Delivering Primary Health Care (PHC) Services for Controlling NCDs During the COVID-19 Pandemic: A Scoping Review

Abstract

Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs also increase mortality from COVID-19 and primary health care (PHC) services are an important component in the prevention and control of long-term NCDs. The main goal of the present study was to review primary healthcare services for the NCDs patients via primary healthcare network during COVID-19 pandemic. In this scoping review, Search engines including PubMed, Scopus, and Science-direct up to 1st February 2022 were searched to identify studies regarding primary care services for NCDs patients via primary health care during COVID-19 pandemic. A total of 42 studies met the inclusion criteria and were included in our analysis. 24 studies were about the status and changes of primary health services for NCDs patients in PHC settings, while 18 studies focused on adaptive strategies used during COVID-19 in different countries including United States, Canada, United Kingdom, Portugal, Georgia, South Africa, Thailand, Mexico, India, Kenya, Guatemala and Saudi Arabia. These strategies included remote monitoring, follow up, consultation, empowerment and educational services as well as home visiting Disruption of NCDs services in PHC during the COVID-19 pandemic was observed in different countries, which highlights the urgency of attention of researchers and policy-makers to development of appropriate and adaptive policies to improve PHC service coverage and its quality during the pandemics.

Full text

Vol.:(0123456789)
Journal of Prevention
https://doi.org/10.1007/s10935-023-00733-3
1 3
REVIEW
Delivering Primary Health Care (PHC) Services
forControlling NCDs During theCOVID‑19 Pandemic:
AScoping Review
JavadBarzegari1· PouranRaeissi1· Seyed‑MasoudHashemi2·
AidinAryanKhesal1· NahidReisi3
Accepted: 5 April 2023
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature
2023
Abstract
Non-communicable diseases (NCDs) are the leading cause of death worldwide.
NCDs also increase mortality from COVID-19 and primary health care (PHC) ser-
vices are an important component in the prevention and control of long-term NCDs.
The main goal of the present study was to review primary healthcare services for
the NCDs patients via primary healthcare network during COVID-19 pandemic. In
this scoping review, Search engines including PubMed, Scopus, and Science-direct
up to 1st February 2022 were searched to identify studies regarding primary care
services for NCDs patients via primary health care during COVID-19 pandemic.
A total of 42 studies met the inclusion criteria and were included in our analysis.
24 studies were about the status and changes of primary health services for NCDs
patients in PHC settings, while 18 studies focused on adaptive strategies used dur-
ing COVID-19 in different countries including United States, Canada, United King-
dom, Portugal, Georgia, South Africa, Thailand, Mexico, India, Kenya, Guatemala
and Saudi Arabia. These strategies included remote monitoring, follow up, consul-
tation, empowerment and educational services as well as home visiting Disruption
of NCDs services in PHC during the COVID-19 pandemic was observed in differ-
ent countries, which highlights the urgency of attention of researchers and policy-
makers to development of appropriate and adaptive policies to improve PHC service
coverage and its quality during the pandemics.
Keywords COVID-19· Primary health care· NCDs· Healthcare
Extended author information available on the last page of the article

Journal of Prevention
1 3
Introduction
The coronavirus disease (COVID-19) emerged at the end of 2019 in Wuhan (Peo-
ple’s Republic of China) and the outbreak was declared as a pandemic by the World
Health Organization (WHO) on March 11, 2020. As of 20 February 2022, over 422
million people across the world have been infected by the novel coronavirus SARS-
CoV-2, causing 5.8 million deaths (WHO, 2022).
Non-communicable diseases (NCDs), the leading cause of death worldwide,
could increase mortality from COVID-19 as uncontrolled diabetes and high blood
pressure (Pettus & Skolnik, 2021, Beran etal., 2021) are shown to be associated
with severe covid-19 disease and increased mortality (Kraef etal., 2020). Primary
health care (PHC) services are a person’s first point of contact with the health sys-
tem (Halcomb etal., 2022) and PHC services are an important component in the
prevention and control of long-term NCDs globally (Haque et al., 2020). During
the COVID-19 pandemic, when health systems are overwhelmed, dramatic mortal-
ity increase occurs, both directly from an outbreak and indirectly, from preventable
conditions, such as NCDs (Mobula etal., 2020). Therefore, continuity of care for
NCDs within PHC is of great importance to prevent chronic condition exacerbation
(Organization, 2020b).
Although improving the resilience of health systems and maintaining essential
and routine health service delivery within the PHC during the pandemic must be a
high priority, the World Health Organization (WHO) survey of ministries of health
in 163 member states, has reported that 122 countries had service disruptions due to
the pandemic (Organization, 2020a), as 53% of the countries surveyed reported hav-
ing partly or completely disrupted services for hypertension treatment and 49% for
diabetes and diabetes-related complications (Organization, 2020b).
The present study was designed to review the status of the primary healthcare
services for the NCDs patients via primary healthcare network during COVID-19
pandemic in different countries.
Methods
Identifying theResearch aims
The aim of the present study was to map the existing knowledge regarding primary
care services for the NCDs patients via primary healthcare network during COVID-
19 in various countries.
Identifying Relevant Studies
In this scoping review, we systematically searched related articles using PubMed,
Scopus and Science Direct (accessed on 5th February). The literature search
was adapted to the databases, and sources used and included the following

1 3
Journal of Prevention
subject heading terms and keywords: "hypertension” OR "diabetes” OR "NCD"
OR "NCDs" OR "non-communicable diseases" OR "blood pressure" OR
"cardiovascular diseases" OR "CVDs" OR "CVD” AND "covid-19″ OR "COVID"
OR "corona" OR "SARS-CoV-2″ AND "primary health care" OR "community
medicine" OR "family medicine" OR "family physician" OR "primary care" OR
"health care" OR "health services" OR "PHC" OR "health system".
We limited the search to the following dates: up to 1st February 2022. Addi-
tional references were identified by searching the gray literature and hand search-
ing the reference lists of the included articles.
Study Selection
Inclusion criteria consisted of all articles that had information related to all
studies, which reported the status of primary health care services for the NCDs
patients and its disruption during COVID-19 and secondly to review adaptive ser-
vices in PHC for NCDs patients during COVID-19 in different countries. Studies
that were conducted in settings other than primary health care system or were
focusing on other diseases were excluded. Screening of titles and abstracts was
followed by full-text screening and data extraction.
Charting theData, Summarizing andReporting Results
To map the existing literature, selected studies were reviewed and summarized. In
all stages two of the authors held regular meetings to discuss findings and reach a
consensus about the management of findings.
Results
As illustrated in the flow diagram (Fig. 1), 529 records were identified, 378
records were screened, and 42 studies met the inclusion criteria and were included
in our analysis. The following is a detailed description of these studies.
Studies Regarding theStatus ofPrimary Health Care Services forNCDs andits
disruption During COVID‑19: Global andCountry Level Evidence
During the COVID-19 pandemic, the health care for non-COVID-19 patients was
affected due to the reallocation of resources towards urgent care for COVID-19
patients, which leads to inadequate ongoing care for NCDs prevention (Organiza-
tion, 2020b). Several evidence from different countries have analyzed the impact
of the COVID-19 pandemic during the lockdown on disruption of the delivery of

Journal of Prevention
1 3
chronic care on prevention management for NCDs, which their findings are pre-
sented in follows:
Global Level Evidence
Disruptions to delivery of health services during the COVID-19 pandemic
have been reported internationally for NCDs. In May 2020, through collabora-
tion between WHO headquarters and the five regional offices including African,
south-east Asia, European, Eastern Mediterranean and western pacific regions,
web-based questionnaires were distributed through facilitated discussions with
key informants within the national ministries of health (Organization, 2020c).
Questions were asked about the disruption of up to 25 essential health services
using a three-point ordinal scale: no, partial or severe-complete disruption. In
Idenficaon
Screening and eligibility
Included
Recordsidentified through database searching
PubMed, Scopus, Science direct and grey literature (n=529)
Records after removal of duplicates (151)
(n=378)
Records screened by title and
abstract (n=378)
Records excluded by tile and
abstract (n=227)
Records assessed for eligibility
(n=151)
Full text articles excluded with
reasons (n=108)
Not relevant to the aim of the study
regarding NCDs or primary health
care setting during COVID-19
(n=90)
Review articles not focus on the aim
of the studies (n=18)
Full text articles included (n=42)
Articles on reduction of primary health
care for NCDs during covid-19 (n=25)
Articles on implementation or
evaluation of adaptive strategies in
COVID-19 for NCDs in primary health
care (n=17)
Fig. 1 Flow diagram for the study selection process

