuanto a variables clínicas que incrementaron sus cifras postconfinamiento, se observó aumento colesterol LDL en mayores de 65 (p=0,005). Aumento presión arterial diastólica en mujeres (p=0,005), mayores de 65 (p=0,022) e hipertensos (p=0,038), y aumento de presión arterial sistólica en mujeres (p=0,041). Aumento ingresos postconfinamiento (p=0,001); 57,1% de ingresos estuvo relacionado con su patología crónica y una disminución visitas enfermería durante y postconfinamiento (p=0,000). Conclusiones: Los pacientes crónicos han empeorado sus condiciones relacionadas con su patología durante y después del confinamiento. La atención presencial disminuida durante este período podría ser un factor que ha contribuido a esta situación.

          Translated abstract

          ABSTRACT: Introduction People with chronic diseases are vulnerable to disruption of care and stress with the COVID-19 pandemic. Their post-confinement cardiovascular risk needs to be reassessed. Objective To assess the impact of confinement and modifications in health care system on the health of people with chronic diseases in a Basic Health Zone in Toledo during COVID-19 pandemic. Methods Analytical, observational, longitudinal, retrospective study. Patients with chronic pathologies. Random sample 420. Review of clinical records to collect clinical/metabolic parameters before and after confinement. Number and type of nursing visits and hospital admissions before, during and after confinement. Results: 349 records were evaluated. Mean age 65.36 and 52.7% were men. It was found that after confinement there was a significant decrease in weight (p=0.046) and increase in diastolic blood pressure (p=0.018) in the whole sample. The decrease in weight was greater in women, patients aged >65 years, those with hypertension and those with hyperlipidemia. In terms of clinical variables that increased post-confinement Figures, an increase in LDL cholesterol was observed in patients aged >65 (p=0.005). Increased diastolic blood pressure in women (p=0.005), patients aged >65 (p=0.022) and those with hypertension (p=0.038) and increased systolic blood pressure in women (p=0.041). Increased post-confinement admissions (p=0.001); 57.1% of admissions were related to their chronic pathology and a decrease in nursing visits during and post-confinement (p=0.000). Conclusions Chronic patients have worsened conditions related to their pathology during and after confinement. Decreased face-to-face patient care during this period could be a contributing factor to this situation.

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          Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals

          Currently most global healthcare resources are focused on coronavirus disease (COVID-19). This resource reallocation could disrupt the continuum of care for patients with chronic diseases. We aimed to evaluate the global impact of COVID-19 on routine care for chronic diseases. (see Table 1 ) Table 1 Responses from healthcare professionals who completed the online survey between March 31 and April 23, 2020. Table 1 Survey questions No. (%) Healthcare profession (n = 202) Primary care physician 75 (37.1) Hospital physician 40 (19.8) Nurse 46 (22.8) Other 41 (20.3) 

 How are you continuing to provide routine chronic disease management care for your patients? (n = 202) Face-to-face 29 (14.4) Telephone 90 (44.6) Both (face-to-face and telephone) 70 (34.7) Other 13 (6.4) 

 How has the management of chronic disease care for your patients been since the outbreak of COVID-19? (n = 202) Very poor 9 (4.5) Poor 39 (19.3) Fair 96 (47.5) Good 52 (25.7) Excellent 6 (3.0) 

 What effect do you think changes in healthcare services has had on your patients with chronic disease since the outbreak of COVID-19? (n = 200) No effect 5 (2.5) Mild effect 61 (30.5) Moderate effect 92 (46.0) Severe effect 42 (21.0) 

 How frequently have your patients been impacted by medication shortages since the start of COVID-19? (n = 201) Never 32 (15.9) Rarely 37 (18.4) Sometimes 96 (47.8) Often 35 (17.4) Always 1 (0.5) 

