Abstract:
Background: Recovery of health services after COVID-19 has often been framed in terms of operational performance, focusing on restoring clinical activity, reducing waiting lists, reopening care pathways, and increasing service delivery. While these are important indicators of service restoration, they do not necessarily reflect recovery in population health outcomes. This is particularly relevant for patients with type 2 diabetes and heart failure, whose clinical stability depends on care continuity, regular monitoring, medication review, and early response to deterioration. During the pandemic, many experienced delayed diagnosis, interrupted disease management, reduced monitoring, and limited access to rehabilitation and self-management support creating substantial unmet health needs, some of which persisted even as services resumed.
Methods: This analysis examined how disruptions to non-pandemic care during COVID-19 affected service continuity and health outcomes for people with type 2 diabetes and heart failure. Evidence was synthesised from routine healthcare datasets, cohort studies, surveys, qualitative studies, policy reports, and cross-country analyses covering 30 European countries. Findings on service activity, care access, and health outcomes to identify where continuity broke down, which groups were most affected, and how disruptions translated into unmet need and adverse outcomes.
Results: Service activity fell significantly for both conditions during early pandemic phases. Type 2 diabetes services saw reductions in new diagnoses, monitoring, and complication screening, while heart failure services saw declines in admissions, investigations, specialist review, rehabilitation, and treatment optimisation. Recovery was uneven across care functions. Diagnostic activity and some routine monitoring was restored earlier, particularly where supported by remote consultations and electronic prescribing. However, more clinically intensive activities, including complication screening, structured education, psychosocial support, specialist review, cardiac rehabilitation, treatment optimisation, and multidisciplinary management, recovered more slowly. Remote care preserved some patient contact, but was limited where care depended on physical assessment or medication titration.
While service activity improved, adverse health outcomes persisted. In type 2 diabetes, disrupted monitoring and follow-up were associated with poorer glycaemic control, severe foot disease, higher amputation risk, diabetic ketoacidosis admissions, and greater illness severity. In heart failure, reduced routine review and delayed presentation were associated with advanced disease at admission, acute decompensation, higher early post-discharge mortality, and a shift in mortality from hospitals to homes and communities. Some patients re-entered care with poorer disease control, greater clinical complexity, or more advanced illness. Unmet need accumulated more rapidly among older adults, people with multimorbidity, deprived communities, and patients facing digital or practical barriers.
Conclusion: Recovery in service activity after COVID-19 did not automatically translate into recovery in chronic disease outcomes. Disruptions to diagnosis, monitoring, treatment optimisation, and self-management support continued to affect patients beyond the immediate crisis. Some components of chronic disease care were more vulnerable to disruption than others, particularly those dependent on in-person assessment, rehabilitation, follow-up, and treatment adjustment. Restoring service activity alone was insufficient to reverse the effects of missed or delayed care. Future pandemic preparedness planning should prioritise protecting essential chronic disease functions, targeting patients at risk of deterioration, and ensuring access for those unable to rely on remote or digital care.
Biography:
Dr Lem Ngongalah is a public health researcher specialising in health inequalities, digital health ethics and health systems resilience. She holds a PhD in Public Health from Newcastle University and an MSc in Public Health Nutrition from the University of Westminster. Dr Ngongalah has worked on European public health projects on pandemic preparedness, healthcare access during emergencies and inclusive digital health innovation. She is currently a Postdoctoral Researcher with the Global Health Team at the School of Health Sciences, University of Galway, Ireland.
Copyright 2024 Mathews International LLC All Rights Reserved
