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Månsson Sandberg H, Tjulin Å, Brulin E, Landstad BJ. How general practitioners used job crafting strategies during the COVID-19 pandemic in Sweden. Scand J Prim Health Care 2024; 42:276-286. [PMID: 38315554 PMCID: PMC11003318 DOI: 10.1080/02813432.2024.2309633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE General practitioners (GPs) played a crucial role in limiting the impact of the COVID-19 pandemic, and many GPs experienced they did not have the prerequisites to provide adequate care. However, GPs developed approaches that helped them to provide care to patients through various job crafting strategies. The aim of this study is to identify how job crafting strategies were deployed by GPs at the beginning of the COVID-19 pandemic in Sweden and the significance of the strategies on their work situation. DESIGN A qualitative design with semi-structured interviews. The data was analysed using qualitative content analysis with job crafting as the conceptual framework for the analysis process. SETTING Primary healthcare in five healthcare regions in Sweden. SUBJECTS Fourteen GPs participated in individual interviews. RESULTS In their endeavours to organise and provide care, GPs shaped the task, relational and cognitive boundaries of their work. GPs felt proud about finding new ways of working when given room to manoeuvre. Intensified collaboration between healthcare professionals made GPs more confident in their clinical work. GPs expressed that they consequently felt stronger in their professional role through what they accomplished in the organisation of care. CONCLUSIONS/IMPLICATIONS The results suggest that the job crafting strategies GPs used were meaningful to them in clinical practice. Knowledge about how GPs' job crafting strategies were deployed might be useful for healthcare organisations in preparing for future health crises. Taking advantage of GPs' experiences and strategies is considered important for promoting sustainable working conditions for GPs in the future.
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Affiliation(s)
- Helena Månsson Sandberg
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Tjulin
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Emma Brulin
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bodil J. Landstad
- Faculty of Human Sciences, Mid Sweden University, Östersund, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
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Tureck F, Chioro A, Tofani LFN, Lima CL, Vieira ADCS, Andreazza R. Innovations produced in Primary Health Care during the COVID-19 pandemic: an integrative literature review. CIENCIA & SAUDE COLETIVA 2024; 29:e07022023. [PMID: 38896673 DOI: 10.1590/1413-81232024296.07022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 06/21/2024] Open
Abstract
Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to keep up its provision of regular services as well. This article identifies the main arrangements made to provide PHC care in the context of the COVID-19 pandemic. An integrative literature review of articles found in PubMed, SciELO and LILACS databases was performed using the descriptors "Primary Health Care" and "COVID-19". Findings were analyzed considering three questions: Information and Communication Technologies (ICT), Organizations of Work Processes and Non-COVID Chronic Diseases. The use of different forms of ICT to provide PHC is highlighted regarding patients with respiratory symptoms and chronic patients. Changes in team composition, service flows, physical spaces and working hours were also introduced. Although strategies aimed at monitoring chronic patients and at remote care may have helped minimize deterioration of their health, the decrease in the number of visits performed during this period could have resulted in an increased demand for PHC in post-pandemic years.
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Affiliation(s)
- Fernando Tureck
- Escola de Medicina, Universidade do Contestado. Av. Nereu Ramos 1071, Jardim do Moinho. 89300-000 Mafra SC Brasil.
| | - Arthur Chioro
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Luís Fernando Nogueira Tofani
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Carolina Loyelo Lima
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Amanda da Cruz Santos Vieira
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Rosemarie Andreazza
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
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Cao W, Li X, Yan Y, Zhou J, Ye J, Lv Q. Changes in sleep patterns in primary care workers during the first wave of the COVID-19 pandemic in 2022 in Shanghai: a cross-sectional study. Sci Rep 2024; 14:12373. [PMID: 38811616 PMCID: PMC11137069 DOI: 10.1038/s41598-024-61311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/03/2024] [Indexed: 05/31/2024] Open
Abstract
The coronavirus disease (COVID-19) pandemic has significantly affected the sleep health of healthcare workers (HCWs); however, no studies have assessed this effect in primary HCWs. This cross-sectional, web-based study explored the prevalence and factors associated with sleep disorders among primary HCWs during the first COVID-19 outbreak in Shanghai from 12 July to 15 August 2022. Sociodemographic and work-related characteristics, various sleep dimensions, and exposure to patients with COVID-19 were assessed. They were screened for common mental disorders (depression, burnout, and stress). Overall, 313 primary HCWs were recruited. At least one sleep dimension in 84% of respondents deteriorated compared with that observed pre-pandemic; sleep quality (decline of 66%) and daytime sleepiness (increase of 56%) were the most affected domains. After excluding 145 primary HCWs with pre-pandemic 'poor sleep', depression (odds ratio [OR] 3.08; 95% confidence interval [CI] 1.59-5.98), weekly burnout symptoms (OR 2.57; 95% CI 1.32-5.03), and high psychological stress (OR 4.51; 95% CI 2.09-9.72) were associated with poor sleep patterns during the pandemic. After adjusting for significant differences between groups, for every 1-point increase in the Perceived Stress Scale score, an associated 12% increased risk of poor sleep (adjusted OR 1.12; 95% CI 1.05-1.21; p = 0.002) was observed. Most primary HCWs showed significant worsening of sleep quality, with increases in daytime sleepiness during the first wave of the COVID-19 pandemic in Shanghai. HCWs with high stress levels were at greater risks of sleep disorders.
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Affiliation(s)
- Wenshu Cao
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Xiaoting Li
- Nanhui New Town Community Health Service Center of Pudong New Area, 280 Chaohe Road, Shanghai, China
| | - Yini Yan
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Jianfeng Zhou
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Jizhong Ye
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China.
| | - Qiwei Lv
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China.
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Fu S, Sima X, Duan L, Zeng Y, Fan C. Comparison of the quality of Nurse-Led palliative care with standard medical care during six months in 405 patients with Parkinson's disease and burdens of their Caregivers: A retrospective study at a single center in China. J Clin Neurosci 2024; 121:53-60. [PMID: 38359650 DOI: 10.1016/j.jocn.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Palliative care is mainly used to improve the quality of life of patients with chronic diseases by addressing their medical conditions and psychological problems. End-stage Parkinson's disease (PD) is also a progressive disease like cancer and could be managed by palliative care. This study was conducted at a single center in China and aimed to compare the quality of nurse-led palliative care with standard medical care during six months in 405 patients with Parkinson's disease (PPD) and their caregivers using the Chinese version of the 39-item Parkinson's Disease Questionnaire (PDQ-39) and the Chinese Zarit Burden Interview (ZBI) scale. METHODS PPD (stage 2-5) received nurse-led palliative care (NP cohort, 103 patients; 103 caregivers) or neurologist-led standard care (NS cohort, 134 patients; 134 caregivers), or primary care practitioner-led usual care (PS cohort, 168 patients; 168 caregivers) for six months. RESULTS Before the health professional-led care (BN), the PDQ-39 score of PPD was 68 (71-64) and their caregivers had 54.86 ± 7.64 a ZBI scale. After 6-months of the health professional-led care (AN), the PDQ-39 score of PPD and a ZBI scale of their caregivers decreased for the NP cohort as compared to those of BN condition and those of patients in the NS and PS cohorts at AN condition (p < 0.001 for all). CONCLUSIONS The quality of life of PPD must be improved and the burden on their caregivers must be relieved. Nurse-led palliative care successfully improved the quality of life of PPD and reduced their caregiver burden.
