Recently the United Nations Secretary General António Guterres characterised the COVID-19 healthcare crisis as the most challenging the humanity has faced since World War Two.1 In line with primary care’s strategic role in responding to health disasters effectively,2 most of its human and material resources have been allocated in fighting this outbreak, postponing or even disregarding other patients’ needs, including the prevention and management of chronic non-communicable diseases. To make things worse, patients may even avoid attending primary care appointments for fear of catching COVID-19.
Prevention and management of chronic non-communicable diseases are important to mitigate the risk of both morbidity and avoidable mortality, and limit severe acute and chronic complications; the latter may include cardiovascular disease, blindness, end-stage renal disease, and lower-limb amputation. Additionally, community-dwelling subjects harbouring underlying chronic non-communicable diseases, including cardiovascular disease, hypertension, diabetes mellitus, and chronic lung disease, carry an increased risk of adverse COVID-19 outcomes.3 Therefore, a major concern is that the suspension of prevention and caring for chronic disease could elicit a deterioration of the global health status and a steep rise in hospital admissions and related healthcare costs, which may in turn overburden health systems and surpass their surge capacity.
The current shift from on-site to remote consultations might balance the need for maintaining continuity of care while containing COVID-19. However, reverting to virtual consultations may prove not only technically, logistically, and regulatorily challenging, but also clinically risky and ineffective for some patients.4 Therefore, selection of candidate patients should be subject to a meticulous patient-centred risk–benefit assessment. Individuals unsuitable for remote consultations should be prompted to attend in person, after properly managing their worries over COVID-19 transmission. In case these cannot be effectively addressed, the alternative of a home visit may be contemplated, especially in high-risk individuals or patients with chronic mental disease, where sustaining continuity of care needs to be prioritised. Proactive strategies are necessary to maximise patient adherence to regular follow-up and minimise their anxiety or fears. Policymakers are urged to secure adequate human and material resources for chronic disease care, and ensure its uninterrupted provision.
- © British Journal of General Practice 2020