Abstract
The COVID-19 pandemic disrupted healthcare systems globally, particularly affecting chronic disease management in low- and middle-income countries. While immediate impacts have been documented, long-term effects on primary care services for non-communicable diseases remain poorly understood. This study investigated the impact of the COVID19 pandemic on primary care services for diabetes and hypertension in northern Thailand over a five-year period. A panel study was conducted from 2018 to 2022, covering 47 districts across five provinces in northern Thailand. Secondary data were obtained from the Ministry of Public Health databases and the National Health Security Office, including service coverage: Quality Care Bundle scores for diabetes (QCB-DM) and hypertension (QCB-HT), quality indicators: hospitalization rates for ambulatory care sensitive conditions for diabetes (ACSCs-DM) and hypertension (ACSCs-HT) and health outcomes: glycemic control (HbA1c < 7%). Generalized Estimating Equation (GEE) models were used to assess the relationship between COVID-19 case numbers and healthcare indicators. COVID-19 case numbers showed no statistically significant associations with QCB-DM and QCB-HT scores. ACSCs-HT decreased significantly (p < 0.001), whereas ACSCs-DM remained stable (p = 0.360). Glycemic control (HbA1c < 7%) significantly decreased during the pandemic period (p = 0.005). The findings suggest that adaptive healthcare strategies may help sustain continuity of chronic disease services during public health emergencies, although broader determinants of health should also be considered to optimize patient outcomes.
Keywords: Coverage, COVID-19, Diabetes Mellitus, Hypertension, Primary Care, Quality.