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Affiliation(s)
- Su Fu
- Neurological General Ward of West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiutian Sima
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Lijuan Duan
- Neurological General Ward of West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuping Zeng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Chaofeng Fan
- Neurological General Ward of West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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Wen Z, Xu J, Yu J, Huang X, Ni Y. Effects of work-family conflict on turnover intention among primary medical staff in Huaihai Economic Zone: a mediation model through burnout. Front Psychiatry 2023; 14:1238315. [PMID: 37817834 PMCID: PMC10561281 DOI: 10.3389/fpsyt.2023.1238315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
Background Countries worldwide face the challenge of how medical personnel manage conflicts between work and family. Especially after the challenge of the COVID-19 epidemic, it is necessary to explore the possible mechanisms of work-family conflict, burnout, and turnover intention among primary medical staff. Objectives This study aims to observe the turnover intention of Chinese primary medical staff and explore the relationship between work-family conflict, burnout, and turnover intention. Methods A cross-sectional study included a turnover intention questionnaire, the Maslach Burnout Inventory-General Survey (MBI-GS), and the Work-Family Conflict Scale (WFCS) to understand turnover intention, burnout, and work-family conflict among primary medical staff in four cities (Xuzhou, Linyi, Huaibei, and Shangqiu cities) within the Huaihai Economic Zone. Spearman correlation analysis and hierarchical multiple regression analysis were used to examine the related factors of turnover intention. Structural equation modeling (SEM) was used to study the mediating role of burnout between work-family conflict and turnover intention. Results In this study, there is a positive correlation between work-family conflict and turnover intention (P < 0.01). Demographic characteristics, work-family conflict, and burnout explained 2.3%, 20.3%, and 8.8% of the incremental variances, respectively. Burnout mediated the association between work-family conflict and turnover intention. Conclusions Burnout can be regarded as a mediator between two different variables: work-family conflict and turnover intention. Improving work-family conflict and alleviating burnout may play a key role in reducing the willingness of primary medical staff to resign. Corresponding measures can be taken to balance the conflict between work and family, alleviate burnout, reduce turnover rates, and build a primary medical staff team with higher medical service quality and stability.
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Affiliation(s)
- Zongliang Wen
- School of Management, Xuzhou Medical University, Xuzhou, China
- School of Public Health, Xuzhou Medical University, Xuzhou, China
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jintao Xu
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Jinxun Yu
- School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xiaojing Huang
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Yuting Ni
- School of Management, Xuzhou Medical University, Xuzhou, China
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Knutsen Glette M, Ludlow K, Wiig S, Bates DW, Austin EE. Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis. BMJ Open 2023; 13:e071828. [PMID: 37730402 PMCID: PMC10514639 DOI: 10.1136/bmjopen-2023-071828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify, review and synthesise qualitative literature on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic. DESIGN Systematic review with meta-synthesis. DATA SOURCES Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus. ELIGIBILITY CRITERIA Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis. RESULTS Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services. CONCLUSION Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals' experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.
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Affiliation(s)
- Malin Knutsen Glette
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Kristiana Ludlow
- Centre for Health Services Research, The University of Queensland School of Psychology, Saint Lucia, Queensland, Australia
| | - Siri Wiig
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - David Westfall Bates
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, New South Wales, Australia
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Shami E, Gholipour K, Naghibi D, Azami-Aghdash S. The roles and challenges of the primary health care systems in epidemic management: a scoping review. Prim Health Care Res Dev 2023; 24:e55. [PMID: 37705282 PMCID: PMC10539738 DOI: 10.1017/s1463423623000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND AIM During the early stage of pandemics, primary health care (PHC) is the first point of contact with the health system for people. This study aimed to find the leading roles and challenges of the PHC system in dealing with the outbreak of infectious diseases. METHODS The current scoping review was conducted in 2022 using the Arkesy and O'Malley framework. A bibliographic search was conducted in PubMed, Web of Science, and Scopus databases. Following a Google Scholar search, a manual search in some journals, reference checks for articles, and a review of organizational reports, websites, and other sources of information were also conducted. Data were analyzed using the content-analysis method. FINDINGS Finally, 65 documents (42 articles and 23 reports, books, and news) were included in the study. Initially, 626 codes were extracted, and 132 final codes were categorized into eight main themes and 44 sub-themes. The main themes for the roles of PHC included: service provision, education and knowledge, surveillance, access, coordination and communication, management and leadership, infrastructure change and rapid preparation, and patient and community management. Regarding the challenges faced by PHC in the epidemic of infectious diseases, 24 key challenges were identified and categorized into four major areas. CONCLUSIONS Based on the results of the present study, there is a need for further studies to formulate and theorize the specific roles of PHC in managing infectious disease epidemics. The results of this study can be utilized by researchers and officials to inform their efforts in addressing this purpose.
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Affiliation(s)
- Elham Shami
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Social Determinants of Health Research Center, Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Deniz Naghibi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Zhang HL, Wu C, Yan JR, Liu JH, Wang P, Hu MY, Liu F, Qu HM, Lang HJ. The relationship between role ambiguity, emotional exhaustion and work alienation among chinese nurses two years after COVID-19 pandemic: a cross-sectional study. BMC Psychiatry 2023; 23:516. [PMID: 37464335 DOI: 10.1186/s12888-023-04923-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/03/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND work alienation is receiving increasing attention as a psychological risk at work, and little is known about the mechanisms of role ambiguity and work alienation in nurses in the context of the COVID-19 pandemic. This article aims to examine how role ambiguity affects work alienation among Chinese nurses during the two years after COVID-19 pandemic and verify emotional exhaustion as mediators. METHODS A cross-sectional study design was used to recruit 281 Chinese nurses. Nurses completed online questionnaires containing demographic characteristics, role ambiguity, emotional exhaustion, and work alienation, and SPSS 26.0 and AMOS 24.0 were used for data analysis and structural equation modelling. RESULTS work alienation scores were (34.64 ± 10.09), work alienation was correlated with role ambiguity and emotional exhaustion (r1 = 0.521, r2 = 0.755; p < .01), and role ambiguity was positively correlated with emotional exhaustion (r = 0.512; p < .01). A mediating effect of emotional exhaustion between role ambiguity and work alienation held (mediating effect of 0.288, 95% CI: 0.221-0.369, accounting for 74.8% of the total effect). CONCLUSION Role ambiguity has a significant direct effect on nurses' feelings of alienation and exacerbates alienation through emotional exhaustion. Clarifying roles at work and being less emotionally drained are effective ways to reduce nurses' feelings of alienation.
