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

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          Abstract

          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.

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          Most cited references101

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          The COVID-19 pandemic and health inequalities

          This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemic pandemic. It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.
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            Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis

            Currently, the number of patients with coronavirus disease 2019 (COVID-19) has increased rapidly, but relationship between comorbidity and patients with COVID-19 still not clear. The aim was to explore whether the presence of common comorbidities increases COVID-19 patients’ risk. A literature search was performed using the electronic platforms (PubMed, Cochrane Library, Embase, and other databases) to obtain relevant research studies published up to March 1, 2020. Relevant data of research endpoints in each study were extracted and merged. All data analysis was performed using Stata12.0 software. A total of 1558 patients with COVID-19 in 6 studies were enrolled in our meta-analysis eventually. Hypertension (OR: 2.29, P<0.001), diabetes (OR: 2.47, P<0.001), chronic obstructive pulmonary disease (COPD) (OR: 5.97, P<0.001), cardiovascular disease (OR: 2.93, P<0.001), and cerebrovascular disease (OR:3.89, P=0.002)were independent risk factors associated with COVID-19 patients. The meta-analysis revealed no correlation between increased risk of COVID-19 and liver disease, malignancy, or renal disease. Hypertension, diabetes, COPD, cardiovascular disease, and cerebrovascular disease are major risk factors for patients with COVID-19. Knowledge of these risk factors can be a resource for clinicians in the early appropriate medical management of patients with COVID-19.
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              Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

              Abstract Aims To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). Methods and Results We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7–32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3–70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7–6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1–2.8; P = 0.009). Conclusion Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.
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                Author and article information

                Journal
                Risk Manag Healthc Policy
                Risk Manag Healthc Policy
                rmhp
                rmhp
                Risk Management and Healthcare Policy
                Dove
                1179-1594
                15 February 2021
                2021
                : 14
                : 575-584
                Affiliations
                [1 ]Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital , Ottawa, Ontario, Canada
                [2 ]Department of Medicine, University of Ottawa , Ottawa, Ontario, Canada
                [3 ]School of Epidemiology and Public Health, University of Ottawa , Ottawa, Ontario, Canada
                [4 ]Faculty of Science, Western University , London, Ontario, Canada
                [5 ]Department of Medicine, Sunnybrook Health Sciences Centre/University of Toronto , Toronto, Ontario, Canada
                [6 ]University of Ottawa Heart Institute , Ottawa, Ontario, Canada
                [7 ]The Institut Du Savoir Montfort , Ottawa, Ontario, Canada
                [8 ]The Royal’s Institute of Mental Health Research/University of Ottawa , Ottawa, Ontario, Canada
                [9 ]C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute , Ottawa, Ontario, Canada
                [10 ]Department of Family Medicine, University of Ottawa , Ottawa, Ontario, Canada
                Author notes
                Correspondence: Tetyana Kendzerska The Ottawa Hospital Research Institute , 501 Smyth Road, Ottawa, OntarioK1H 8L6, CanadaTel +1 613-761-4636 Email tkendzerska@toh.ca
                Author information
                http://orcid.org/0000-0002-5301-1796
                http://orcid.org/0000-0002-0246-594X
                http://orcid.org/0000-0002-1491-997X
                Article
                293471
                10.2147/RMHP.S293471
                7894869
                33623448
                ba690518-b8ae-4184-ba6b-6288cbacce5a
                © 2021 Kendzerska et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 23 November 2020
                : 18 January 2021
                Page count
                Figures: 0, References: 105, Pages: 10
                Funding
                Funded by: Ottawa Hospital Academic Medical Organization (TOHAMO);
                The Ottawa Hospital Academic Medical Organization (TOHAMO).
                Categories
                Review

                Social policy & Welfare
                narrative review,chronic disease,covid-19 pandemic,primary care,specialist care

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