Highlights
- •During the COVID-19 pandemic less diabetes care was delivered by healthcare providers.
- •Healthcare providers observed a negative effect of the COVID-19 pandemic on people with diabetes.
- •Most healthcare providers worried about getting overloaded by work during the COVID-19 pandemic.
- •Video consultations in primary diabetes care were seen as having potency by healthcare providers
Abstract
Aims
Methods
Results
Conclusions
Keywords
1. Introduction
- Forde R.
- Arente L.
- Ausili D.
- De Backer K.
- Due-Christensen M.
- Epps A.
- et al.
2. Methods
2.1 Study design and participants
2.2 Study instrument
3. Results
3.1 Characteristics of the participants
The Netherlands | United Kingdom | Turkey | Ukraine | Sweden | Total sample | |
---|---|---|---|---|---|---|
Total participants | n = 109 | n = 24 | n = 21 | n = 14 | n = 12 | n = 180 |
Women, n (%) | 96 (86.5) | 20 (69.0) | 6 (33.3) | 1 (7.7) | 4 (33.3) | 127 (70.6) |
Age in years, mean (SD) | 49.2 (10.4) | 48.8 (9.8) | 32.7 (6.2) | 46.3 (11.1) | 53,9 (12.4) | 49.2 (10.9) |
Profession, n (%) | ||||||
primary care physician | 38 (34.2) | 13 (44.8) | 9 (42.9) | 1 (7.1) | 12 (100,0) | 73 (40.6) |
hospital physician | 0 (0.0) | 0 (0,0) | 3 (14.3) | 13 (92.9) | 0 (0,0) | 16 (8.9) |
nurse or nurse practitioner | 68 (61.3) | 15 (51.7) | 0 (0,0) | 0 (0,0) | 0 (0,0) | 101 (56.1) |
other | 5 (4.5) | 1 (3.4) | 9 (42.9) | 0 (0,0) | 0 (0,0) | 15 (8.3) |
Experience in years, mean (SD) | 12.9 (8.1) | 18.5 (11.7) | 7.3 (5.7) | 17.9 (9.7) | 20.5 (14.2) | 15.7 (9.4) |
GP practice location, n (%) | ||||||
rural | 22 (20.4) | 8 (27.6) | 0 (0,0) | 0 (0,0) | 1 (8.3) | 31 (17.2) |
urban, low SES | 24 (22.2) | 9 (31.0) | 3 (16.7) | 0 (0,0) | 2 (16.7) | 38 (21.1) |
urban, middle SES | 52 (48.1) | 12 (41.4) | 11 (61.1) | 10 (76.9) | 7 (58.3) | 92 (51.1) |
urban, high SES | 10 (9.3) | 0 (0,0) | 4 (22.2) | 3 (23.1) | 2 (16.7) | 19 (10.6) |
Covid-19 + , n (%) | 19 (18.1) | 2 (8.3) | 8 (53.5) | 8 (66.7) | 6 (50.0) | 43 (23.9) |
Covid-19 + family, n (%) | 22 (21.0) | 3 (12.5) | 10 (66.7) | 6 (50.0) | 6 (50.0) | 47 (26.1) |
3.2 Delivery of care during the covid-19 pandemic: Response time and amount of care
All | GP | Hospital Specialist | Nurse | Other | |
---|---|---|---|---|---|
How fast could a diabetes related problem be answered compared to before the covid-19 pandemic? n (%) | n = 155 | n= 62 | n = 9 | n = 73 | n = 11 |
Faster | 20 (12.9) | 10 (16.1) | 4 (44.4) | 2 (2.7) | 4 (36.4) |
Equal | 126 (81.3) | 47 (75.8) | 4 (44.4) | 68 (93.2) | 7 (63.6) |
Slower | 8 (5.2) | 5 (8.1) | 1 (11.1) | 2 (2.7) | 0 (0.0) |
Unknown | 1 (0.6) | 0 (0.0) | 0 (0.0) | 1 (1.4) | 0 (0.0) |
Did the amount of healthcare for your type 2 diabetes patients decrease during the COVID-19 pandemic compared to before? n (%) | n = 161 | n = 65 | n = 10 | n = 75 | n = 11 |
Yes, less care to all | 15 (9.3) | 8 (12.3) | 1 (10.0) | 6 (8.0) | 0 (0.0) |
Yes, less care to some | 77 (47.8) | 35 (53.8) | 2 (20.0) | 36 (48.0) | 4 (36.4) |
Same amount of care | 52 (32.3) | 18 (27.7) | 4 (40.0) | 24 (32.0) | 6 (54.5) |
