Chronic disease management processes improved in primary care clinics during pandemic

Overall care management processes for chronic diseases improved in primary care practices from 2019 to 2021, despite disruptions in care due to the COVID-19 pandemic, a recent study showed.

The pandemic’s far-reaching impacts overwhelmed practices, affecting care for many patients, “especially for those with chronic conditions like diabetes and cardiovascular disease,” Leif I. Solberg, MD, a senior research investigator at HealthPartners Institute, and colleagues wrote in Annals of Family Medicine.

“Although there are early reports of decreased performance measures of disease control and preventive services for patients with chronic conditions during the pandemic, little is known about the mechanisms underlying these effects,” they wrote, pointing out that until causations become clear, “it will be difficult to recover.”

For the study, the researchers measured the scores of care management processes (CMP) for chronic conditions among 269 primary care clinics in Minnesota that participated in Physician Practice Connections Readiness Surveys (PPC-RS) in 2017, 2019 and 2021. The researchers added questions to the PPC-RS in 2021 to examine the extent of which disruptions affected diabetes care management in clinics.

The survey domains consisted of:

• survey and tracking;
• chronic disease management;
• patient self-management;
• care plans and shared decisions;
• performance measurement;
• managing high-risk patients; and
• overall survey.

Overall, CMP scores increased from 72.1% in 2017 to 73.7% in 2019 and 75.8% in 2021, according to Solberg and colleagues. The only survey domains that were lower in 2021 compared with 2019 were performance measurement (94.4% vs. 89.3%) and high-risk patient management (86.1% vs. 83.6%).

“It is understandable that performance measurement might be viewed as a luxury during this stressful time, but one could also think it might require a renewed focus on the processes for consistent care of high-risk patients,” they wrote. “It is possible that the disruptions during the early phase of the pandemic, especially the inability or unwillingness of patients to come to the clinic for care and monitoring tests, forced the need for more systematic approaches to patient outreach and care.”

While individual clinic size did not appear to affect the results, the system size and location did, according to the researchers. Clinics in large systems — defined as those having 12 or more sites — had higher scores overall compared with smaller systems (78.5% vs. 66.1%) along with greater scores in each domain.

The smaller systems “also tended to change scores between 2019 and 2021 the same as the overall sample, while clinics in small groups experienced a decrease in 2021, both in total score and in 4 of 6 domains,” Solberg and colleagues wrote.

Rural clinics also fared better than urban clinics, only decreasing in the same two domains as the overall sample in 2021 — performance management and high-risk patient management.

Solberg and colleagues additionally found that 32% and 55% of clinics reported the pandemic was mildly or extremely disruptive for diabetes management, respectively, a notable result given that “the presence of important processes for quality care were largely the same or better than before the pandemic,” they wrote.

“It seems likely that this capability was due to the high degree to which Minnesota clinics have adopted systematic approaches to ensuring care quality,” they added.

The researchers concluded that “the continued introduction of more highly organized care management may be an important step in recovering from any losses in quality.”