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Affiliation(s)
- Hong-Li Zhang
- School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Chao Wu
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Jia-Ran Yan
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Jun-Hua Liu
- Department of Nursing, Qufu Traditional Chinese Medicine Hospital, Shandong, China
| | - Pei Wang
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Meng-Yi Hu
- School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Fang Liu
- School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Huan-Min Qu
- Human Resources Department, Tangdu Hospital, Air Force Medical University, Shaanxi, 710032, Xian, China.
| | - Hong-Juan Lang
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Liang X, Yan M, Li H, Deng Z, Lu Y, Lu P, Cai S, Li W, Fang L, Xu Z. WeChat official accounts' posts on medication use of 251 community healthcare centers in Shanghai, China: content analysis and quality assessment. Front Med (Lausanne) 2023; 10:1155428. [PMID: 37378298 PMCID: PMC10291264 DOI: 10.3389/fmed.2023.1155428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Background The dissemination of online health information (OHI) on medication use via WeChat Official Accounts (WOAs) is an effective way to help primary care practitioners (PCPs) address drug-related problems (DRPs) in the community. Although an increasing number of primary care institutions in China have published WOA posts on medication use, their content and quality have not yet been assessed. Objective This study aimed to explore the general features and content of WOA posts on medication use published by community healthcare centers (CHCs) in Shanghai, China and to assess their quality of content. It also aimed to explore the factors associated with the number of post views. Methods From June 1 to October 31, 2022, two coauthors independently screened WOA posts on medication use published throughout 2021 by the CHCs in Shanghai. Content analysis was performed to analyze their general features (format, length, and source, etc.) and content (types of medicines and diseases). The QUEST tool was used to assess the quality of the posts. We compared the differences among posts published by CHCs in central urban areas and suburban areas, and used multiple linear regression to explore the factors associated with the number of post views. Results A total of 236 WOAs of interest published 37,147 posts in 2021, and 275 (0.74%) of them were included in the study. The median number of post views was 152. Thirty percent of the posts were reviewed by the CHCs' staff before publication and only 6% provided information on PCPs' consultations. The most commonly mentioned medicines and diseases in the posts were Chinese patent medicines (37.1%) and respiratory diseases (29.5%). The posts frequently provided information on indications (77%) and usage (56%) but rarely on follow-up (13%) and storage (11%). Of the posts, 94.9% had a total QUEST score < 17 (full score = 28). The median number of post views and total post quality scores did not significantly differ among the CHCs in central urban and suburban areas. In the multiple linear regression model, the number of post views was associated with scores of complementarity (B = 56.47, 95% CI 3.05, 109.89) and conflict of interest (B = -46.40, 95% CI -56.21, -36.60). Conclusion The quantity and quality of WOA posts on medication use published by CHCs in China need improvement. The quality of posts may partially impact the dissemination effect, but intrinsic causal associations merit further exploration.
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Affiliation(s)
- Xujian Liang
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ming Yan
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haixin Li
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhiling Deng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yiting Lu
- Department of General Practice, Tongji University School of Medicine, Shanghai, China
| | - Panpan Lu
- Department of General Practice, Taizhou Municipal Hospital, Taizhou, China
| | - Songtao Cai
- Department of General Practice, Longgang District People’s Hospital of Shenzhen, Shenzhen, China
| | - Wanchao Li
- LinCheng Health Center of Changxing County, Huzhou, China
| | - Lizheng Fang
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Yang C, Wang X, Zhang X, Liu W, Wang C. Burnout and associative emotional status and coping style of healthcare workers in COVID-19 epidemic control: A cross-sectional study. Front Public Health 2023; 11:1079383. [PMID: 36969660 PMCID: PMC10034002 DOI: 10.3389/fpubh.2023.1079383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectiveThe aim of this study was to evaluate the prevalence of burnout, clinical anxiety, depression, and insomnia and to estimate the associations of adverse emotional status, coping style, and level of self-efficacy with burnout of healthcare workers in the Shenzhen Longgang District Frontline District Headquarters of COVID-19 epidemic control, China.MethodsIn this cross-sectional study, 173 staff completed the anonymous questionnaires of the Maslach Burnout Inventory, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), Insomnia Severity Index (ISI), General Self-efficacy Scale, and Simplified Coping Style Questionnaire electronically (https://www.wjx.cn/) in June 2022. Hierarchical logistic regression was used to explore the associated factors of burnout in this study.ResultsThe prevalence of burnout in our participants (defined as high emotional exhaustion or high depersonalization) was 47.40%, and reduced personal accomplishment was 92.49%. The prevalence of clinically significant depression (the cutoff score of ≥15), anxiety (the cutoff score of ≥10), and insomnia (the cutoff score of ≥15) was 11.56, 19.08, and 19.08%, respectively. There was a degree of overlap between burnout and other measures of adverse mental status, most notably for anxiety (odds ratio, 27.049; 95% CI, 6.125–117.732; p < 0.001). Hierarchical logistic regression demonstrated that burnout was strongly associated with anxiety (OR = 23.889; 95% CI, 5.216–109.414; p < 0.001) and negative coping style (OR = 1.869; 95% CI, 1.278–2.921; p < 0.01) independently.ConclusionMedical staff involved in COVID-19 epidemic control in the post-epidemic era were at high risk of burnout, and most of them were in low personal accomplishment. Reducing anxiety and improving coping style by medical management institutions from the system level may be effective in alleviating burnout in healthcare workers.
