JMIR Publications

ABSTRACT

Background:

With interruptions to health care since the COVID-19 pandemic, there have been concerns that comprehensive primary care for chronic conditions may have been reduced, with possible longer-term implications for population health.

Objective:

This study aims to describe the impacts of the COVID-19 pandemic on primary care access, comprehensiveness and appropriateness among adult patients with chronic conditions, and to determine whether changes were associated with patients’ socio-demographic characteristics and multimorbidity.

Methods:

This is a retrospective, single-arm, pre-post study using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data. CPCSSN is a research network supported by a primary care electronic medical record database, comprising over 1500 physicians, and nearly 2 million patients. We are examining changes in care (i.e. frequency of contacts, lab tests and investigations, referrals and medications prescribed) across the adult population. We will also examine indicators that would suggest care that is in step with evidence-based recommendations for patients with diabetes and patients with congestive heart failure (CHF). We will describe changes in the management of various chronic conditions from March 13, 2020 to December 31, 2021 to an equal period prior. Changes will be examined among specific sub-groups of adults, including by decade of age, number of comorbidities and socio-economic status. Regression models appropriate to outcome distributions will be used to estimate changes, adjusting for potential confounders. This analysis is part of a mixed-methods study with a qualitative component investigating how patients with diabetes with or without concurrent CHF perceived the impact of the pandemic on access to primary care and health care related decisions. This study was approved by the Hamilton Integrated Research Ethics Board (14782-C).

Results:

The start date of this study was October 5, 2022, and the prospective end date is January 31st, 2024. As of May 2023, we have completed data cleaning and begun exploratory analyses of the CPCSSN data. We have also defined our study cohort (n = 875, 934). Extended analyses using 2022 data are planned for once the new data becomes available. We will disseminate results through peer-reviewed publications and academic conference. We will also create evidence briefs, infographics and a video for policy-maker and patient audiences.

Conclusions:

This study will help investigate whether the COVID-19 pandemic has resulted in changes in the provision of primary care, and if these potential changes have led to gaps in care. Indicators specific to chronic conditions will also be explored. Clinical Trial: This study is registered with clinicaltrials.gov: NCT05813652.