1 3
Journal of Prevention
total, 105 countries responded and 28 reported disruptions in 75–100% of ser-
vices, 27 in 50–74% services, 20 in 25–49% of services and 19 in less than 25%
of services, and 11 countries respond no service disruptions. Frothy-eight percent
of countries reported at least partial disruptions in all NCD services compared to
other service groups (Organization, 2020c). In the same study it is reported that
the NCDs diagnosis and treatment was disrupted in 69% of the investigated coun-
tries, with 5% reporting severe/complete disruptions (Organization, 2020c). Half
of the countries (53%) reported having severe/complete or partial disruptions of
hypertension management services, and (49%) diabetes and diabetic complication
management services (Organization, 2020c). In a second round of the national
pulse survey on continuity of essential health services during the COVID-19 pan-
demic, 45% and 42% countries reported disruptions of hypertension and diabetes
service managements respectively (Organization, 2021). Another global study of
the disruption of chronic medical health services among health workers from 47
countries showed that about two-thirds of the health care professionals reported
severely disrupted health services and diabetes care was most affected by the
reduction of healthcare resources, followed by chronic obstructive pulmonary
disease, hypertension, heart disease, asthma, cancer, and depression (Chudasama
etal., 2020).
In the other study at global level explored the impact of COVID-19 on hyper-
tension care in the Excellence Center (EC) network of the European Society of
Hypertension via an electronic survey among ECs. The results from the 52 ECs
from 20 European and three non-European countries showed that the number of
patients treated per week decreased by 90% compared to the time before the pan-
demic (2021).
Country‑Level Studies
There are several reports from different countries including United States (Alex-
ander etal., 2020; Beckman etal., 2021), Canada (Laing & Johnston, 2021; Ste-
phenson etal., 2021), European countries including Spain (Coma etal., 2020, 2021;
Lopez Segui etal., 2021; Sisó-Almirall etal., 2022), Germany (Schäfer etal., 2021),
United Kingdom (Seidu etal., 2022, Carr et al., 2022), Netherland (Velek etal.,
2022), Switzerland (Rachamin etal., 2021), France (Davin-Casalena etal., 2021;
Ludwig etal., 2021) as well as Thailand (Sornsenee etal., 2021), Ethiopia (Enbiale
etal., 2021), Oman (Al Harthi etal., 2021), Peru (Pesantes etal., 2020), and China
(Chan etal., 2020) which analyzed the impact of the COVID-19 on primary care for
NCDs services, visits and metabolic control and access to healthcare focusing on
quantitative data analysis. The results of all the included studies in this regard are
presented and summarized in Table1.
For example, in Canada, Stephenson etal. study aimed to determine reasons for
primary care visits changed during the COVID-19 pandemic (Stephenson et al.,
2021). Using data from the University of Toronto Practice-Based Research Network
(UTOPIAN), they compared the most common reasons for primary care visits before
and after the onset of the COVID-19 pandemic. Diabetes and hypertension remained

Journal of Prevention
1 3
Table 1 Studies regarding the status of primary health care services for NCDs and its disruption during COVID-19: country level evidence
Country Study Results
United States (USA) Beckman etal. (2021) Patients with hypertension were 50% less likely to have a blood pressure (BP) recorded in April com-
pared with February
Patients with uncontrolled vs controlled hypertension were no more likely to have a visit
Alexander etal. (2020) Reduction in the total number of encounters to 117.9 million (95% CI, 112.6–123.2 million) in first
calendar quarter (Q1) and 99.3 million (95% CI, 94.9–103.8 million) in Second calendar quarter (Q2)
of 2020, a decrease of 21.4% (27.0 million visits) from the average number of Q2 encounters in 2018
and 2019
Reduction in Office-based from a mean of 116.9 million (95% CI, 111.6–122.1 million) for the average
quarterly visit volume in 2018–2019 to 105.9 million (95% CI, 101.2–110.7 million) in Q1 of 2020,
then 58.7 million (95% CI, 55.3–62.1 million) in Q2 of 2020, a decrease of 50.2% (59.1 million visits)
compared with Q2 2018–2019 levels
Reduction in blood pressure level assessment (50.1% decrease, 44.4 million visits) and cholesterol level
assessment (36.9% decrease, 10.2 million visits) in Q2 of 2020 compared with Q2 2018–2019 levels
Reduction in New medication visits in Q2 of 2020 by 26.0% (14.1 million visits) from Q2 2018–2019
levels
Canada Stephenson etal. (2021) Diabetes and hypertension remained among the top 5 reasons for visit during the pandemic, but there
were 23.7% and 26.2% fewer visits and 19.5% and 28.8% fewer individual patients accessing care
for diabetes and hypertension, respectively when compared patients’ visits in pre-pandemic versus
pandemic period
Laing and Johnston (2021) The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (− 0.3%
to − 14.7%; 95% CI), colorectal cancer decreased by 8.1% (− 0.3% to − 15.8%; 95% CI), and type 2
diabetes decreased by 4.5% (− 0.2% to − 8.7%; 95% CI)

1 3
Journal of Prevention
Table 1 (continued)
Country Study Results
Spain Sisó-Almirall etal. (2022) Face-to-face scheduled visits for chronic disease detection and monitoring fell by almost 41%. There was
a 39% and 40% reduction in the annual incidence of type II diabetes and hypertension, respectively, in
2020, when compared to 2017–2019
Coma etal. (2021) Indicators’ results were reduced in 2020 compared to 2019, highlighting the indicators of foot and retin-
opathy screening (−51.6% and -25.7%, respectively); the glycemic control indicator (-21.2%); the BP
control indicator (−33.7%) and the incidence of T2DM (-25.6%). Conversely, the percentage of type 2
diabetes patients with HbA1c > 10% increased by 34%. PCPs with < 11 weekly face-to-face appoint-
ments offered per professional had greater reductions than those PCPs with more than 40. For instance,
a reduction of −60.7% vs. −38.2% (p-value < 0.001) in the foot screening’s indicator; −27.5% vs.
−12.5% (p-value < 0.001) in glycemic control and −40.2 vs. −24.3% (p-value < 0.001) in BP control
Lopez Segui etal. (2021) The increase in non–face-to-face visits (+ 267%) did not counterbalance the decrease in face-to-face
visits (–47%), with an overall reduction in the total number of visits of 1.36%, despite the notable
increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related
to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing
problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased
in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial
hypertension (ICD-10 codes I10-I16: –32.73%) or diabetes (ICD-10 codes E08-E13: –21.13%), but
also obesity (E65-E68: –48.58%) and bodily injuries (ICD-10 code T14: –33.70%). Visits with mental
health–related diagnostic codes decreased, but the decrease was less than the average decrease. There
was a decrease in consultations—for children, adolescents, and adults—for respiratory infections (ICD-
10 codes J00-J06: –40.96%)
Coma etal. (2020) There was a 2.13 and 2.59% reduction in the control of blood pressure in March and April respectively
compare to previous month
Germany Schäfer etal. (2021) When comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time
during the lockdown (21 April to 14 July 2020), they have found that during lockdown, the frequency
of five reasons for consultation (−43.0% to −31.5%) and eleven services (−56.6% to −33.5%) had
significantly decreased (Schäfer etal., 2021)

