Abstract
BACKGROUND/OBJECTIVES: The COVID-19 pandemic presented unprecedented challenges to healthcare systems worldwide, significantly impacting individuals with chronic conditions who depend on continuous medical care. In Romania, the pandemic revealed systemic vulnerabilities, particularly in ensuring access to services for older adults and rural populations. This study aimed to assess perceived barriers to healthcare access and service quality among Romanian patients with chronic diseases and a confirmed history of COVID-19, within the framework of the country's multi-tiered healthcare system. METHODS: A cross-sectional study was conducted between January and March 2025, involving 16 adult participants diagnosed with at least one chronic illness. Data were collected using a 30-item questionnaire administered by the principal investigator after obtaining informed consent. The instrument explored access to services, challenges related to remote consultations, and satisfaction with nursing care. Descriptive and comparative analyses were carried out based on age group and area of residence. Due to the small sample size, the results are considered exploratory and context-specific. RESULTS: Most participants reported disrupted access to healthcare services, especially within public sector facilities. Rural residents experienced longer delays in receiving care than those in urban areas. Digital health tools were perceived as barriers by 75% of respondents aged 60 and above, while younger participants adapted more easily. Overall satisfaction with nursing care was moderate to high (mean score: 3.56/5), with the highest ratings observed among patients aged 30-60 years. CONCLUSIONS: This study highlights significant barriers to healthcare access among Romanian patients with chronic illnesses and a confirmed COVID-19 diagnosis during the pandemic. The key challenges included digital exclusion and rural-urban disparities. The findings underscore the need for targeted strategies to enhance digital health literacy, adapt care delivery models, and strengthen healthcare system resilience in future public health emergencies.