Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia
COVID-19 affects individuals in different ways. Most infected patients develop a mild to moderate form of the disease and recover without hospitalization but adults of any age living with chronic conditions have an increased risk of serious symptoms and severe form of illness. Based on current evidence, conditions that increase risk include asthma, hypertension or high blood pressure, overweight or type 1 diabetes mellitus (ECDC, 2020). The threat to these patients is twofold, forcing them to avoid infection at the same time as their care routines are affected by the health protection measures put in place by governments. A better understanding of those impacts helps health systems to prepare adequately to provide patient-centered care during the pandemic.
A new study conducted by our team of the “School of Patients” researchers, has systematically explored these insights throught the stories of 34 chronically ill persons from the Andalusian region, at the South of Spain. This research, published last month in Gaceta Sanitaria (Link to the original article in Spanish), has exposed significant problems about the self-care of people experiencing chronic conditions during the quarantine of Spain`s population.
About the “School of Patients”
The Patients' School is an initiative of the Regional Health Ministry, which directs and manages this pioneering project in Spain, at the service of a large European region, Andalusia, with more than 8 million inhabitants.
What did we do?
Our team recruited 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. We conducted a qualitative study via virtual focus groups. A content analysis was carried out with the information recorded.
What did our study find?
People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the limited access to health services.
All interviewees stated that they were mainly informed by official sources, although they were aware of contradictions between official and expert sources. This caused them a great deal of confusion and insecurity.
Confinement leads to neglect of self-care. Difficulty in doing physical activity was one of the most frequently mentioned drawbacks. In many households, engaging in physical activity was not easy and online tutorials were not designed for older people or people with limitations.
On the other hand, many expressed concern about being overweight because of confinement. Some relaxation about maintaining a healthy diet and concern about being physically active was prominent in the discourses.
Most patients with diabetes acknowledged having to increase insulin doses to maintain adequate blood glucose levels. In addition, people requiring anticoagulation treatment reported difficulties in monitoring their health status due to delayed or suspended anticoagulation checks.
In terms of contact with health services, participants expressed fear of having to come to a health care centre. They accept the need to postpone check-ups and suspend diagnostic tests to avoid infection, but criticized that in some cases, patients and families had to decide between the risk of infection and the continuity of long-term treatments. There was also considerable confusion about who to contact in case of emergency, and they complained that the telephone numbers provided to the public were constantly engaged. On the other hand, the online initiatives for medication renewal and self-monitoring materials were very satisfactory.
Suggested principles for improvement
Looking ahead to the next pandemic waves and life after the crisis, participants call for the further strengthening of public health care. More and better targeted information, patient training, involvement of patient associations, and improved remote access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases.
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