No, more care some | 13 (8.1) | 3 (4.6) | 1 (10.0) | 8 (10.7) | 1 (9.1) |
No, more care all | 3 (1.9) | 0 (0.0) | 2 (20.0) | 1 (1.3) | 0 (0.0) |
Unknown | 1 (0.6) | 1 (1.5) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
How would you assess the impact of COVID-19 related changes in healthcare services on your patients with diabetes? n (%) | n = 162 | n = 65 | n = 10 | n = 75 | n = 12 |
Strongly positive | 1 (0.6) | 1 (1.5) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
positive | 10 (6.2) | 2 (3.1) | 0 (0.0) | 6 (8.0) | 2 (16.7) |
No effect | 22 (13.6) | 7 (10.8) | 6 (60.0) | 9 (12.0) | 0 (0.0) |
negative | 98 (60.5) | 46 (70.8) | 2 (20.0) | 42 (56.0) | 8 (66.7) |
Strong negative | 20 (12.3) | 7 (10.8) | 1 (10.0) | 12 (16.0) | 0 (0.0) |
I do not know | 11 (6.8) | 2 (3.1) | 1 (10.0) | 6 (8.0) | 2 (16.7) |
3.3 Workload and work-related stress during the COVID-19 pandemic

3.4 Experiences with video-consultation during the covid-19 pandemic

Adjusted model | Crude model | |||||
---|---|---|---|---|---|---|
B-coefficient | 95% CI for B-coefficient | P-value | B-coefficient | 95% CI for B-coefficient | P-value | |
Profession | 1.353 | 0.412 to 2.295 | 0.005 | 1.679 | 0.776 to 2.582 | 0.000 |
Years of experience | 0.001 | -0.048 to 0.050 | 0.959 | |||
GP practice location | 0.215 | -0.312 to 0.741 | 0.421 | |||
Capability of patients to perform video consultation | -0.335 | -1.098 to 0.427 | 0.386 | |||
Could video-consultation be a replacement for face-to-face contact | -0.397 | -0.880 to 0.086 | 0.106 |
4. Discussion
- Forde R.
- Arente L.
- Ausili D.
- De Backer K.
- Due-Christensen M.
- Epps A.
- et al.
- Forde R.
- Arente L.
- Ausili D.
- De Backer K.
- Due-Christensen M.
- Epps A.
- et al.
Funding
Contributors
Declaration of interest for all authors
Appendix A. Supplementary material
Supplementary material
References
- A comprehensive review of COVID-19 characteristics.Biol. Proced. Online. 2020; 22: 1
- Life in the pandemic: Social isolation and mental health.J. Clin. Nurs. 2020; 29: 2756-2757
- Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study.Lancet Diabetes Endocrinol. 2020; 8: 813-822
- Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study.Lancet Diab. Endocrinol. 2020; 8: 823-833
- Reply to the letter of Singh and Singh in response to the article: "Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis" (Kumar et al.).Diabetes Metab. Synd. 2020; 14: 1147-1148
- Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis.Diabetes Metab. Synd. 2020; 14: 535-545
- Costs, outcomes and challenges for diabetes care in Spain.Glob. Health. 2013; : 9
- Rutten-van Molken MPMH. Exploring payment schemes used to promote integrated chronic care in Europe.Health Policy. 2013; 113: 296-304
- NHG-standaard diabetes mellitus type 2 (M01).Versie. 2018; 5: 3
Type 2 diabetes in adults: management. United Kingdom: National Institute for Health and Care Excellence; NICE guideline 2015.
American Diabetes Association Professional Practice C. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S144-S74.
