Relative Impacts on Preventative Primary Care--a Longitudinal Evaluation of COVID-19:Phase 1 (RIPPLE-C)

McMaster University

Status: Completed

Conditions: Chronic Kidney Diseases; Osteoarthritis; Depression, Anxiety; Chronic Obstructive Pulmonary Disease; Diabetes Mellitus; Dementia; Congestive Heart Failure

Treatments: Other: Pre-pandemic time period (Jun 22, 2018 to March 12, 2020); Other: Peri-pandemic time period (March 13, 2020 to December 3, 2021)

Study type: Observational

Funder types: Other

Identifiers

NCT05813652

WI1-179885

Details and patient eligibility

About

The goal of this observational study is to describe the impacts of COVID-19 on primary care chronic condition management in Canada within various patient populations. This will be done by analyzing primary care electronic medial record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, including data on primary care encounters, as well as various markers for chronic conditions.

The research questions to be investigated are:

1a) What are the changes to the management of chronic conditions in primary care since the onset of the COVID-19 pandemic?

1b) How do these changes differ by age, health status, and socioeconomic status?

Full description

This is a retrospective closed cohort study, using a single-arm, pre-post design. The objectives of this study are to describe the impacts of COVID-19 on access, comprehensiveness and appropriateness among adult patients with chronic diseases, and to determine whether changes were associated with socio-demographic characteristics and multi-morbidity. This will be done using using electronic medial record (EMR) data made available by the CPCSSN network. CPCSSN is a research network supported by a primary care EMR database, comprising over 1500 physicians, and nearly 2 million patients from across Canada.

We will be examining prevention and management activities for several exemplar chronic conditions that have a validated CPCSSN case definition and substantial prevalence in primary care (e.g. diabetes, heart failure, etc.). CPCSSN data between 2018-2021 will be analyzed for changes in management of various chronic conditions prior to, and through phases of the pandemic. Changes will also be examined among specific sub-groups of adults, including those with multi-morbidity and socio-economic vulnerabilities.

The primary exposure is the onset of the pandemic: March 13, 2020 to December 3, 2021 versus the equal time frame prior. March 13, 2020 was selected as the date when Canadian provincial governments began enforcing various public health and safety measures in response to the World Health Organization formally declaring the circulating SARS-CoV-2 as a pandemic on March 11, 2020.

We will be examining whether there have been changes in overall access, comprehensiveness, continuity and appropriateness of care (including potential decreases in burdensome or unnecessary care) by applying indicators that incorporate chronic condition monitoring (physical measures, lab tests and investigations), prescriptions, referrals and preventive care, to chronic condition patient populations.

Enrollment: 919,928 patients

Sex: All

Ages: 18 to 105 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 years of age or older as of 2018
• Records included in the CPCSSN database
• Patient had at least one encounter with their clinic between March 13, 2018 and March 13, 2020

Exclusion criteria

• Patients aged 105 or older as of 2018 will be excluded due to possibility of data entry error

Trial design

919,928 participants in 1 patient group

RIPPLE-C cohort

Description:

This is a retrospective closed cohort study using a single-arm, pre-post design. Therefore, we will be selecting patients from the CPCSSN database to create our single-arm cohort. Patients included in this cohort will be 18 years of age or older, and will have had at least one contact with their primary care clinic between the dates of March 13, 2018 and March 13, 2020.

Treatment:

Other: Peri-pandemic time period (March 13, 2020 to December 3, 2021)

Other: Pre-pandemic time period (Jun 22, 2018 to March 12, 2020)