Chronic diseases represent the leading cause of disability worldwide, with approximately one in three adults suffering from one or more chronic conditions.1 Chronic diseases, with the most prevalent conditions being cardiovascular disease, chronic lung disease, diabetes, and chronic kidney disease, have been consistently associated with higher healthcare utilization and worse health outcomes when care is disrupted.1–3 The likelihood of hospital admission for an adverse event increases with the number of chronic conditions, especially in the elderly population.1 While the complex interplay of chronic disease management is seldom seamless under normal circumstances, the novel barriers imposed by the COVID-19 pandemic increase this difficulty substantially. Globally, the pandemic has strained healthcare systems’ resources and adversely affected clinical decision-making by limiting ancillary testing (eg, bloodwork, imaging, pulmonary function tests) and physical exams.4–6 Further, in March 2020, governments around the world ubiquitously imposed restrictions on the use of hospital and ambulatory services by cancelling all elective, routine, and non-urgent patient procedures, enforcing stricter physical distancing measures, and transitioning into remote care to reallocate resources towards the urgent care of COVID-19 patients.7 This has hindered the ability of individuals with chronic conditions to receive timely and effective access to primary and specialty care.8–10 As the COVID-19 pandemic progresses, there is still considerable uncertainty surrounding the management of individuals with chronic conditions. Thus, in this narrative review, we aim to overview how individuals with chronic conditions have been affected by changes in (1) adaptions in the healthcare system for both primary and specialty care, (2) levels of healthcare utilization (eg, hospitalizations, emergency department [ED] visits, use of ancillary testing, medications supply), and (3) socioeconomic and environmental risk factors, in response to the COVID-19 pandemic.
Between July 2020 and January 2021, we conducted a literature search in PubMed, Google Scholar, Science Direct, and Scopus for articles published between January 2020 and January 2021 (with an exception to this time range if the article was only used to contextualize general challenges and epidemiology of chronic disease patients). Combinations of the search terms “chronic disease”, “COVID-19”, “cardiovascular disease”, “coronary artery disease”, “heart failure”, “myocardial infarction”, “hypertension”, “chronic obstructive pulmonary disease”, “asthma”, “diabetes”, “epilepsy”, “insomnia”, “obstructive sleep apnea”, “telemedicine”, “drug shortages”, “diet”, “nutrition”, “physical exercise”, “primary care”, “hospitalization”, “fee-for-service”, “capitation”, “mental health”, and “stress” were used to initially retrieve articles. We screened titles and abstracts using the following criteria. Inclusion criteria were defined as any English-language peer-reviewed primary articles, review articles, or opinion and commentary articles that focused on, or at least included, non-SARS-CoV-2 infected patients with chronic diseases during the COVID-19 pandemic. Exclusion criteria were defined as any sources that did not fit into these criteria, such as articles that focused only on SARS-CoV-2 infected patients with comorbid chronic diseases. Articles that met inclusion criteria were subsequently evaluated in their entirety for content relevancy to our narrative discussion. All authors agreed on the final reference list.
Healthcare Characteristics and Utilization by Individuals with Chronic Conditions During the COVID-19 Pandemic
Primary Care Characteristics and Utilization by Individuals with Chronic Conditions
Primary care serves as a gateway into the healthcare system and…