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Başer DA, Döner Güner P, Gümüştakım RŞ, Agadayi E, Aksoy H, Fidancı İ. The experiences and thoughts of Turkish family physicians about COVID-19 pandemic: A qualitative study. Eur J Gen Pract 2023:2169270. [PMID: 36786197 DOI: 10.1080/13814788.2023.2169270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Efforts to contain the SARS-CoV-2 virus would fall short without strong primary health care. OBJECTIVES In this study, we aimed to determine the experiences, views and suggestions of family physicians regarding their roles, primary care health systems' preparedness and the challenges/needs for a better organisation during the pandemic via in-depth exploration. METHODS Twenty-one family physicians working in different cities of Turkey participated in semi-structured interviews between 15/08/2020-21/01/2021. Convenience sampling was used. We did this qualitative study through interviews by telephone. Participants were asked seven open-ended questions. Thematic analysis was used, which included reading the transcript, identifying significant phrases and formulating meanings and validating meanings through research team discussions to reach consensus, identifying themes. RESULTS Ten of the participants were female and the average age of the participants was 39.5 (SD = 10.5) years. Twelve of the family physicians are specialists in family medicine. Four themes were identified: role of primary care in the pandemic, pandemic preparedness of primary care, challenges of working in primary care centres during the COVID-19 pandemics, and approaches to future pandemics. CONCLUSION Our study showed that, despite unprepared primary care and undefined roles of family physicians in pandemic planning, family physicians played a significant role in pandemic management.
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Affiliation(s)
- Duygu Ayhan Başer
- Department of Family Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Pınar Döner Güner
- Department of Family Medicine, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Raziye Şule Gümüştakım
- Department of Family Medicine, School of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Ezgi Agadayi
- Department of Medical Education, Sivas Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Hilal Aksoy
- Department of Family Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - İzzet Fidancı
- Department of Family Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Aslanyan L, Arakelyan Z, Atanyan A, Abrahamyan A, Karapetyan M, Sahakyan S. Primary healthcare providers challenged during the COVID-19 pandemic: a qualitative study. BMC PRIMARY CARE 2022; 23:310. [PMID: 36463103 PMCID: PMC9719166 DOI: 10.1186/s12875-022-01923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and long-lasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers' experiences with coronavirus pandemic preparedness and response in Armenia. METHODS We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the "SPSS22.0.0.0" software. RESULTS Five main themes of primary healthcare providers' experiences were drawn out based on the study findings: 1) the gap in providers' risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers' experiences during the pandemic. The study highlighted the health systems' unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers' behalf. CONCLUSION The study discovered that PHC providers have a very important role in healthcare system's preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment.
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Affiliation(s)
- Lusine Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Zaruhi Arakelyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Astghik Atanyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Arpine Abrahamyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Manya Karapetyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
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Taylor MK, Kinder K, George J, Bazemore A, Mannie C, Phillips R, Strydom S, Goodyear-Smith F. Multinational primary health care experiences from the initial wave of the COVID-19 pandemic: A qualitative analysis. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100041. [PMID: 35043104 PMCID: PMC8755427 DOI: 10.1016/j.ssmqr.2022.100041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/29/2021] [Accepted: 01/08/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To learn from primary health care experts' experiences from the COVID-19 pandemic across countries. METHODS We applied qualitative thematic analysis to open-text responses from a multinational rapid response survey of primary health care experts assessing response to the initial wave of the COVID-19 pandemic. RESULTS Respondents' comments focused on three main areas of primary health care response directly influenced by the pandemic: 1) impact on the primary care workforce, including task-shifting responsibilities outside clinician specialty and changes in scope of work, financial strains on practices, and the daily uncertainties and stress of a constantly evolving situation; 2) impact on patient care delivery, both essential care for COVID-19 cases and the non-essential care that was neglected or postponed; 3) and the shift to using new technologies. CONCLUSIONS Primary health care experiences with the COVID-19 pandemic across the globe were similar in their levels of workforce stress, rapid technologic adaptation, and need to pivot delivery strategies, often at the expense of routine care.
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Affiliation(s)
- Melina K. Taylor
- American Board of Family Medicine, 1648 McGrathiana Parkway Suite 550, Lexington, KY, 40511, USA,Corresponding author. American Board of Family Medicine, Lexington, KY, USA
| | - Karen Kinder
- Technische Universität Berlin, Fachgebiet Management im Gesundheitswesen, Straße des 17, Juni 135, H80, 10623, Berlin, Germany
| | - Joe George
- Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Andrew Bazemore
- American Board of Family Medicine, 1648 McGrathiana Parkway Suite 550, Lexington, KY, 40511, USA,Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Cristina Mannie
- Mast Analytics, 4th Floor, Sunclare Building, 21 Dreyer Street, Claremont, 7708, South Africa,Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
| | - Robert Phillips
- Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Stefan Strydom
- Mast Analytics, 4th Floor, Sunclare Building, 21 Dreyer Street, Claremont, 7708, South Africa,Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
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14
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Burn E, Smith J, Fisher R, Locock L, Shires K. Practising in a pandemic: A real time study of primary care practitioners' experience of working through the first year of COVID-19. FRONTIERS IN SOCIOLOGY 2022; 7:959222. [PMID: 36276432 PMCID: PMC9582286 DOI: 10.3389/fsoc.2022.959222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
This article presents reflections on the lessons learnt from developing and initiating a rapid research project in 4 weeks during the first year of the COVID-19 pandemic. The article highlights the importance of selecting methods appropriate to rapid research, discusses the challenges of data collection in a shifting context, and the importance of the research team being prepared to cede some degree of control over the data collection process. To protect staff and patients and prevent the spread of COVID-19, general practice shifted to remote service delivery and consultations occurred via the telephone or online platforms. In the study, submissions were collected from those working in general practice to capture their experiences of the first year of the COVID-19 pandemic. Participants could choose how to submit their narratives, with some preferring to be interviewed and others contributing self-recorded submissions. This article offers practical reflections in response to the challenges of carrying out rapid research during a pandemic, including the importance of constructing a research team which can respond to the demands of the study, as well as the benefits of an expedited ethical review process. The study highlighted the importance of selecting appropriate methods to facilitate the rapid collection of data. In particular, the authors reflect on the differences between participants' response to interviews, written submissions, and audio diaries. Open approaches to data collection were found to encourage participation and reflexivity and also generated rich narrative accounts. Rapid research has progressed our understanding of general practice's experience of the first year of COVID-19.
