Changes in treatment adherence and the quality of chronic disease follow-up in adults with non-communicable diseases in an urban area sample during the COVID-19 pandemic period

Objective: The aim of this study is to determine the changes in the chronic disease monitoring/care management practices, accessibility of health services, change in chronic disease risk factors, adherence to medication, and perceived general health and perceived mental health change in individuals with non-communicable disease (NCD) during the COVID-19 epidemic. Material and Method: This study was carried out on individuals with NCD who applied to ten Family Health Centers (FHCs) selected from the central districts of Manisa city (n=500). The Patient Assessment of Chronic Illness Care scale (PACIC), Morisky Medication Adherence Scale-8 (MMAS-8) and a structured questionnaire were used in data collection. SPSS 23.0 package program was used for statistical analysis. Chi-square and Fisher's exact test were used in the analyses of categorical variables. Where appropriate Student's t test or Mann Whitney U test, one-way analysis of variance or Kruskal Wallis analysis of variance were used in continuous variables. Logistic regression was used in multivariate analyses. Type 1 error was taken as <0.05 in all hypothesis testing. Results: 51.8% of the participants had increased and/or new complaints related to their chronic disease during the COVID-19 pandemic. Poor access to health services during the pandemic period (OR: 2.05, 95%CI: 1.40-2.99), poor quality of chronic disease follow-up/care (OR:1.49, 95%CI: 1.01-2.23) being compliant with medication (OR:1.48, 95%CI: 1.02-2.16) and worsening of chronic disease risk factors (OR:1.72, 95%CI: 1.11-2.70) had increased the risk of new complaints and/or chronic disease-related symptoms. The perceived health status of 37.2% of patients deteriorated compared to that of pre-pandemic period. Poor access to health services during the pandemic period (OR: 2.01, 95%CI: 1.37-2.95) and poor sleep patterns (OR: 2.14, 95%CI: 1.34-3.42) increase the risk of worsening perceived general health during the pandemic period compared to the pre-pandemic period. The frequency of perceived mental health status to be worse during the pandemic period compared to the pre-pandemic period is 23.2%. In women (OR: 2.46, 95%CI: 1.18-5.10), in those whose sleep quality was badly affected during the pandemic period (OR: 8.25 95%CI: 4.66-14.60) and and during this period those who were less satisfied with their family (OR: 4.21, 95%CI: 2.46-7.21) and social relationships (OR: 2.69, 95%CI: 1.58-4.57) increased risk of worsening perceived mental health status during the pandemic compared to the pre-pandemic period. 47.6% of the participants experienced problems related to chronic disease monitoring/controls during the pandemic period. Being 65 and over (OR: 4.15, 95% CI: 2.39-7.21) and perceived income less than expenses (OR: 3.19, 95% CI: 1.58-6.45) increase the risk of not being able to access health services during the pandemic. During the pandemic period, the risky behaviors of the participants in terms of chronic diseases were adversely affected. 15.6% of the participants gained weight during the pandemic period; 22.0% stated that they did less walking/exercise during this period. In this study, the total score from the PACIC scale was 2.43±0.24. In those aged 65 and over (OR: 17.38, 95%CI: 7.68-39.33); women (OR: 2.63, 95%CI: 1.46-4.75), in those with perceived income less than expenses (OR: 2.71, 95%CI: 1.19-6.15), and those without a physician following the chronic disease (OR: 22.61, 95%CI: 6.35-80.49) the quality of chronic disease care was worse during the COVID-19 pandemic. 43.4% of the participants showed low adherence to drug treatment. To be perceived income equal to expenditure (OR: 1.88, 95%CI: 1.25-2.81), to be perceived income greater than expenditure (OR: 1.93, 95%CI: 1.04-3.60), and having only one chronic illness (OR: 2.16, 95%CI: 1.41) -3.30) increases the risk of non-adherence to drug therapy. Conclusion: In the two years passed with the COVID-19 pandemic, the routine controls of approximately half of the individuals with chronic diseases have been disrupted; the quality of chronic disease follow-up/care has deteriorated. The COVID-19 pandemic has adversely affected both the physical and mental health of individuals with chronic diseases.