Journal of Prevention
1 3
Table 1 (continued)
Country Study Results
United Kingdom Seidu etal. (2022) Based on an online survey of healthcare professionals delivering diabetes care from January to May
2021, the majority of respondents felt overloaded with work (71.2%) or emotionally drained at the end
of a working day (79.1%) compared with the pre-pandemic period
79.1% of respondents felt the COVID-19 pandemic affected moderate to significant impact on their prac-
tice’s ability to provide routine diabetes care; 70.6% of respondents felt the COVID-19 pandemic had
moderate to significant impact on their practice’s ability to provide routine health checks or screening
for type 2 diabetes
Carr etal. (2022) Reduction in rates of performing health checks by 76–88% when compared with 10-year historical
trends, with older people from deprived areas experiencing the greatest reductions in April 2020
~ 7.4 million fewer care processes undertaken March-December 2020 extrapolated to the UK population
Reduction in rates for new medication fell during April varying from 10% (95% CI: 4% to 16%) for
antiplatelet agents to 60% (95% CI: 58% to 62%) for antidiabetic medications
Reduction of the rate of prescribing new diabetes medications fell by 19% (95% CI: 15% to 22%) and
new antihypertensive medication prescribing fell by 22% (95% CI: 18% to 26%), but prescribing of new
lipid-lowering or antiplatelet therapy was unchanged. Between March and December 2020
Netherland Velek etal. (2022) Reduction in The number of GP consultations related to cerebrovascular and cardiovascular care by 38%
(0.62, 95% confidence interval 0.56–0.68) during the first wave, as compared to expected counts based
on prepandemic levels
Reduction in the number of new diagnoses for cerebrovascular events: 37% for TIA (0.63, 0.41–0.96) and
29% for stroke (0.71, 0.59–0.84)
No significant changes for cardiovascular events (myocardial infarction [0.91, 0.74–1.14], angina [0.77,
0.48–1.25])
Switzerland Rachamin etal. (2021) During the shutdown, weekly consultation counts were lower than predicted by − 17.2% (total popu-
lation), − 16.5% (patients with hypertension), − 17.5% (diabetes), − 17.6% (cardiovascular dis-
ease), − 15.7% (patients aged < 60years), − 20.4% (60–80years), and − 14.5% (> 80years)
Reduction in Weekly BP counts by − 35.3% (total population) and − 35.0% (hypertension), and HbA1c
counts by − 33.2% (total population) and − 29.8% (diabetes)

1 3
Journal of Prevention
Table 1 (continued)
Country Study Results
France Ludwig etal. (2021) −423 (49.4%) and 790 (92.3%) patients did not consult their general practitioner and diabetologist
Davin-Casalena etal. (2021) Reduction in private physician activity during the lockdown (−23% for general practitioners; −46% for
specialist doctors), followed by a return to a semblance of normalcy
Thailand Sornsenee etal. (2021) The percentage of uncontrolled Hypertension visits decreased from 43 to 31% comparing (February 2019
to February 2020) and COVID-19 period (March to August 2020)
Ethiopia Enbiale etal. (2021) Reduction in the average number of monthly patient visits in the emergency department, pediatrics
outpatient, and adult outpatient dropped by 27%, 30%, and 27%, respectively during the COVID-19
compared with the pre-COVID-19 period
No significant change in antenatal care-, hypertension- and diabetic patient follow-up between pre-
COVID-19 and during COVID-19
Oman Al Harthi etal. (2021) 937 patients continued to follow and received DM care after pandemic announcement. Median number
of consultations was 2 with interquartile range (IQR): 3–2. 57.4% had face-to-face alone, 32.4% had
combined face to face and telephone consultation and 10% had telephone consultation alone
Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to
0.3), p = 0.002. With multivariable linear regression, the mean difference in HbA1c was -0.3 (−2.3 to
1.5), p = 0.734 for telephone consultation alone, −0.5 (−2.4 to 1.4), P = 0.613 for face-to-face alone,
and −0.5 (−2.4 to 1.3), P = 0.636 for combined consultations, compared to those who did not receive
any formal consultation
Peru Pesantes etal. (2020) Care and treatment continuity have been affected since the national state of emergency due to COVID-19
began; because many healthcare facilities suspended outpatient consultations
China Chan etal. (2020) Low household income and residence in government-subsidized housing were significant predictors for
the subjects who had trouble in managing during first 2months of the pandemic (11% of the NCD
patients)
Of those on long-term NCD medication, 10% reported having less than one-week’s supply of medication
Nepal Singh etal. (2021) Chronic diseases treatment facilities were severely affected in both rural and urban settings. The interrup-
tions in health services were mostly due to the closure of health services at local health care facilities,
limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-
19 transmission among health care workers and within health centers, and disruption of transportation
services

Journal of Prevention
1 3
Table 1 (continued)
Country Study Results
Nshimyiryo etal. (2021) Of 220 chronic care patient respondents, 44% reported at least one barrier to accessing healthcare
Barriers included lack of access to emergency care (n = 50; 22.7%), lack of access to medication (n = 44;
20.0%) and skipping clinical appointments (n = 37; 16.8%)
Experiencing barriers was associated with the clinical program (p < 0.001), with oncology patients being
highly affected (64.5%), and with increasing distance from home to the health facility (p = 0.031)
Forty (18.2%) patients identified positive coping mechanisms to ensure continuation of care, such as
walking long distances during suspension of public transport (n = 21; 9.6%), contacting clinicians via
telephone for guidance or rescheduling appointments (n = 15; 6.8%), and delegating someone else for
medication pick-up (n = 6; 2.7%)

1 3
Journal of Prevention
among the top 5 reasons for visit during the pandemic, but there were 23.7% and
26.2% fewer visits, and 19.5% and 28.8% fewer individual patients accessing care
for diabetes and hypertension, respectively when compared patients’ visits in pre-
pandemic versus pandemic period (Stephenson et al., 2021). Sisó-Almirall et al.
evaluated the impact of the COVID-19 pandemic on conditions and new cases of
diseases commonly seen in primary care in Spain. They have found that face-to-face
scheduled visits for chronic disease detection and monitoring fell by almost 41%.
There was a 39% and 40% reduction in the annual incidence of type II diabetes and
hypertension, respectively, in 2020, when compared to 2017–2019 (Sisó-Almirall
etal., 2022). Another piece of evidence from Spain is a study that uses the database
of the Primary Care Services Information Technologies Information System
of Catalonia. In this study Lopez Segiu etal. found that the largest reductions in
visits were chronic pathologies such as arterial hypertension (ICD-10 codes I10-
I16: −32.73%) or diabetes (ICD-10 codes E08–E13: −21.13%), obesity (E65-E68:
−48.58%) and bodily injuries (ICD-10 code T14: -33.70%) (Lopez Segui et al.,
2021). Coma etal. also in a Retrospective study in 288 primary care practices (PCP)
of the Catalan Institute of Health observed that there was a 2.13 and 2.59% reduction
in the control of blood pressure in March and April respectively compare to previous
month (Coma etal., 2020).
In Germany, Shafer etal. analyzed the effect of the COVID-19 pandemic and
lockdown on primary care regarding the number of consultations, the prevalence
of specific reasons for consultation presented by the patients, and the frequency
of specific services performed by the GP (Schäfer etal., 2021). When compar-
ing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017)
with the time during the lockdown (21 April to 14 July 2020), they have found
that during lockdown, the frequency of five reasons for consultation (−43.0% to
−31.5%) and eleven services (−56.6% to −33.5%) had significantly decreased
(Schäfer etal., 2021). Also, In Thailand, Sornsenee etal. defined two study peri-
ods as the pre-COVID-19 period (February 2019 to February 2020) and COVID-
19 period (March to August 2020) and found that during the COVID-19 period,
the percentage of uncontrolled Hypertension visits decreased from 43 to 31%
(Sornsenee etal., 2021).
Few studies focused on exploring barriers to accessing primary healthcare
for NCDs patients too (Nshimyiryo etal., 2021; Singh et al., 2021) For exam-
ple, Singh etal., in Nepal, reported that chronic diseases treatment facilities were
severely affected in both rural and urban settings (Singh etal., 2021). Participants
in this study reported that the interruptions in health services were mostly due to
the closure of health services at local health care facilities, limited affordability,
and involvement of private health sectors during the pandemic, fears of COVID-
19 transmission among health care workers and within health centers, and disrup-
tion of transportation services (Singh etal., 2021).

