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
Responses from healthcare professionals who completed the online survey between March
31 and April 23, 2020.
Healthcare profession (n = 202)
Primary care physician
How are you continuing to provide routine chronic disease management care for your
patients? (n = 202)
Both (face-to-face and telephone)
How has the management of chronic disease care for your patients been since the outbreak
of COVID-19? (n = 202)
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)
How frequently have your patients been impacted by medication shortages since the
start of COVID-19? (n = 201)
Has the mental health of your patients worsened since the outbreak of COVID-19? (n = 200)
Yes (most patients)
Yes (some patients)
No, it has stayed the same
No, it has improved
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 . 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
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 . 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
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
The National Institute for Health Research (NIHR) Applied Research Collaboration East
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.