 Has the mental health of your patients worsened since the outbreak of COVID-19? (n = 200) Yes (most patients) 41 (20.5) Yes (some patients) 118 (59.0) No, it has stayed the same 36 (18.0) No, it has improved 5 (2.5) We developed an English language nine-item online survey targeted at healthcare professionals (HCPs) across the globe, using a drop-down menu format. Prior to dissemination the survey was tested by a group of HCPs for the time to complete and to ensure no questions were distressing. The survey was administered between March 31 and April 23, 2020. The survey link was posted to social media (including Twitter, Facebook, and Instagram), websites, and mailing lists. The posts were sharable to facilitate snowball sampling. Informed consent was obtained. Descriptive analyses were performed. 202 HCPs from 47 countries responded; 47% from Europe, 20% Asia, 12% South America, 10% Africa, 9% North America, 2% Oceania. 75 (37%) were primary care physicians, 40 (20%) hospital physicians, 46 (23%) nurses, and 41 (20%) other HCPs (Table). Only 14% reported continuing face-to-face care for all consultations, whilst the majority reported a change to either a proportion (35%) or all now being carried out by telephone (45%). HCPs who selected other (6%), highlighted use of telemedicine where online video consultations were being used through Zoom, Skype, WhatsApp, Facebook messenger. Some reported home visits, or cancellation of all outpatient appointments. Diabetes (38%) was the condition reported to be most impacted by the reduction in healthcare resources due to COVID-19, followed by chronic obstructive pulmonary disease (COPD, 9%), hypertension (8%), heart disease (7%), asthma (7%), cancer (6%) and depression (6%) (Figure). Additionally, the two most common co-occurring chronic diseases for which care was impacted by COVID-19 were diabetes and hypertension (30%), diabetes and COPD (13%), heart failure and COPD (8%) (Figure). Whilst the overall management of chronic disease care for patients was reported to be fair (48%) or good (26%), most HCPs (67%) rated moderate or severe effects on their patients due to changes in healthcare services since the outbreak. Moreover, 80% reported the mental health of their patients worsened during COVID-19 (Table). Findings from this global survey showed HCPs have adapted to new ways of delivering care using telemedicine in order to reduce face-to-face contacts. Adapting new ways of virtual healthcare and digital technologies is imperative to allow HCPs to continue routine appointments. Further, the use of apps can support self-management of chronic conditions, i.e. continuous glucose monitoring enables support with diabetes. However, the majority of people with non-communicable diseases live in low-middle income countries, where these technologies may not be widely available or practical [1]. Moreover, those with multiple chronic conditions may rely heavily on regular check-ups or hospital appointments to manage risk factors, are left trying to adapt to non-face-to-face interactions, or experiencing delay in treatment which may potentially have severe consequences. Limitations of this survey include that it was only disseminated in English, as part of our networks we may have preferentially approached those working in diabetes. Also, difficulty in obtaining responses from HCPs when workloads may have already increased considerably. There will be heterogeneity between countries in that some countries are currently not as affected by the virus compared to others, and regulations of lockdown and social distancing differ by country, thus further research is required. To avoid a rise in non-COVID-19-related morbidity and mortality, including increased depression and anxiety, it is important that patients with chronic diseases continue to receive care in spite of the pandemic [2]. Our study found that this is currently being done through face-to-face consultation in clinics (away from COVID-19 patients) or through virtual communication.Fig. 1 Fig. 1 Chronic disease and comorbidities most impacted by COVID-19 due to the reduction in care, based on responses by healthcare professionals who completed the online survey between March 31 and April 23, 2020 Fig. 1 Funding/support The National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC-EM). Ethical approval and informed consent All participants gave informed consent at the start of the survey and no confidential data was collected, as all responses remained completely anonymous. This study has been approved by the University of Leicester College of Life Sciences Committee for Research Ethics Concerning Human Subjects (Non-NHS). Declaration of competing interest The authors have no conflict of interest to declare.
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            The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing

            The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. Infection containment measures will have substantial short- and long-term consequences; social distancing and quarantine restrictions will reduce physical activity and increase other unhealthy lifestyles, thus increasing NCD risk factors and worsening clinical symptoms. Vitamin D levels might decrease and there might be a rise in mental health disorders. Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.
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              Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care

              Background The COVID-19 pandemic has impacted the psychological health and health service utilisation of older adults with multimorbidity, who are particularly vulnerable. Aim To describe changes in loneliness, mental health problems, and attendance to scheduled medical care before and after the onset of the COVID-19 pandemic. Design and setting Telephone survey on a pre-existing cohort of older adults with multimorbidity in primary care. Method Mental health and health service utilisation outcomes were compared with the outcomes before the onset of the COVID-19 outbreak in Hong Kong using paired t-tests, Wilcoxon’s signed-rank test, and McNemar’s test. Loneliness was measured by the De Jong Gierveld Loneliness Scale. The secondary outcomes (anxiety, depression, and insomnia) were measured by the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder tool, and the Insomnia Severity Index. Appointments attendance data were extracted from a computerised medical record system. Sociodemographic factors associated with outcome changes were examined by linear regression and generalised estimating equations. Results Data were collected from 583 older (≥60 years) adults. There were significant increases in loneliness, anxiety, and insomnia, after the onset of the COVID-19 outbreak. Missed medical appointments over a 3-month period increased from 16.5% 1 year ago to 22.0% after the onset of the outbreak. In adjusted analysis, being female, living alone, and having >4 chronic conditions were independently associated with increased loneliness. Females were more likely to have increased anxiety and insomnia. Conclusion Psychosocial health of older patients with multimorbidity markedly deteriorated and missed medical appointments substantially increased after the COVID-19 outbreak.
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                Author and article information

                Journal
                eg
                Enfermería Global
                Enferm. glob.
                Universidad de Murcia (Murcia, Murcia, Spain )
                1695-6141
                2023
                : 22
                : 70
                : 437-464
                Affiliations
                [2] Cuenca orgnameUniversidad de Castilla-La Mancha orgdiv1Facultad de Enfermería Spain
                [1] Toledo orgnameGerencia Atención Primaria de Toledo orgdiv1Unidad Docente Multiprofesional orgdiv2Centro Salud de Torrijos España solefuensa@ 123456hotmail.com
                Article
                S1695-61412023000200016 S1695-6141(23)02207000016
                10.6018/eglobal.540881
                3a760933-a7ec-4a3a-bb53-0d64704c24ce

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 01 October 2022
                : 19 January 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 28
                Product

                SciELO Spain

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                impactos en la salud,COVID-19,Coronavirus infections,enfermedades no transmisibles,enfermedad crónica,Infecciones por coronavirus,impacts on health,Noncommunicable diseases,chronic disease

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