Journal of Prevention
1 3
Table 2 Adaptive strategies in primary health care for NCDs during COVID-19: Experiences from different countries
Country Study Results
United States Albert etal. (2021)Primary care structures and processes developed for remote chronic disease management through strate-
gies such as home-based monitoring and remote patient education, however people with fewer resources,
lower health literacy, and older adults were the most difficult to reach and manage during this time
Jetty etal. (2021) Adaption of telehealth and telephone consults and e-consults were made. The total visits (nearly 400
million) to primary care physicians, 42% were amenable to telehealth and 73% of the total services
rendered could be delivered through telehealth modalities. Of the primary care physicians, 44% pro-
vided telephone consults and 19% provided e-consults
McNamara etal. (2021) There was significantly more average medication related problems resolved per patient encounter in
face to face visits compared with telehealth visits, particularly in patient encounters that were previ-
ously seen by the pharmacist, who were under 65years old, identified as Black/African American,
had chronic kidney disease but not on dialysis, diabetes with end organ damage, and had uncontrolled
blood pressure and uncontrolled A1c
Alexander etal. (2020) Telemedicine visits increased from 1.1% of total Q2 2018–2019 visits (1.4 million quarterly visits) to
4.1% in Q1 of 2020 (4.8 million visits) and 35.3% in Q2 of 2020 (35.0 million visits)
Aubert etal. (2022) There was a shift to virtual visits and a decrease in A1c measurement during the pandemic, however no
association with A1c level or short-term T2D-related outcomes was observed, providing some reas-
surance about the adequacy of virtual visits
Canada Kiran etal. (2022) Virtual-first recommendations to support family physicians and other primary care professionals to
manage type 2 diabetes during COVID-9 pandemic was developed
United Kingdom Walker etal. (2021) Patients with obesity, type 2 diabetes or pre-diabetes attended six 90min sessions over 19weeks on
Zoom. The session included consultation on low-carbohydrate diet, physical activity, and stress
management. The results showed significant improvement on health outcomes including weight loss,
blood pressure and mental wellbeing in a group of primary care patients when delivered remotely
Portugal Lapão etal. (2021) Efforts were done to support primary health care provision with a web-based digital health platform for
remotely management the care of patients with chronic diseases during the COVID-19 pandemic
Gomes-de Almeida etal. (2021) They have found overall a high level of satisfaction and interest in future telemedicine follow-up. How-
ever, older patients were less interested in this type of follow-up
Georgia Woodhouse etal. (2022) Similar efforts were done in Georgia which pharmacist provided telephonic monitoring for diabetic
patients during the COVID-19

1 3
Journal of Prevention
Table 2 (continued)
Country Study Results
South Africa Mash etal. (2022) Home delivery of medication by community health workers was adopted as an alternative delivery
strategy for stable patients with chronic conditions in Cape Town in South Africa (Mash etal., 2022).
Over a 6-month period 1,054,657 pre-packaged parcels were sent to primary care facilities, 819,649
(77.7%) were delivered and of those 97,297 (11.9%) returned (Mash etal., 2022). Patients were posi-
tive about the new service and 42.3% of patients reported better adherence to their medication
A telemedicine service in the public sector reduced mortality in COVID-19 positive high risk diabetic
patients by 20% through identifying the patients with COVID-19 and providing them daily telephonic
follow—up for the first ten days after diagnosis
Thailand Chattranukulchai etal. (2021) Different telemedicine services have been developed and active collaborations from multi-stakeholders
are vitally important to ensure that telemedicine services for NCDs will finally become practical, suc-
cessful, and sustainable
Songsermpong etal., (2021) Telemedicine services, home blood pressure monitoring, community delivery of medicines and facility
infrastructure changes were reported to maintain hypertension and diabetes control rates during the
COVID-19
India Kunwar etal. Implementation of adaptive strategy of community-based drug distribution through
wellness centers (HWCs)/Sub-Centers (SCs) which improved access to hypertension care during the
COVID-19 pandemic
Mexico Silva-Tinoco and Torre-Saldaña (2021) There was a shift from face-to-face care to a telemedicine care service and different health areas par-
ticipated such as medical care, diabetes education, nutrition, psychology and podiatry by telephone in
some diabetes primary care centers
India Kunwar etal. (2021) The India Hypertension Control Initiative (IHCI) also implemented adaptive strategy of community-
based drug distribution through wellness centers (HWCs)/Sub-Centers (SCs) which improved access
to hypertension care during the COVID-19 pandemic (Kunwar etal., 2021)
Joshi etal. (2020) Using telemedicine and engaging a team of para-clinical doctors was devised. Telephonic follow up
consults were given and diabetes care was efficiently delivered
Kenya Kamano etal. (2021) Initiation of several interventions to maintain continuity of NCD care for such patients during COVID-
19 pandemic: Protect, Preserve, Promote, Process, and Plan. They conducted an intensive telephone
outreach effort to contact patients with diabetes and hypertension. They also disseminated health
education via nine radios shows from February to July 2020

Journal of Prevention
1 3
Table 2 (continued)
Country Study Results
Guatemala Hernández-Galdamez etal. (2021) Phone calls were made to participants from both intervention and control groups to monitor measures
important to the study: delivery of antihypertensive medications in both groups, receipt of coach-
ing sessions and use of a home blood pressure monitor by intervention group participants, as well
as reasons that they were not implemented. Regarding the delivery of antihypertensive drugs by the
MoH to participants, those in the intervention group had a higher level of medication delivery (73%)
than the control group (51%), p < 0.001. Of the total participants in the intervention group, 62% had
received at least one health coaching session in the previous three months and 81% used a digital
home blood pressure monitor at least twice a week. Intervention activities were lower than expected
due to restricted public transportation on top of decreased availability of health providers
Saudi-Arabia Tourkmani etal., (2021) They assessed the effect of a virtual integrated care clinic on glycemic control among 130 patients with
diabetes at a chronic illness center in a family medicine department in Riyadh. They found that over
a period of 4months of telemedicine intervention, the HbA1c decreased significantly comparing pre-
intervention

1 3
Journal of Prevention
Studies Regarding Adaptive Strategies inPrimary Health Care forNCDs During
COVID‑19: Experiences From Different Countries
There are several experiences in different countries including United States (Albert
etal., 2021; Alexander etal., 2020; Aubert etal., 2022; Jetty etal., 2021; McNamara
etal., 2021), Canada (Thesenvitz etal., 2022), United Kingdom (Walker etal., 2021),
Portugal (Lapão etal., 2021, Gomes-de Almeida etal., 2021), Georgia (Woodhouse
etal., 2022), South Africa (Mash etal., 2022), Thailand (Chattranukulchai et al.,
2021; Songsermpong etal., 2021), Mexico (Silva-Tinoco & Torre-Saldaña, 2021),
India (Kunwar etal., 2021), Kenya (Kamano etal., 2021), Guatemala (Hernández-
Galdamez etal., 2021), India (Joshi etal., 2020), and Saudi-Arabia (A etal., 2021)
which used different adaptive strategies within the primary care setting to provide
essential cares for NCDs and chronic diseases during the Covid-19 pandemic. These
studies were focused on describing how adaptive strategies developed while con-
sidering implementation considerations (Albert etal., 2021; Chattranukulchai etal.,
2021; Hernández-Galdamez etal., 2021; Kamano etal., 2021; Lapão etal., 2021;
Mash etal., 2022; Songsermpong etal., 2021), evaluating the feasibility, capacity
and patient satisfaction of adaptive strategies (Jetty etal., 2021, Thesenvitz etal.,
2022, Lapão etal., 2021, Gomes-de Almeida etal., 2021, Mash etal., 2022) as well
as assessing the effect of adaptive strategies (Aubert etal., 2022; Mash etal., 2022;
McNamara et al., 2021; Silva-Tinoco & Torre-Saldaña, 2021; Tourkmani et al.,
2021; Walker et al., 2021; Woodhouse etal., 2022). Totally, two main strategies
including (1) remote monitoring, follow up, consultation, empowerment and educa-
tional services as well as (2) home visiting were applied in these countries, Saudi-
Arabia (Tourkmani etal., 2021) which are described in bellow (Table2).
Remote Monitoring, Follow Up andConsultation Services
In Canada, Virtual-first recommendations to support family physicians and other
primary care professionals to manage type 2 diabetes during COVID-9 pandemic
was developed (Kiran etal., 2020). Patient self-assessment to make virtual visits
more effective are also recommended and Canada has introduced several home
blood pressure monitors and practical advice to control blood pressure at home
(Kiran etal., 2020). Central Alberta’s primary care networks (PCNs) made part-
nership with a technology provider to implement home heath monitoring (HHM)
for patients with chronic diseases in Alberta’s Central Zone, a rural area with a
population of over 450,000 (Thesenvitz etal., 2022). HHM provided monitoring,
educating and empowering patients from their home. The results of the feasibility
study from phase 1 (N = 37) and phase 2 (N = 127) showed that HHM was suc-
cessful within the primary care setting, and patients reported being satisfied with
the technology and privacy issues (Thesenvitz etal., 2022).
In United States, primary care structures and processes developed for remote
chronic disease management through strategies such as home-based monitoring
and remote patient education, however people with fewer resources, lower health
literacy, and older adults were the most difficult to reach and manage during this