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Affiliation(s)
- Emily Burn
- Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
| | - Judith Smith
- Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
| | | | - Louise Locock
- Heath Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
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15
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Chen K, Li Z, Liu R, Zhu Y, Yan W, Pui NAP, Chen Z. Distribution of health problems at the general outpatients' clinic of the University of Hong Kong-Shenzhen Hospital: A cross-sectional study. Front Public Health 2022; 10:889819. [PMID: 36003636 PMCID: PMC9393786 DOI: 10.3389/fpubh.2022.889819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe study aimed to understand the distribution of health problems of a general practice clinic to provide guidance on how to develop primary care in Shenzhen, China.Study designThis is a cross-sectional study.MethodsPatients' sociodemographic data and diagnoses were recorded from the electronic medical record system of the University of Hong Kong-Shenzhen Hospital from Jan 2014 to Dec 2020 and coded using the International Classification of Primary Care-2. Descriptive statistics were used to describe the distribution of health problems.ResultsA total of 368,167 health problems were recorded. Respiratory, digestive, musculoskeletal, general, and cardiovascular were the top five categories, which accounted for 67.71% of the total in this study. Acute upper respiratory tract infection (AURTI) was the most common health problem (6.67%). Chronic diseases, including hypertension and diabetes mellitus, accounted for about 7% of all health problems. The proportion of cardiovascular problems increased significantly with age (r = 0.96, P < 0.05). The proportion of consultations for mental health problems was low in all age groups.ConclusionsThe results represent an understanding of the common health problems of patients in Shenzhen city, which can provide a reference for preventing diseases and developing primary care.
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Affiliation(s)
- Kai Chen
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Zhuo Li
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
- *Correspondence: Zhuo Li
| | - Ruihong Liu
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Yanyan Zhu
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Weihui Yan
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Ng Amy Pui Pui
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Shenzhen, China
| | - Zhiyuan Chen
- Department of General Practice, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
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16
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A longitudinal qualitative study of the UK general practice workforce experience of COVID-19. Prim Health Care Res Dev 2022; 23:e45. [PMID: 35924721 PMCID: PMC9381165 DOI: 10.1017/s1463423622000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The COronaVIrus Disease 2019 (COVID-19) pandemic has led to significant re-organisation of general practice in the United Kingdom and around the world. The general practice workforce has led changes to their services, often dealing with high levels of uncertainty. The way in which many practitioners consult has shifted significantly, and there has been an increase in the number of phone and online consultations. We know very little about how those working in general practice experienced the service reorganisation introduced in the first year of the COVID-19 pandemic. Aim: The aim of this project was to describe the changes in the delivery of general practice in the United Kingdom in the first year of the COVID-19 pandemic. Furthermore, to explore primary care practitioners’ and managers’ experiences of change within general practice during this time and investigate shifts in perceptions of professional identities. Method: We conducted a longitudinal qualitative study that captured narrative accounts from 17 primary care practitioners and managers across England and Scotland. Each participant submitted narrative accounts in the first year of the COVID-19 pandemic using self-recorded or written contributions, or via an interview if preferred. These were analysed using a grounded theory approach, with thematic coding used to construct common themes. Findings: Participants’ narratives describe the challenges COVID-19 presented to general practice. Responses mirror the shifts in the pandemic and its management – from an initial sense of autonomy but uncertainty, to a period of stability and patients’ increasing frustration. The re-organisation of general practice has affected practitioners’ views of their work and their role as clinicians. Participants’ narratives were framed profoundly by the importance of their relationships with patients. This analysis of practitioners’ and managers’ narratives highlights the need for further exploration of how to support the general practice workforce’s well-being longer term in a context of increased demand and significant change.
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17
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Li J, Zhao N, Zhang H, Yang H, Yang J. Roles and Challenges for Village Doctors in COVID-19 Pandemic Prevention and Control in Rural Beijing, China: A Qualitative Study. Front Public Health 2022; 10:888374. [PMID: 35844871 PMCID: PMC9277090 DOI: 10.3389/fpubh.2022.888374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Rural areas in China are more vulnerable to COVID-19 pandemic than urban areas, due to their far fewer health care resources. Village doctors, as rural grassroots health workers in China, have been actively engaged in the pandemic prevention and control. This study aims to describe the roles of village doctors in rural China, and the challenges they have faced during the prevention and control of the COVID-19 pandemic. Setting This study was conducted in three towns in Huairou District, Beijing, China. Design We carried out semi-structured interviews with 75 key informants. All the interviews were audio-recorded and transcribed verbatim. We employed thematic analysis to define themes and sub-themes from the qualitative data. Results We reported four themes. First, the village doctor guided the village committee to carry out decontamination, monitored home-isolated residents, and disseminated knowledge on prevention of the COVID-19 pandemic during the rural pandemic prevention and control. Second, they took pandemic prevention measures in village clinics, distributed pandemic prevention materials, and undertook pre-screening triage. Third, village doctors provided basic medical care, including treatment of common diseases as well as the purchase and delivery of medicines to villagers. Fourth, village doctors faced difficulties and challenges, such as inadequate medical skills, aging staff structure, and lack of pandemic prevention materials. Conclusions Despite many difficulties and challenges, village doctors have actively participated in rural pandemic prevention and control, and made outstanding contributions to curbing spread of COVID-19 pandemic in rural areas. Village doctors provide basic health care while participating in various non-medical tasks.
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Affiliation(s)
- Jin Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Ning Zhao
- School of Public Health, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Health Education, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Hui Yang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, China
- *Correspondence: Jia Yang
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Eyayu M, Motbainor A, Gizachew B. Practices and associated factors of infection prevention of nurses working in public and private hospitals toward COVID-19 in Bahir Dar City, Northwest Ethiopia: Institution-based cross-sectional study. SAGE Open Med 2022; 10:20503121221098238. [PMID: 35646356 PMCID: PMC9130809 DOI: 10.1177/20503121221098238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/14/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the levels of practices and associated factors of infection prevention of nurses working in public and private hospitals toward coronavirus 2019 (COVID-19) in Bahir Dar City, Ethiopia. Methods Institution-based cross-sectional study design employed in public and private hospitals in Bahir Dar city from 26 March 2021 to 8 April 2021. A total of 442 study participants were recruited using stratified followed by simple random sampling techniques. A self-administered questionnaire was prepared and pretested on 5% of the total sample. The collected data were checked for completeness and consistency, and then the data were coded, entered, and cleaned with SPSS version 25 software. Descriptive statistics were carried out to display the means and proportions of sociodemographic characteristics. Logistic regression analysis was used to assess the association between the level of prevention practices and the independent variables. An adjusted odds ratio with 95% confidence interval was used to report the results. A significant association was set at p-value <0.05. Results Of the total 442 samples, 431 (with response rate of 97.5%) answered the questions completely. The mean (±standard deviation) age of the participants was 29.33 (±5.62) years and 217 (50.3%) were females. The proportion of good prevention practices of nurses toward COVID-19 was 39.4% (95% confidence interval: 35%-44%). Female (adjusted odds ratio = 1.77, 95% confidence interval: 1.18-2.68), have training on COVID-19 (adjusted odds ratio = 1.65, 95% confidence interval: 1.10-2.48), personal protective equipment access (adjusted odds ratio = 1.57, 95% confidence interval: 1.01-2.44), availability of infection prevention guideline (adjusted odds ratio = 1.63, 95% confidence interval: 1.06-2.49), and favorable attitude (adjusted odds ratio = 2.05, 95% confidence interval: 1.25-3.36) were factors significantly associated with good infection prevention practices. Conclusion Most nurses in Bahir Dar City public and private hospitals had poor prevention practices against COVID-19. Training provision, infection prevention guidelines distribution, sustainable personal protective equipment access, and promotion to change their attitudes are intervention areas that required emphasis.
