The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgi
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RESEARCH ARTICLE
Open Access
The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium Katrien Danhieux1,2*† , Veerle Buffel3†, Anthony Pairon1, Asma Benkheil1, Roy Remmen1, Edwin Wouters3† and Josefien van Olmen1,2†
Abstract Background: The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods: A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results: Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion: Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic. Keywords: COVID-19, Chronic illness, Qualitative research, Continuity of care, Practice management, Telemedicine
Background The COVID-19 pandemic has had a profound impact on public health, resulting in excess death rates of 170,000 in Europe and of more than 100,000 in the USA [1] during the first outbreak. However, not all people are equally * Correspondence: [email protected] † Katrien Danhieux, Veerle Buffel, Edwin Wouters and Josefien van Olmen contributed equally to this work. 1 University of Antwerp, Primary and Interdisciplinary Care, Doornstraat 331, 2610 Wilrijk, Belgium 2 Institute of Tropical Medicine, Antwerp, Belgium Full list of author information is available at the end of the article
affected by the virus; people with diabetes or cardiovascular disease had a 2,5–3,9 times higher odds of being infected [2], with infection generally resulting in worse outcomes and a higher mortality rate in elderly people and in patients with comorbidities s
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