Journal of Prevention
1 3
time. (Albert etal., 2021). Aubert etal. who reported the changes in management,
control, and outcomes in older people with type 2 diabetes (T2D) associated with
the shift from in-person to virtual visits in United States, have found that there
was a dramatic shift to virtual visits and a decrease in A1c measurement rates
during the pandemic, however they didn’t observe an effect on T2D control or
short-term T2D-related outcomes which provides some reassurance about virtual
visits adequacy (Aubert etal., 2022).
Due to restrictions disrupted the primary care weight management referral and
delivery in United Kingdom, remotely delivered primary care consultations were
also used to maintain these services (Walker etal., 2021). Walker etal. evaluated
outcomes from a multicomponent weight loss and health promotion program in
UK primary care. Patients with obesity, type 2 diabetes or pre-diabetes attended
six 90min sessions over 19weeks on Zoom. The session included consultation
on low-carbohydrate diet, physical activity, and stress management. The results
showed significant improvement on health outcomes including weight loss, blood
pressure and mental wellbeing in a group of primary care patients when delivered
remotely (Walker etal., 2021). In Mexico, there was also a shift from face-to-face
care to a telemedicine care service and different health areas participated such as
medical care, diabetes education, nutrition, psychology and podiatry by telephone
in some diabetes primary care centers (Silva-Tinoco & Torre-Saldaña, 2021). In
Portugal, similar efforts were done to support primary health care provision with
a web-based digital health platform for remotely management the care of patients
with chronic diseases during the COVID-19 pandemic (Lapão etal., 2021). In
another study in Portugal, Gomes etal. evaluated the telemedical satisfaction of
patients with diabetes, hypertension and other diseases from a primary health
care center during COVID-19 via a Likert scale questionnaire. They have found
overall a high level of satisfaction and interest in future telemedicine follow-up.
However, older patients were less interested in this type of follow-up (Gomes-de
Almeida etal., 2021).
In Saudi Arabia, many health centers shifted their in-person integrated care pro-
grams to virtual clinics to ensure that patients with diabetes receive the essential health
care during the COVID-19 (Al etal. 2021). Tourkmani etal. assessed the effect of a
virtual integrated care clinic on glycemic control among 130 patients with diabetes at
a chronic illness center in a family medicine department in Riyadh (Tourkmani etal.,
2021). They have found that over a period of 4months of telemedicine intervention, the
HbA1c decreased significantly comparing pre-intervention (Tourkmani etal., 2021).
Similar efforts were done in Georgia which pharmacist provided telephonic monitoring
for diabetic patients during the COVID-19(Woodhouse etal., 2022). In Thailand, tele-
medicine services, home blood pressure monitoring, community delivery of medicines
and facility infrastructure changes were reported to maintain hypertension and diabe-
tes control rates during the COVID-19 (Chattranukulchai etal., 2021) (Songsermpong
etal., 2021). The India Hypertension Control Initiative (IHCI) also implemented adap-
tive strategy of community-based drug distribution through wellness centers (HWCs)/
Sub-Centers (SCs) which improved access to hypertension care during the COVID-19
pandemic (Kunwar etal., 2021).

1 3
Journal of Prevention
In Kenya the primary integrated care for four chronic diseases (PIC4C) initiated sev-
eral interventions to maintain continuity of NCD care for such patients during COVID-
19 pandemic: Protect, Preserve, Promote, Process, and Plan. They conducted an inten-
sive telephone outreach effort to contact patients with diabetes and hypertension. They
also disseminated health education via nine radios shows from February to July 2020
(Kamano et al., 2021). In South Africa, a telemedicine service in the public sector
reduced mortality in COVID-19 positive high-risk diabetic patients by 20% through
identifying the patients with COVID-19 and providing them daily telephonic follow—
up for the first ten days after diagnosis (David etal., 2021).
Home Visiting orHome Delivery ofMedication
Home delivery of medication by community health workers was adopted as an alter-
native delivery strategy for stable patients with chronic conditions in Cape Town in
South Africa (Mash etal., 2022). Over a 6-month period 1,054,657 pre-packaged par-
cels were sent to primary care facilities, 819,649 (77.7%) were delivered and of those
97,297 (11.9%) returned (Mash etal., 2022). Patients were positive about the new ser-
vice and 42.3% of patients reported better adherence to their medication (Mash etal.,
2022).
Discussion
Reviewing existing evidence at the global level (Organization, 2020c, Organization,
2021, Chudasama etal., 2020) and from different countries such as United States
(Alexander etal., 2020; Beckman etal., 2021), Canada (Laing & Johnston, 2021;
Stephenson etal., 2021), European countries including Spain (Coma et al., 2020,
2021; Lopez Segui etal., 2021; Sisó-Almirall etal., 2022), Germany (Schäfer etal.,
2021), United Kingdom (Seidu etal., 2022, Carr et al., 2022), Netherland (Velek
etal., 2022), Switzerland (Rachamin etal., 2021), France (Davin-Casalena etal.,
2021; Ludwig etal., 2021) as well as Thailand (Sornsenee etal., 2021), Ethiopia
(Enbiale etal., 2021), Oman (Al Harthi etal., 2021), Peru (Pesantes etal., 2020),
India (Joshi etal., 2020) and China (Chan etal., 2020) showed concerns for main-
taining NCDs primary care regarding hypertension and diabetes during the COVID-
19 pandemic. This could weaken the effects of the COVID-19 pandemic on popula-
tions. Previous outbreaks also showed that when health systems are overwhelmed,
dramatic mortality rise occurs, both directly from an outbreak, and indirectly from
preventable conditions. For example in the 2014–2015 Ebola outbreak, the increased
number of deaths attributed to HIV/AIDS, measles, malaria and tuberculosis attrib-
uted to health system failures exceeded deaths from Ebola (Raina et al., 2021).
Therefore, countries should have a context-specific national strategies to increase
the resilience of health system maintain the capacity of their primary health care
services, minimize fragmentation and improve governance (Rieckert etal., 2021).
Identification of factors affecting the disruption of the primary care services for
chronic disease however, is of great importance for policymaking, and improvement

Journal of Prevention
1 3
of the condition. Few studies were done in this regard which put their attention on
high blood pressure or diabetes. However, reasons for overall service disruption
were categorized as demand and supply side in the WHO Pulse study. The most
mentioned demand side factors were: (1) patients not presenting to outpatient care;
(2) perceptions that government or public transport lockdowns were hindering
access; and (3) perceptions that financial difficulties during the outbreak were
affecting attendance (Organization, 2020c). On the supply side: (1) cancellation of
elective care; (2) health workforce difficulties; (3) unavailability of survives; (4) lack
of supplies; and (5) changes in treatment policies. All were listed (Organization,
2020c). Further qualitative studies are recommended in different countries to
understand enabling and disabling factors affecting the maintenance and quality of
care during the COVID-19 pandemic.
Developing innovative ways to maintain chronic care for diabetes and hyper-
tension primary care within the PHC are highly recommended in pandemics like
COVID-19 (Albert etal., 2021). Several primary care practices were set up using
telehealth during the pandemic in different countries including United States(Albert
etal., 2021; Alexander etal., 2020; Aubert etal., 2022; Jetty etal., 2021; McNa-
mara et al., 2021), Canada (Thesenvitz et al., 2022), United Kingdom (Walker
etal., 2021), Portugal (Lapão etal., 2021, Gomes-de Almeida etal., 2021), Geor-
gia (Woodhouse et al., 2022), South Africa (Mash etal., 2022), Thailand (Chat-
tranukulchai et al., 2021; Songsermpong et al., 2021), Mexico (Silva-Tinoco &
Torre-Saldaña, 2021), India (Kunwar etal., 2021), Kenya (Kamano etal., 2021),
Guatemala (Hernández-Galdamez etal., 2021) and Saudi-Arabia (Tourkmani etal.,
2021), however few data exist on long-term outcomes of these intervention which
warrant further studies. Furthermore, several considerations need to be taken into
account when adapting telemedicine into primary health care to prevent unintended
outcomes. As older adults, patients with public insurance and lower health literacy
were less likely to adopt telemedicine, Addressing barriers to prevent inequalities
is of great importance (Albert et al., 2021; Aubert etal., 2022; McNamara etal.,
2021). Government health policy support, proper technical infrastructure, sufficient
training for community health workers and considering privacy issues for patients’
information are also very important when developing telehealth in primary health
care (Hoffer-Hawlik etal., 2020; Lapão etal., 2021; Mash etal., 2022; Tourkmani
etal, 2021).
Conclusion
Disruption of NCDs services in PHC during the COVID-19 pandemic highlights
the urgency of attention of policy-makers to support appropriate policies to improve
PHC service coverage and its quality during the pandemics. Improving telemedicine
infrastructure within the PHC is highly recommended for maintaining essential care
for chronic disease patients during the COVID-19 pandemic.
Acknowledgements The study was approved and financed by the Iran University of Medical Sciences.