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Affiliation(s)
| | - Achenef Motbainor
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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19
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Jefferson L, Golder S, Heathcote C, Avila AC, Dale V, Essex H, van der Feltz Cornelis C, McHugh E, Moe-Byrne T, Bloor K. GP wellbeing during the COVID-19 pandemic: a systematic review. Br J Gen Pract 2022; 72:e325-e333. [PMID: 35314428 PMCID: PMC8966782 DOI: 10.3399/bjgp.2021.0680] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/31/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Doctors' organisations in the UK have reported worrying levels of work-related stress and burnout in the GP workforce for some time, and the COVID-19 pandemic has presented clear new challenges. AIM To synthesise international evidence exploring the impact of COVID-19 on primary care doctors' mental health and wellbeing, and identify risk factors associated with their psychological wellbeing during this time. DESIGN AND SETTING Mixed-methods systematic review. METHOD Six bibliographic databases, Google Scholar, and MedRxiv were searched on 19 November 2020 and 3 June 2021 to identify studies of GP psychological wellbeing during the pandemic. Reference checking was also conducted. Two reviewers selected studies, extracted data, and assessed the quality of studies using standardised tools. Heterogeneity in outcomes, setting, and design prohibited statistical pooling; studies were combined using a convergent integrated thematic synthesis. RESULTS Thirty-one studies were included. Multiple sources of stress were identified including changed working practices; risk, exposure, and inadequate personal protective equipment (PPE); information overload; pandemic preparedness; and cohesion across sectors. Studies demonstrated an impact on psychological wellbeing, with some GPs experiencing stress, burnout, anxiety, depression, fear of COVID-19, lower job satisfaction, and physical symptoms. Studies reported gender and age differences: women GPs had poorer psychological outcomes across all domains, and older GPs reported greater stress and burnout. Use of outcome measures and reporting practice varied greatly. CONCLUSION This review of international evidence demonstrates that the COVID-19 pandemic has adversely affected GPs' wellbeing around the world. Further research could explore gender and age differences, identifying interventions targeted to these groups.
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Affiliation(s)
| | - Su Golder
- Department of Health Sciences, University of York, York
| | | | | | - Veronica Dale
- Department of Health Sciences, University of York, York
| | - Holly Essex
- Department of Health Sciences, University of York, York
| | | | | | | | - Karen Bloor
- Department of Health Sciences, University of York, York
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Jackson C, Manley K, Webster J, Hardy S. A thematic analysis of system wide learning from first wave Covid-19 in the East of England. BMC Health Serv Res 2022; 22:552. [PMID: 35468767 PMCID: PMC9037583 DOI: 10.1186/s12913-022-07797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background The Covid-19 pandemic has created an unprecedented challenge for health and social care systems globally. There is an urgent need for research on experiences of COVID-19 at different levels of health systems, including lessons from professional, organisational and local system responses, that can be used to inform managerial and policy responses. Methods This paper presents the findings from a thematic analysis of front-line staff experiences working across the Norfolk and Waveney integrated care system (ICS) in the East of England during April and October 2020 to address the question “What are the experiences and perceptions of partner organisations and practitioners at multiple levels of the health system in responding to COVID-19 during the first wave of the pandemic?” This question was posed to learn from how practitioners, interdependent partner organisations and the system experienced the pandemic and responded. 176 interview transcripts derived from one to one and focus group interviews, meeting notes and feedback from a “We Care Together” Instagram campaign were submitted for qualitative thematic analysis to an external research team at a regional University commissioned to undertake an independent evaluation. Three phases of qualitative analysis were systematically undertaken to derive the findings. Findings Thirty-one themes were distilled highlighting lessons learned from things that went well compared with those that did not; challenges compared with the celebrations and outcomes; learning and insights gained; impact on role; and system headlines. The analysis supported the ICS to inform and capitalise on system wide learning for integration, improvement and innovations in patient and care home resident safety, and staff wellbeing to deal with successive waves of the pandemic as well as prioritising workforce development priorities as part of its People Plan. Conclusions The findings contribute to a growing body of knowledge about what impact the pandemic has had on health and social care systems and front-line practitioners globally. It is important to understand the impact at all three levels of the system (micro, meso and macro) as it is the meso and macro system levels that ultimately impact front line staff experiences and the ability to deliver person centered safe and effective care in any context. The paper presents implications for future workforce and health services policy, practice innovation and research. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07797-7.
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Affiliation(s)
- Carolyn Jackson
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR7 4TJ, UK.
| | - Kim Manley
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR7 4TJ, UK
| | - Jonathan Webster
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR7 4TJ, UK
| | - Sally Hardy
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR7 4TJ, UK
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21
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Early Nurse Management Experiences from Finnish COVID-19 Hubs: An In-Action Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084885. [PMID: 35457757 PMCID: PMC9031167 DOI: 10.3390/ijerph19084885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
Primary healthcare (PHC) clinics are the point of access for many COVID-19 patients; however, the focus of crisis response work has been in securing hospital capacities. The purpose of this study was to describe the early nurse management experiences from PHC clinics within Greater Helsinki dedicated to caring for all ambulatory patients with possible COVID-19 symptoms. The study objectives were to make PHC crisis response contributions known and to provide an in-action review (IAR) of crisis response efforts. Nurse managers from the four COVID-19 hubs in Greater Helsinki were interviewed using thematic pair interviews. The data were analyzed inductively using thematic analysis, by which four main themes emerged: (1) capacity development led to a state of flux, (2) infection prevention control (IPC) was critical, (3) management of staff was essential in facilitating crisis response, and (4) respondents’ personal experiences. The state of flux stressed the provision of PHC services, but quick developments in telemedicine eased that burden. Conversation surrounding IPC was extensive, though discrepancies suggest that global efforts to standardize IPC practices must begin locally. Leadership was adjusted to accommodate for the crisis, especially regarding the motivation of staff. A vision to aspire toward in crisis recovery is needed.
