Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study

Abstract Background The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care. Methods In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses. Results Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021. Conclusions Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics. Key messages • Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care. • This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.