1 3
Journal of Prevention
Declarations
Conflict of Interest The authors declare that there are no conflicts of interest
References
Al Harthi T., Anwar H., Al Lawati A., Al Shuriqi F., Al Rashdi F., Al Mahrouqi A., Al Ismaili M., Al
Syiabi R., Al Azri H., Meah U.H., & Al Ghafri, T. (2021). The impact of Covid-19 on diabetes care
in muscat governorate: A retrospective cohort study in primary care. Journal of Primary Care and
Community Health 12, 21501327211051930. doi:https:// doi. org/ 10. 1177/ 21501 32721 10519 30
Albert, S. L., Paul, M. M., Nguyen, A. M., Shelley, D. R., & Berry, C. A. (2021). A qualitative study
of high-performing primary care practices during the COVID-19 pandemic. BMC Family Practice,
22(1), 237. https:// doi. org/ 10. 1186/ s12875- 021- 01589-4
Alexander, G. C., Tajanlangit, M., Heyward, J., Mansour, O., Qato, D. M., & Stafford, R. S. (2020). Use
and content of primary care office-based vs telemedicine care visits during the COVID-19 pandemic
in the US. JAMA Network Open, 3(10), e2021476. https:// doi. org/ 10. 1001/ jaman etwor kopen. 2020.
21476
Aubert, C. E., Henderson, J. B., Kerr, E. A., Holleman, R., Klamerus, M. L., & Hofer, T. P. (2022).
Type 2 diabetes management, control and outcomes during the COVID-19 pandemic in older US
veterans: An observational study. Journal of General Internal Medicine, 37(4), 870–877. https:// doi.
org/ 10. 1007/ s11606- 021- 07301-7
Beckman, A. L., King, J., Streat, D. A., Bartz, N., Figueroa, J. F., & Mostashari, F. (2021). Decreasing
primary care use and blood pressure monitoring during COVID-19. The American Journal of
Managed Care, 27(9), 366–368. https:// doi. org/ 10. 37765/ ajmc. 2021. 88644
Beran, D., Aebischer, P. S., Castellsague, P. M., Chappuis, F., Chopard, P., Haller, D. M., Jacquerioz, B.
F., Maisonneuve, H., Perone, N., & Gastaldi, G. (2021). Beyond the virus: Ensuring continuity of
care for people with diabetes during COVID-19. Primary Care Diabetes, 15(1), 16–17. https:// doi.
org/ 10. 1016/j. pcd. 2020. 05. 014
Carr, M. J., Wright, A. K., Leelarathna, L., Thabit, H., Milne, N., Kanumilli, N., Ashcroft, D. M., &
Rutter, M. K. (2022). Impact of COVID-19 restrictions on diabetes health checks and prescribing
for people with type 2 diabetes: A UK-wide cohort study involving 618 161 people in primary care.
BMJ Quality and Safety, 31(7), 503–514. https:// doi. org/ 10. 1136/ bmjqs- 2021- 013613
Chan, E. Y. Y., Kim, J. H., Lo, E. S. K., Huang, Z., Hung, H., Hung, K. K. C., Wong, E. L. Y., Lee, E.
K. P., Wong, M. C. S., & Wong, S. Y. S. (2020). What happened to people with non-communicable
diseases during COVID-19: Implications of H-EDRM policies. International Journal of
Environmental Research and Public Health, 17(15), 5588. https:// doi. org/ 10. 3390/ ijerp h1715 5588
Chattranukulchai, P., Thongtang, N., Ophascharoensuk, V., Muengtaweepongsa, S., Angkurawaranon,
C., Chalom, K., Supungul, S., Thammatacharee, J., Kittikhun, S., Shantavasinkul, P. C.,
Leelahavarong, P., Rawdaree, P., Tangsawad, S., Pitayarangsarit, S., Kanaderm, C., Assawamakin,
A., Roubsanthisuk, W., & Sukonthasarn, A. (2021). An implementation framework for telemedicine
to address noncommunicable diseases in Thailand. Asia-Pacific Journal of Public Health, 33(8),
968–971. https:// doi. org/ 10. 1177/ 10105 39521 10087 54
Chudasama, Y. V., Gillies, C. L., Zaccardi, F., Coles, B., Davies, M. J., Seidu, S., & Khunti, K. (2020).
Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare
professionals. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 14(5), 965–967.
https:// doi. org/ 10. 1016/j. dsx. 2020. 06. 042
Coma, E., Miró, Q., Medina, M., Marin-Gomez, F. X., Cos, X., Benítez, M., Mas, A., Fàbregas, M.,
Fina, F., Lejardi, Y., & Vidal-Alaball, J. (2021). Association between the reduction of face-to-face
appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic
in Catalonia. Diabetes Res Clin Pract, 182, 109127. https:// doi. org/ 10. 1016/j. diabr es. 2021. 109127
Coma, E., Mora, N., Méndez, L., Benítez, M., Hermosilla, E., Fàbregas, M., Fina, F., Mercadé, A.,
Flayeh, S., Guiriguet, C., Balló, E., Martinez Leon, N., Mas, A., Cordomí, S., Lejardi, Y., & Medina,
M. (2020). Primary care in the time of COVID-19: monitoring the effect of the pandemic and the
lockdown measures on 34 quality of care indicators calculated for 288 primary care practices