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22
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Chemali S, Mari-Sáez A, El Bcheraoui C, Weishaar H. Health care workers' experiences during the COVID-19 pandemic: a scoping review. HUMAN RESOURCES FOR HEALTH 2022; 20:27. [PMID: 35331261 PMCID: PMC8943506 DOI: 10.1186/s12960-022-00724-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/09/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers' (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs' experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included. RESULTS 161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs' well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs' personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs' experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs' experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries. DISCUSSION This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs' experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs' circumstances. CONCLUSIONS Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.
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Affiliation(s)
- Souaad Chemali
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Almudena Mari-Sáez
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
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Russell A, de Wildt G, Grut M, Greenfield S, Clarke J. What can general practice learn from primary care nurses' and healthcare assistants' experiences of the COVID-19 pandemic? A qualitative study. BMJ Open 2022; 12:e055955. [PMID: 35292497 PMCID: PMC8927928 DOI: 10.1136/bmjopen-2021-055955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES UK general practice has radically altered in response to COVID-19. The general practice nursing team has been central to these changes. To help learn from COVID-19 and maintain a sustainable nursing workforce, general practice should reflect on their support needs and perceptions of organisational strategies. This study aimed to explore primary care nurses' and healthcare assistants' experiences and perceptions of general practice, and the changes made to it, during the pandemic. DESIGN Exploratory qualitative study using semistructured interviews. Interview data were analysed using Braun and Clarke's 'codebook' thematic analysis. SETTING General practices in the Midlands, South East and South West England. Interviews were conducted in February and March 2021, as England began to unlock from its third national lockdown. PARTICIPANTS Practice nurses (n=12), healthcare assistants (n=7), advanced nurse practitioners (n=4) and nursing associates (n=1) recruited using convenience and snowball sampling. RESULTS Three themes were identified. Difficult changes describes dramatic changes made to general practice at the onset of the pandemic, creating confusion and anxiety. Dealing with change characterises how negative emotions were intensified by fear of infection, problematic government guidance, personal protective equipment (PPE) shortages and friction with doctors; but could be mitigated through effective practice communication, peer support and individual coping strategies. An opportunity for improvement highlights certain changes (eg, the increased use of telehealth) that participants believed could be adopted long term to improve efficiency. CONCLUSION General practice should learn from the COVID-19 pandemic to nurture the clinical role and resilience of nurses and healthcare assistants in the postpandemic 'new normal'. Robust PPE provision could enable them to undertake their patient-facing duties safely and confidently. Judicious implementation of telehealth could help preserve the practical and caring nature of nursing. Improving channels of communication and interprofessional collaboration could help realise their potential within the primary care team.
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Affiliation(s)
- Alice Russell
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Gilles de Wildt
- Institute of Clinical Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Minka Grut
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
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Couper I, Walters L, Williams S, Campbell D, White I, Stewart R, Konkin J. Exploring rural doctors’ early experiences of coping with the emerging COVID‐19 pandemic. J Rural Health 2022; 38:923-931. [PMID: 35191080 PMCID: PMC9115214 DOI: 10.1111/jrh.12654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose To understand how rural doctors (physicians) responded to the emerging COVID‐19 pandemic and their strategies for coping. Methods Early in the pandemic doctors (physicians) who practise rural and remote medicine were invited to participate through existing rural doctors’ networks. Thirteen semi‐structured interviews were conducted with rural doctors from 11 countries. Interviews were transcribed verbatim and coded using NVivo. A thematic analysis was used to identify common ideas and narratives. Findings Participants’ accounts described highly adaptable and resourceful responses to address the crisis. Rapid changes to organizational and clinical practices were implemented, at a time of uncertainty, anxiety, and fear, and with limited information and resources. Strong relationships and commitment to their colleagues and communities were integral to shaping and sustaining these doctors’ responses. We identified five common themes underpinning rural doctors’ shared experiences: (1) caring for patients in a context of uncertainty, fear, and anxiety; (2) practical solutions through improvising and being resourceful; (3) gaining community trust and cooperation; (4) adapting to unrelenting pressures; and (5) reaffirming commitments. These themes are discussed in relation to the Lazarus and Folkman stress and coping model. Conclusions With limited resources and support, these rural doctors’ practical responses to the COVID‐19 crisis underscore strong problem‐focused coping strategies and shared commitments to their communities, patients, and colleagues. They drew support from sharing experiences with peers (emotion‐focused coping) and finding positive meanings in their experiences (meaning‐based coping). The psychosocial impact on rural doctors working at the limits of their adaptive resources is an ongoing concern.
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Affiliation(s)
- Ian Couper
- Ukwanda Centre for Rural Health Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa
| | - Lucie Walters
- Adelaide Rural Clinical School Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia
| | - Susan Williams
- Adelaide Rural Clinical School Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia
| | - David Campbell
- Australian College of Rural and Remote Medicine Brisbane Queensland Australia
- Cunninghame Arm Medical Centre Lakes Entrance Victoria Australia
| | - Isabella White
- Adelaide Rural Clinical School Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia
| | - Ruth Stewart
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Jill Konkin
- Department of Family Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada
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Bello K, De Lepeleire J, Agossou C, Apers L, Zannou DM, Criel B. Lessons Learnt From the Experiences of Primary Care Physicians Facing COVID-19 in Benin: A Mixed-Methods Study. FRONTIERS IN HEALTH SERVICES 2022; 2:843058. [PMID: 36925823 PMCID: PMC10012796 DOI: 10.3389/frhs.2022.843058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022]
Abstract
Introduction In sub-Saharan Africa, there is a need to better understand and guide the practice of primary care physicians (PCPs), especially in a crisis context like the COVID-19 pandemic. This study analyses the experiences of PCPs facing COVID-19 in Benin and draws policy lessons. Methods The study followed a fully mixed sequential dominant status design. Data were collected between April and August 2020 from a sample of PCPs in Benin. We performed descriptive analyses on the quantitative data. We also performed bivariate analyses for testing associations between various outcomes and the public/private status of the PCPs, their localization within or outside the cordon sanitaire put in place at the beginning of COVID-19, and their practice' category. A thematic content analysis was done on qualitative data. Results from both analyses were triangulated. Results Ninety PCPs participated in the quantitative strand, and 14 in the qualitative. The median percentage of the COVID-19 control measures implemented in the health facilities, as reported by the PCPs, was 77.8% (interquartile range = 16.7%), with no difference between the various groups. While 29.4% of the PCPs reported being poorly/not capable of helping the communities to deal with COVID-19, 45.3% felt poorly/not confident in dealing with an actual case. These percentages were bigger in the private sector. The PCP's experiences were marked by anxiety and fear, with 80.2% reporting stress. Many PCPs (74.1%) reported not receiving support from local health authorities, and 75.3% felt their concerns were not adequately addressed. Both percentages were higher in the private sector. The PCPs especially complained of insufficient training, insufficient coordination, and less support to private providers than the public ones. For 72.4 and 79.3% of the PCPs, respectively, the pandemic impacted services utilization and daily work. There were negative impacts (like a decrease in the services utilization or the quality of care), but also positive ones (like improved compliance to hygiene measures and new opportunities). Conclusion Our study highlighted the need for more structured support to PCPs for optimizing their contribution to epidemics control and good primary healthcare in Benin. Efforts in this direction can build on several good practices and opportunities.
