Docs could face looming health crisis as COVID-19 disrupts care for chronically ill

Isolated senior citizen looking out window
Only 38% of patients said they feel prepared to manage their health during COVID-19, with more than half (58%) reporting that they worry they will lose access to essential treatments. (Getty/LSOphoto)

More than two-thirds of chronically ill patients in the U.S. report they are having problems managing their conditions during the COVID-19 pandemic.

If significant care delivery disruptions continue, healthcare providers may face an even bigger crisis down the road, according to a new report from InCrowd, a real-time market insights firm.

InCrowd worked with Rare Patient Voice, a company that recruits patients and caregivers for market research to survey chronically ill and immunocompromised patients

The survey found 69% of chronic disease patients reported some degree of impact on their ability to manage one of seven high-risk conditions. Those conditions include diabetes, high blood pressure, migraine, asthma, cancer, multiple sclerosis and autoimmune illnesses such as rheumatoid arthritis.

Patients voiced concerns about access to care during the health crisis and worried about how to pay for their medications after being furloughed or laid off.

“Loss of work hours means I am now ‘stretching’ my insulin and other diabetic supplies because I am anticipating not being able to afford the copays each month," said one 34-year-old diabetes patient, according to the survey.

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  • Only 38% of respondents feel prepared to manage their health during COVID-19, with more than half (58%) reporting that they worry they will lose access to essential treatments.

“My appointments have been canceled and I have developed pulmonary arterial hypertension, ascites, anasarca and pleural effusion, and my specialist appointments and tests have all been canceled too. I am really short of breath with any exertion and cannot even get the pulmonary function tests that are needed. It is a very scary time for me," a 47-year-old autoimmune disease patient said.

  • Another autoimmune disease patient, age 22, said, "I have had to pause a treatment taper due to the risks of anything going wrong and causing a flair requiring hospitalization. Also, my mother is my primary caretaker and a nurse, so due to potential exposure at her work, I cannot see her and have been struggling some with daily medication routines."

Interferences with medical care have been severe in some cases with patients reporting they have been unable to receive critical treatments.

  • A 70-year-old cancer patient reported not being able to schedule the next infusion treatment. "COVID-19 has affected me quite directly by taking away the medication I was on for lupus and erythromelalgia. I ran out of hydroxychloriquine and now cannot get it for probably six months."
  • Patients are also worried about their health and safety during the health crisis, the survey found. Nearly 1 in 3 patients surveyed (31%) report being afraid to leave their homes for treatments because of COVID-19, with 70% sharing that they feel more concerned about their health during this time than usual.

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  • While 12% of patients report they are unable to receive their medications, 10% mention appointment cancellations or delays due to the pandemic.

The pandemic is causing significant disruption to care delivery, with limited supplies and resources for clinicians and limited access for high-need patients, many of whom can’t risk exposure to COVID-19, said Daniel Fitzgerald, CEO and president of InCrowd.

“In monitoring the impact of COVID-19 system-wide for physicians and patients, it was sobering to note the tenuous nature of patient access to care, even in this time of enabling technology," Fitzgerald said. "We’re seeing the beginning of the impact of COVID-19 and shelter-in-place policies on high-need patients—joblessness, inability to access or afford medications, anxiety over virus exposure or ability to self-care."

InCrowd's physician COVID-19 research found that front-line treating physicians and specialists in practices are turning to technology tools as "workarounds," such as virtual visits, external triage systems and remote monitoring, Fitzgerald said.

Chronic disease management companies and their health plan partners also are shifting their approach as their members with prediabetes or Type 2 diabetes are encouraged to stay within their homes. Many health plans have adapted existing tools aimed at lifestyle change to meet the new, more isolated reality.

Health plans also have been forced to quickly roll out options to help people work out at home and manage their nutrition more independently. 

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Increased patient adoption of telehealth and remote monitoring technologies could help to open up access to care in new ways. The survey found that more than half of patients (56%) said they are likely to switch to telehealth to continue to receive care for their condition.

The majority of patients believe disruptions to medical care will last another five months before things return to normal.

“When we return to some degree of normalcy, the future of care delivery may look very different post-pandemic with both patients and physicians ensconced in new modalities," Fitzgerald said. "Though this pandemic is a catastrophic event with untold victims, it is providing us with an opportunity to improve patient access, leverage technology better to monitor and engage with those in need, and deliver care more effectively in the future.”