Journal of Prevention
1 3
covering about 6 million people in Catalonia. BMC Fam Pract, 21(1), 208. https:// doi. org/ 10. 1186/
s12875- 020- 01278-8
David, N. J., Brey, Z., & Ismail, M. (2021). Telemedicine in the Western Cape Department of Health
during the first peak of the COVID-19 pandemic: Leveraging data to save lives by activating a
telemedicine response. African Journal of Primary Health Care and Family Medicine, 13(1), e1–e4.
Davin-Casalena, B., Jardin, M., Guerrera, H., Mabille, J., Tréhard, H., Lapalus, D., Ménager, C., Nauleau,
S., Cassaro, V., Verger, P., & Guagliardo, V. (2021). L’impact de l’épidémie de COVID-19 sur les
soins de premier recours en région Provence-Alpes-Côte d’Azur : retour d’expérience sur la mise en
place d’un dispositif de surveillance en temps réel à partir des données régionales de l’Assurance
maladie [The impact of the COVID-19 pandemic on first-line primary care in southeastern France:
Feedback on the implementation of a real-time monitoring system based on regional health
insurance data]. Rev Epidemiol Sante Publique, 69(3):105–115. French. doi:https:// doi. org/ 10.
1016/j. respe. 2021. 04. 135
Enbiale, W., Abdela, S. G., Seyum, M., BedanieHundie, D., Bogale, K. A., Tamirat, K. S., Feleke, M. B.,
Azage, M., Nigatu, D., & de Vries, H. J. C. (2021). Effect of the COVID-19 pandemic preparation
and response on essential health services in primary and tertiary healthcare settings of Amhara
region, Ethiopia. The American journal of tropical medicine and hygiene, 105(5), 1240–1246.
https:// doi. org/ 10. 4269/ ajtmh. 21- 0354
Gomes-de Almeida, S., Marabujo, T., & do Carmo-Gonçalves, M. (2021). Grado de satisfacción de
los pacientes de la Unidad de Salud Familiar Vitrius con la teleconsulta durante la pandemia del
COVID-19 [Telemedicine satisfaction of primary care patients during COVID-19 pandemics].
Semergen, 47(4), 248–255. Spanish. doi:https:// doi. org/ 10. 1016/j. semerg. 2021. 01. 005
Halcomb, E., Fernandez, R., Ashley, C., McInnes, S., Stephen, C., Calma, K., Mursa, R., Williams, A., &
James, S. (2022). The impact of COVID-19 on primary health care delivery in Australia. Journal of
Advanced Nursing, 78(5), 1327–1336. https:// doi. org/ 10. 1111/ jan. 15046
Haque, M., Islam, T., Rahman, N. A. A., McKimm, J., Abdullahm, A., & Dhingra, S. (2020).
Strengthening primary health-care services to help prevent and control long-term (chronic) non-
communicable diseases in low- and middle-income countries. Risk Manag Healthc Policy, 18(13),
409–426. https:// doi. org/ 10. 2147/ RMHP. S2390 74
Hernández-Galdamez, D., Mansilla, K., Peralta, A. L., Rodríguez-Szaszdi, J., Ramírez, J. M., Roche,
D., Gulayin, P., Ramirez-Zea, M., He, J., Irazola, V., & Fort, M. P. (2021). Monitoring study
participants and implementation with phone calls to support hypertension control during the
COVID-19 pandemic: The case of a multicomponent intervention trial in guatemala. Global Heart,
16(1), 77. https:// doi. org/ 10. 5334/ gh. 954
Hoffer-Hawlik, M. A., Moran, A. E., Burka, D., Kaur, P., Cai, J., Frieden, T. R., & Gupta, R. (2020).
Leveraging telemedicine for chronic disease management in low- and middle-income countries
during Covid-19. Global Heart, 15(1), 63. https:// doi. org/ 10. 5334/ gh. 852
Jetty, A., Jabbarpour, Y., Westfall, M., Kamerow, D. B., Petterson, S., & Westfall, J. M. (2021). Capacity
of primary care to deliver telehealth in the United States. Journal of the American Board of Family
Medicine, 34(Suppl), S48–S54. https:// doi. org/ 10. 3122/ jabfm. 2021. S1. 200202
Joshi, R., Atal, S., Fatima, Z., Balakrishnan, S., Sharma, S., & Joshi, A. (2020). Diabetes care during
COVID-19 lockdown at a tertiary care centre in India. Diabetes Research and Clinical Practice,
166, 108316. https:// doi. org/ 10. 1016/j. diabr es. 2020. 108316
Kamano, J., Naanyu, V., Ayah, R., Limo, O., Gathecha, G., Saenyi, E., Jefwa, P., Too, K., Manji, I., Gala,
P., & Vedanthan, R. (2021). Maintaining care delivery for non-communicable diseases in the face of
the COVID-19 pandemic in western Kenya. The Pan African Medical Journal, 22(39), 143. https://
doi. org/ 10. 11604/ pamj. 2021. 39. 143. 29708
Kiran, T., Moonen, G., Bhattacharyya, O. K., Agarwal, P., Bajaj, H. S., Kim, J., & Ivers, N. (2020).
Managing type 2 diabetes in primary care during COVID-19. Canadian Family Physician, 66(10),
745–747.
Kraef, C., Juma, P., Kallestrup, P., Mucumbitsi, J., Ramaiya, K., & Yonga, G. (2020). The COVID-
19 pandemic and non-communicable diseases-A wake-up call for primary health care system
strengthening in sub-saharan Africa. Journal of Primary Care and Community Health, 11,
2150132720946948. https:// doi. org/ 10. 1177/ 21501 32720 946948
Kunwar, A., Durgad, K., Kaur, P., Sharma, M., Swasticharan, L., Mallela, M., Saxena, A., Tayade,
S., Gill, S., Gopal, B. K., Pathni, A. K., Tullu, F. T., Dhaliwal, R. S., & Bhargava, B. (2021).
Interventions to ensure the continuum of care for hypertension during the COVID-19 pandemic in

1 3
Journal of Prevention
five Indian states—India Hypertension Control Initiative. Global Heart, 16(1), 82. https:// doi. org/
10. 5334/ gh. 1010
Laing, S., & Johnston, S. (2021). Estimated impact of COVID-19 on preventive care service delivery: An
observational cohort study. BMC Health Services Research, 21(1), 1107. https:// doi. org/ 10. 1186/
s12913- 021- 07131-7
Lapão, L. V., Peyroteo, M., Maia, M., Seixas, J., Gregório, J., Mira da Silva, M., Heleno, B., & Correia,
J. C. (2021). Implementation of digital monitoring services during the COVID-19 pandemic for
patients with chronic diseases: design science approach. Journal of Medical Internet Research,
23(8), e24181. https:// doi. org/ 10. 2196/ 24181
Lopez Segui, F., Hernandez Guillamet, G., PifarréArolas, H., Marin-Gomez, F. X., Ruiz Comellas,
A., Ramirez Morros, A. M., Adroher Mas, C., & Vidal-Alaball, J. (2021). Characterization
and identification of variations in types of primary care visits before and during the COVID-
19 pandemic in catalonia: Big data analysis study. Journal of Medical Internet Research, 23(9),
e29622. https:// doi. org/ 10. 2196/ 29622
Ludwig, L., Scheyer, N., Remen, T., & Guerci, B. (2021). The impact of COVID-19 lockdown on
metabolic control and access to healthcare in people with diabetes: The CONFI-DIAB cross-
sectional study. Diabetes Therapy, 12(8), 2207–2221. https:// doi. org/ 10. 1007/ s13300- 021- 01105-y
Mash, R. J., Schouw, D., Daviaud, E., Besada, D., & Roman, D. (2022). Evaluating the implementation
of home delivery of medication by community health workers during the COVID-19 pandemic in
Cape Town, South Africa: A convergent mixed methods study. BMC Health Services Research,
22(1), 98. https:// doi. org/ 10. 1186/ s12913- 022- 07464-x
McNamara, A., Zhao, M., & Lee, S. Y. (2021). Evaluating the primary care clinical pharmacist visit
transition to telehealth during the COVID-19 pandemic by comparing medication related problems
from telehealth visits and in-person visits. Journal of the American College of Clinical Pharmacy,
4(8), 914–923. https:// doi. org/ 10. 1002/ jac5. 1487
Mobula, L. M., Heller, D. J., Commodore-Mensah, Y., Walker Harris, V., & Cooper, L. A. (2020).
Protecting the vulnerable during COVID-19: Treating and preventing chronic disease disparities.
Gates Open Research, 9(4), 125. https:// doi. org/ 10. 12688/ gates openr es. 13181.1
Nshimyiryo, A., Barnhart, D. A., Cubaka, V. K., Dusengimana, J. M. V., Dusabeyezu, S., Ndagijimana,
D., Umutesi, G., Shyirambere, C., Karema, N., Mubiligi, J. M., & Kateera, F. (2021). Barriers and
coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional
survey among patients with chronic diseases in rural Rwanda. BMC Public Health, 21(1), 704.
https:// doi. org/ 10. 1186/ s12889- 021- 10783-z
Pesantes, M.A., Lazo-Porras, M., Cárdenas, M.K., Diez-Canseco, F., Tanaka-Zafra, J.H., Carrillo
Larco, R.M., Bernabé-Ortiz, A., Málaga, G., & Miranda, J.J. (2020). Los retos del cuidado
de las personas con diabetes durante el estado de emergencia nacional por COVID-19 en Lima,
Perú: recomendaciones para la atención primaria [Healthcare challenges for people with diabetes
during the national state of emergency due to COVID-19 in Lima, Peru: primary healthcare
recommendations]. Rev Peru Med Exp Salud Publica 2;37(3):541–546. Spanish. doi:https:// doi. org/
10. 17843/ rpmesp. 2020. 373. 5980
Pettus, J., & Skolnik, N. (2021). Importance of diabetes management during the COVID-19 pandemic.
Postgraduate Medicine, 133(8), 912–919. https:// doi. org/ 10. 1080/ 00325 481. 2021. 19787 04
Rachamin, Y., Senn, O., Streit, S., Dubois, J., Deml, M. J., & Jungo, K. T. (2021). Impact of the COVID-
19 pandemic on the intensity of health services use in general practice: A retrospective cohort study.
International Journal of Public Health, 66, 635508.
Raina, S. K., Kumar, R., Kumar, A., Kumar, D., Raina, S., Gupta, R., & Joshi, H. (2021). Broad
guidelines for primary care practitioners/standalone private health facilities/frontline healthcare
facilities in view of COVID-19 pandemic. Journal of Family Medicine and Primary Care, 10(1),
1–9. https:// doi. org/ 10. 4103/ jfmpc. jfmpc_ 1192_ 20
Rieckert, A., Schuit, E., Bleijenberg, N., Ten Cate, D., de Lange, W., de Man-van Ginkel, J. M.,
Mathijssen, E., Smit, L. C., Stalpers, D., Schoonhoven, L., Veldhuizen, J. D., & Trappenburg, J.
C. (2021). How can we build and maintain the resilience of our health care professionals during
COVID-19? Recommendations based on a scoping review. BMJ Open, 11(1), e043718. https:// doi.
org/ 10. 1136/ bmjop en- 2020- 043718
Schäfer, I., Hansen, H., Menzel, A., Eisele, M., Tajdar, D., Lühmann, D., & Scherer, M. (2021). The
effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and
performed services in primary care: Results of a longitudinal observational study. BMC Family
Practice, 22(1), 125. https:// doi. org/ 10. 1186/ s12875- 021- 01471-3

