Managing Multimorbidity (Multiple Chronic Diseases) Amid COVID-19 Pandemic: A Community Based Study From Odisha, India

Abstract

While most of the studies to date demonstrate the deleterious effect of multiple chronic diseases on COVID-19 risk and outcome, there is sparse information available on the effect of the pandemic on multimorbidity management, with no reports yet from India. We sought to explore the effect of COVID-19 pandemic on routine and emergency care for multimorbidity among community-dwelling adults in Odisha, India. A community-based cross-sectional study was undertaken pandemic lockdown, in Khurda district of Odisha, India. Around 600 individuals having at least one chronic disease residing in rural, urban residential and slums were interviewed using a specifically developed questionnaire MAQ COVID-19. The association of socio-demographic characteristics and multimorbidity with pandemic-related care challenges was examined by multiple logistic regression. Principal Component Analysis was employed to minimize the dimensionality of factors related to multimorbidity care. Multimorbidity was highly prevalent in younger age group (46–60 years) with cardio-metabolic clusters being dominant. Individuals with multimorbidity experienced significantly higher care challenges than those with single condition (AOR = 1.48, 95% CI = 1.01–2.05) with notable disruption in treatment and routine check-up. Most frequently cited concerns were—physician consultation (43%), diagnostic-services (26%), transport (33%), and mobility restrictions (21%). Multivariate analysis revealed older adults living alone in urban residence to have higher challenges than their rural counterparts. Patient activation for self-care, multimorbidity literacy, and technology-enabled tele-consultation could be explored as potential interventions. Future studies should qualitatively explore the challenges of physicians as well as garner an in-depth understanding of multimorbidity management in the vulnerable subgroups.

Non-communicable diseases care during COVID-19 pandemic: A mixed-method study in Khurda district of Odisha, India

“…Similar findings have been observed in a chart review of the morbidity profile of urban primary care patients 29 . Studies have documented the challenges in care-seeking for chronic illnesses like cancer and rheumatoid arthritis 32 33 34 35 . During pandemic situations, these challenges become accentuated due to the prevailing conditions and patient safety concerns.…”

Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India

“…In a study from Belgium, primary care providers observed disruption in the delivery of chronic care for conditions like diabetes and hypertension during the COVID-19 pandemic [ 8 ]. Individuals with multimorbidity (43%) reported more challenges compared to those with single condition (35%) [ 9 ]. The most challenging issue was physician consultation followed by diagnostic investigations (26%).…”

“…The most challenging issue was physician consultation followed by diagnostic investigations (26%). Transport logistics (33%), financial arrangements (26%), mobility-restrictions (21%), and fear of going to hospital owing to the risk of contagion (18%) were other prominent reported factors [ 9 ]. There was evidence of fall in screening tests for diabetes and dyslipidemia during months of February, March 2020 with modest rebound in early April 2020 [ 10 ].…”

Health Communication and Inter-professional Care in Context of Multimorbidity Management: Assessment of Health Professional Curricular Focus in India

“…Our own study has found the prevalence to be around 1/3rd in primary care patient population (Pati et al, 2015b). There is even significant multimorbidity among patients attending secondary and higher levels of health care, as well as specialized settings like psychiatry or antenatal clinics (Pati et al, 2021a;Pati et al, 2021b).…”