Understanding the effect of COVID-19 on the management of non-communicable diseases in patients in a Federally Qualified Health Center in Puerto Rico Open Access

González-Montalvo, Myrna del Mar (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/tt44pp133?locale=en


Introduction: In March 2020, the COVID-19 pandemic broke out in Puerto Rico and an island wide lockdown period from March 15 to April 12 was put into effect. Asthma, diabetes, and hypertension are three of the most frequent chronic illnesses in Puerto Rico, and they are among the major causes of disability and mortality. Patients with chronic conditions were disproportionately impacted during the early stages of the COVID-19 pandemic.

Project goals: The goal of this project is to understand the extent to which health service delivery disruption affected control of common NCDs such as hypertension and diabetes. Secondarily, to understand if that disproportionately affected more vulnerable groups based on SDoH such as income and insurance.

Methodology: This study was conducted using electronic health record data from patients who receive medical services at any of HealthproMed’s clinics throughout Puerto Rico. We compared the proportion of patients with uncontrolled diabetes (HbA1c  9%) and uncontrolled hypertension (SBP 50mmHg) before and during the COVID-19 pandemic. A univariate analysis was conducted, as well as a bivariate analysis and tests of association to determine if there is an association between changes in the proportion of patients with uncontrolled SBP and HbA1c and the social determinants of health of income and insurance. 

Results: After reviewing both the hypertension and diabetes results, we can see concerning trends with a rise in uncontrolled diabetes and hypertension and a reduction in visits to the healthcare centers after the start of the COVID-19 pandemic in 2020. Our findings showed that HealthproMed site location, as a proxy for income, was associated with control of hypertension and diabetes, except in diabetes for 2019 (p > 0.05). Insurance type was associated with worse health outcomes in all cases, except for control of SBP in 2020 (p > 0.05). For both SBP and HbA1c controlled and uncontrolled measurement proportions, a significant difference was observed when comparing both, pre COVID-19 period (January-March 2020) and post COVID-19 period (April-June 2020) to the same periods in 2019.

Discussion: It is critical to develop strategies that enable and promote effective self-management and inform individuals on how to identify challenges and ways to manage adversities associated with their illness that might arise after an event of such magnitude. More robust policies should also be developed to achieve management of NCDs, whether it is through state or federal governments. The need for a unified, multi-sector strategic approach to not only identify areas of insufficiency in the present management system, but also to devise meaningful solutions to this public health disaster is clear.

Table of Contents

Chapter 1: Introduction 1

Introduction and Rationale 1

Project objective 3

Chapter 2: Literature Review 4

Burden of NCDs and importance of uninterrupted health service delivery 5

Role of primary care for management of NCDs 6

Health service disruptions due to COVID-19 8

Solutions for health service disruption 9

Burden of COVID-19 pandemic on people with NCDs 10

Social Determinants of Health, COVID-19 and people with NCDs 14

COVID-19, NCDs and SDOH: Puerto Rico and its territorial health disparities 16

Chapter 3: Manuscript 21

Introduction 22

Methods 23

Results 27

Discussion 36

Conclusion 41

Chapter 4: Conclusion and Recommendations 46

References 49

Appendices 63

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