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

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          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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          Author and article information

          Diabetes Metab Syndr
          Diabetes Metab Syndr
          Diabetes & Metabolic Syndrome
          Diabetes India. Published by Elsevier Ltd.
          23 June 2020
          23 June 2020
          [a ]Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
          [b ]NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester, United Kingdom
          Author notes
          []Corresponding author. Diabetes Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom. yc244@ 123456leicester.ac.uk
          © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.


          routine care, chronic diseases, covid-19, survey, healthcare


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