- 6. Glycemic targets: standards of medical care in diabetes-2022.Diabetes Care. 2022; 45: S83-S96
- Association between full monitoring of biomedical and lifestyle target indicators and HbA(1c) level in primary type 2 diabetes care: an observational cohort study (ELZHA-cohort 1).BMJ Open. 2019; 9: 3
- Socioeconomic status is not associated with the delivery of care in people with diabetes but does modify HbA1c levels: An observational cohort study (Elzha-cohort 1).Int J. Clin. Pract. 2021; 75: 5
- Towards an understanding of the high death rate among young people with diabetes in Ukraine.Diabet. Med. 2001; 18: 3-9
- Management of diabetes and diabetes policies in Turkey.Glob. Health. 2013; : 9
- Diabetes care cascade in Ukraine: an analysis of breakpoints and opportunities for improved diabetes outcomes.BMC Health Serv. Res. 2020; 20: 1
- Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults.Eur. J. Epidemiol. 2013; 28: 169-180
- Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study.Br. J. Gen. Pract. 2021; 71: E166-E177
- Management of patients with diabetes and obesity in the COVID-19 era: Experiences and learnings from South and East Europe, the Middle East, and Africa.Diabetes Res. Clin. Pract. 2021; : 172
- Use and content of primary care office-based vs telemedicine care visits during the COVID-19 pandemic in the US.Jama Netw. Open. 2020; 3: 10
- The impact of the COVID-19 pandemic on people with diabetes and diabetes services: A pan-European survey of diabetes specialist nurses undertaken by the Foundation of European Nurses in Diabetes survey consortium.Diabet. Med. 2021; 38: 5
- Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.Lancet. 2010; 375: 2215-2222
- Inpatient diabetes care during the COVID-19 pandemic: A Diabetes UK rapid review of healthcare professionals' experiences using semi-structured interviews.Diabet. Med. 2021; 38: 1
- Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics.Psychiat Res. 2020; : 290
- Anxiety, pandemic-related stress and resilience among physicians during the COVID-19 pandemic.Depress Anxiety. 2020; 37: 965-971
- Impact of exposure to patients with COVID-19 on residents and fellows: an international survey of 1420 trainees.Post. Med. J. 2021; 97: 706-715
- Impact of the COVID-19 pandemic on burnout in primary care physicians in Catalonia.Int. J. Environ. Res. Pub He. 2021; 18: 17
- Impact of COVID-19 on diabetes health care and service provision in Australian diabetes centers.Diabetes Care. 2021; 44: E163-E164
- Digital health and care in pandemic times: impact of COVID-19.BMJ Health Care Info. 2020; 27: 1
- The Utrecht Diabetes Project: telemedicine support improves GP care in Type 2.diabetes. 2001;
- Video consultations in primary and specialist care during the covid-19 pandemic and beyond.Bmj-Brit Med J. 2020; : 371
Department of Health and Human Services Office for Civil Rights. Notification of enforcement discretion for telehealth remote communications during the covid-19 nationwide public health emergency. 2020.
- Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis.Int J. Epidemiol. 2011; 40: 804-818
- Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US.JAMA Intern. Med. 2021; 181: 388
- Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study.BMC Health Serv. Res. 2021; 21: 1218
- Satisfaction of well-controlled type 2 diabetes patients with three-monthly and six-monthly monitoring.BMC Fam. Pract. 2013; : 14
- The impact of the COVID-19 pandemic on people with diabetes and diabetes services: A pan-European survey of diabetes specialist nurses undertaken by the Foundation of European Nurses in Diabetes survey consortium.Diabet. Med. 2021; 38e14498
- Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey.PLoS One. 2020; 15e0238217
- To burn-out or not to burn-out: a cross-sectional study in healthcare professionals in Spain during COVID-19 pandemic.BMJ Open. 2021; 11e044945
- Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis.BMC Fam. Pract. 2018; : 19
- Elements of the healthy work environment associated with lower primary care nurse burnout.Nurs. Outlook. 2020; 68: 14-25
- Organizational justice, professional identification, empathy, and meaningful work during COVID-19 pandemic: are they burnout protectors in physicians and nurses?.Front Psychol. 2020; 11566139
- Adoption of telemedicine for type 1 diabetes care during the COVID-19 pandemic.Diabetes Technol. Ther. 2021; 23: 642-651
- Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care.Br. J. Gen. Pr. 2019; 69: e586-e594
Greenhalgh T.A.-O., Shaw S.A.-O., Wherton J.A.-O., Vijayaraghavan S.A.-O., Morris J.A.-O.X., Bhattacharya S.A.-O., et al. Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study. (1438–8871 (Electronic)).
- Increase in video consultations during the COVID-19 pandemic: healthcare professionals' perceptions about their implementation and adequate management.Int J. Environ. Res. Pub He. 2020; 17: 14
- Prevalence of and factors associated with nurse Burnout in the US (vol 4, e2036469, 2021).JAMA Netw. Open. 2021; 4
- Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review.Br. J. Gen. Pract. 2016; 66: E114-E127
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