Journal of Prevention
1 3
Seidu, S., Hambling, C., Holmes, P., Fernando, K., Campbell, N. S., Davies, S., & Khunti, K. (2022).
The impact of the COVID pandemic on primary care diabetes services in the UK: A cross-sectional
national survey of views of health professionals delivering diabetes care. Primary Care Diabetes,
16(2), 257–263. https:// doi. org/ 10. 1016/j. pcd. 2021. 12. 015
Silva-Tinoco, R., & Torre-Saldaña, V. (2021). The imperious need for telemedicine for the care of
diabetes during the COVID-19 pandemic. A comprehensive approach study. Gaceta médica de
México, 157(3), 309–312. https:// doi. org/ 10. 24875/ GMM. M2100 0563
Singh, D. R., Sunuwar, D. R., Shah, S. K., Karki, K., Sah, L. K., Adhikari, B., & Sah, R. K. (2021).
Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study
among community members and stakeholders. BMC Health Services Research, 21(1), 174. https://
doi. org/ 10. 1186/ s12913- 021- 06176-y
Sisó-Almirall, A., Kostov, B., Sánchez, E., Benavent-Àreu, J., & González de Paz, L. (2022). Impact of
the COVID-19 pandemic on primary health care disease incidence rates: 2017 to 2020. Annals of
Family Medicine, 20(1), 63–68. https:// doi. org/ 10. 1370/ afm. 2731
Songsermpong, S., Bunluesin, S., Khomgongsuwan, P., Junthon, S., Cazabon, D., Moran, A. E., & Garg,
R. (2021). Innovations to sustain non-communicable disease services in the context of COVID-19:
Report from Pakkred District, Nonthaburi Province, Thailand. Global Heart, 16(1), 44. https:// doi.
org/ 10. 5334/ gh. 1003
Sornsenee, P., Vichitkunakorn, P., Choomalee, K., & Romyasamit, C. (2021). Effect of the COVID-19
pandemic and other predictors of true therapeutic inertia on patients with hypertension in a primary
care clinic in Thailand. Risk Manag Healthc Policy, 13(14), 3807–3816. https:// doi. org/ 10. 2147/
RMHP. S3276 44
Stephenson, E., Butt, D. A., Gronsbell, J., Ji, C., O’ Neill, B., Crampton, N., & Tu, K. (2021). Changes in
the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region
of Canada. PLoS One, 16(8), e0255992. https:// doi. org/ 10. 1371/ journ al. pone. 02559 92
Thesenvitz, J., Corley, S., Solberg, L., & Carvalho, C. (2022). Home health monitoring during the COVID
pandemic: Results from a feasibility study in Alberta primary care. Healthcare Management Forum,
35(1), 29–34. https:// doi. org/ 10. 1177/ 08404 70421 10419 69
M Tourkmani, A., J ALHarbi, T., Rsheed, A. M. B., Alrasheedy, A. A., ALMadani, W., ALJuraisi,
F., AlOtaibi, A.F., AlHarbi, M., AlAbood, A.F. & Alshaikh, A. A. I. (2021). The impact of
telemedicine on patients with uncontrolled type 2 diabetes mellitus during the COVID-19
pandemic in Saudi Arabia: findings and implications. Journal of Telemedicine and Telecare,
1357633X20985763.https:// doi. org/ 10. 1177/ 13576 33X20 985763
Velek, P., Splinter, M. J., Ikram, M. K., Ikram, M. A., Leening, M. J., van der Lei, J., Olde Hartman,
T., Peters, L. L., Tange, H., Rutten, F. H., & van Weert, H. (2022). Changes in the diagnosis of
stroke and cardiovascular conditions in primary care during the first 2 COVID-19 waves in the
Netherlands. Neurology, 98(6), e564–e572. https:// doi. org/ 10. 1212/ WNL. 00000 00000 013145
Walker, L., Smith, N., & Delon, C. (2021). Weight loss, hypertension and mental well-being
improvements during COVID-19 with a multicomponent health promotion programme on Zoom:
A service evaluation in primary care. BMJ Nutrition, Prevention and Health, 4(1), 102–110. https://
doi. org/ 10. 1136/ bmjnph- 2020- 000219
Weber, T., Januszewicz, A., AgabitiRosei, E., Tsioufis, K., Okorie, M., Stergiou, G. S., Volpe, M., Kreutz,
R., Abraham, G., Azizi, M., Barna, I., The corona-virus disease. (2019). Pandemic compromised
routine care for hypertension: A survey conducted among excellence centers of the European
Society of Hypertension. Journal of Hypertension, 39(1), 190–195. https:// doi. org/ 10. 1097/ HJH.
00000 00000 002703
Woodhouse, A. G., Orvin, C., Rich, C., Crosby, J., & Keedy, C. A. (2022). Diabetes outcomes before
and during telehealth advancements surrounding COVID-19. Journal of the American Pharmacists
Association, 62(1), 214–217. https:// doi. org/ 10. 1016/j. japh. 2021. 09. 011
World Health Organization. (2020a). COVID-19 significantly impacts health services for
noncommunicable diseases. World Health Organization. https:// www. who. int/ news- room/ detail/ 01-
06- 2020a- covid- 19- signi fican tly- impac ts- health- servi ces- for- nonco mmuni cable- disea ses. Accessed,
27.
World Health Organization. (2020b). NCDs, mental health and COVID-19. Departmental News. Geneva,
Switzerland: World Health Organization.[Google Scholar].
World Health Organization. (2020c). Pulse survey on continuity of essential health services during the
COVID-19 pandemic: interim report, 27 August 2020c. World Health Organization.

1 3
Journal of Prevention
World Health Organization. (2021). Second round of the national pulse survey on continuity of essential
health services during the COVID-19 pandemic: interim report, 22 April 2021. World Health
Organization.
World Health Organization. (2022). COVID-19 weekly epidemiological update, edition 80, 22 February
2022.
Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps
and institutional affiliations.
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under
a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted
manuscript version of this article is solely governed by the terms of such publishing agreement and
applicable law.
Authors and Aliations
JavadBarzegari1· PouranRaeissi1· Seyed‑MasoudHashemi2·
AidinAryanKhesal1· NahidReisi3
* Pouran Raeissi
raeissi2009@yahoo.com; raeissi.p@iums.ac.ir
Javad Barzegari
barzegari.javad@yahoo.com; barzegari.j@iums.ac.ir; javadbarzegarii@yahoo.com
Seyed- Masoud Hashemi
hashemimasoud@gamil.com; dr.hashemi@sbmu.ac.ir
Aidin Aryan Khesal
a.aryankhesal@gmail.com; aryankhesal.a@iums.ac.ir
Nahid Reisi
reisi@med.mui.ac.ir
1 Department ofHealth Services Management, School ofHealth Services Management
andMedical Information Science, Iran University ofMedical Sciences, No. 6, Rashid Yasemi
St. Vali –e Asr Ave, P.O Box: 1996713883, Tehran, Iran
2 Department ofAnesthesiology, Faculty ofMedicine, Shahid Beheshti University ofMedical
Sciences, Tehran, Iran
3 Department ofPediatric Hematology andOncology, Faculty ofMedicine, Child Growth
andDevelopment Research Center andIsfahan Immunodeficiency Research Center, Isfahan
University ofMedical Sciences, Isfahan, Iran