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Affiliation(s)
- Kéfilath Bello
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Public Health and Primary Care, General Practice, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, General Practice, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Christian Agossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Ludwig Apers
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Idriss S, Aldhuhayyan A, Alanazi AA, Alasaadi W, Alharbi R, Alshahwan G, Baitalmal M, Alonazi W. Physicians’ Perceptions of Telemedicine Use During the COVID-19 Pandemic in Riyadh, Saudi Arabia: Cross-sectional Study (Preprint). JMIR Form Res 2021; 6:e36029. [PMID: 35714293 PMCID: PMC9278404 DOI: 10.2196/36029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/15/2022] [Accepted: 06/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
| | | | | | - Walaa Alasaadi
- Health Administration Department, King Saud University, College of Business, Riyadh, Saudi Arabia
| | - Reem Alharbi
- Home Healthcare Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ghadah Alshahwan
- Home Healthcare Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad Baitalmal
- Quantitative Analysis Department, King Saud University, College of Business Administration, Riyadh, Saudi Arabia
| | - Wadi Alonazi
- Health Administration Department, King Saud University, College of Business Administration, Riyadh, Saudi Arabia
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Reford E, Kellner CP. Stroke and COVID-19: The Value of Narrative Medicine. Stroke 2021; 53:e104-e107. [PMID: 34937421 PMCID: PMC8884129 DOI: 10.1161/strokeaha.121.037003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Stroke and COVID-19 are both traumatic and life-altering experiences that are marked by uncertainty, fear, and medical intervention. The devastation that stroke and COVID-19 oppress on an individual and a population is well established, and these traumas are potently magnified in the troughs of the COVID-19 pandemic. Furthermore, stroke has been shown to be a potential complication of COVID-19 infection, and while there is global controversy regarding this finding, it is undeniable that there are patients across the world presenting with both conditions concurrently. Thus, the topic of isolated stroke and the co-occurrence of stroke and COVID-19 amidst the pandemic both warrant considerable investigation on both a basic science level and a humanistic level. This opinion article advocates for a narrative medicine approach to better explicate the intertwining of stroke and COVID-19. Interviewing patients who presented with both stroke and COVID-19 as well as patients who present with stroke during the pandemic will provide the opportunity to gather and juxtapose individual illness experiences, including encounters with the health care system, relationship with care teams and care takers, recovery, and insights into the future. Creating, analyzing, and comparing such an anthology of illness narratives of the 2 patient populations will offer a unique understanding into the experience of different, yet over-lapping, medical traumas in an unprecedented time. With this deeper appreciation of patient accounts, the health care system can better recognize how to provide for future patients who present specifically with stroke or stroke and COVID-19. However, more broadly, this study can also afford insight into how the health care system can better provide for and support patients who present with complex diagnoses in the context of a complex healthcare system, which most probably will operate under the effects of the pandemic for time to come as well as other, future complicating factors.
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Affiliation(s)
- Emma Reford
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Manhattan, NY
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Pulido-Fuentes M, Flores-Martos JA, Abad-González L, Navarta-Sánchez MV, Valera-Oviedo L, Cipriano-Crespo C. Emotions in the Time of COVID-19: Affections and Impacts among the Spanish Primary Care Workforce. Healthcare (Basel) 2021; 9:1723. [PMID: 34946447 PMCID: PMC8701181 DOI: 10.3390/healthcare9121723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The literature review shows that most studies on the psychological impact of COVID-19 on healthcare professionals have focused on hospital staff, with few specifically addressing the primary care workforce. This study aims to explore primary care workers' verbal accounts of the emotions they experienced. METHODS This is a qualitative study carried out between July and December 2020 in Spain. Semi-structured interviews and focus groups were conducted with primary care workers. Data were analysed through thematic content analysis. Participants were selected using purposive sampling. RESULTS A total of 53 primary care workers participated in the study, of whom 38 were individually interviewed, and 15 participated in three focus groups. Our analysis revealed themes in two categories: (1) from infection to affection; and (2) affected, but not patients-a discourse based on the acceptance of their experience as part of their work in primary care, creating an ideological construct or "shield" based on emotional self-management. CONCLUSIONS Self-reflection on the emotional impact of COVID-19 is scarce. Examples of emotional affections include an obsessive focus on hygiene, the inability to establish clear boundaries between the personal and the professional spheres, and experiencing-and having to self-manage-emotional strain.
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Affiliation(s)
- Montserrat Pulido-Fuentes
- Faculty of Health Sciences, University of Castilla-La Mancha, Avenida Real Fábrica de Sedas s/n, 45600 Talavera de la Reina, Spain;
| | | | - Luisa Abad-González
- Faculty of Education Sciences and Humanities, University of Castilla-La Mancha, 16071 Cuenca, Spain;
| | | | - Laura Valera-Oviedo
- Talaverana Multiple Sclerosis Association, ATAEM, 45600 Talavera de la Reina, Spain;
| | - Carmen Cipriano-Crespo
- Faculty of Health Sciences, University of Castilla-La Mancha, Avenida Real Fábrica de Sedas s/n, 45600 Talavera de la Reina, Spain;
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Zhang T, Shen X, Liu R, Zhao L, Wang D, Lambert H, Cabral C. The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study. BMC Health Serv Res 2021; 21:1048. [PMID: 34610843 PMCID: PMC8490966 DOI: 10.1186/s12913-021-07082-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In China, the primary health care (PHC) system has been designated responsible for control and prevention of COVID-19, but not treatment. Suspected COVID-19 cases presenting to PHC facilities must be transferred to specialist fever clinics. This study aims to understand the impact of COVID-19 on PHC delivery and on antibiotic prescribing at a community level in rural areas of central China. METHODS Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and analysed thematically. RESULTS PHC practitioners reported a major shift in their work away from seeing and treating patients (due to government-mandated referral to specialist Covid clinics) to focus on the key public health roles of tracing, screening and educating in rural areas. The additional work, risk, and financial pressure that PHC practitioners faced, placed considerable strain on them, particularly those working in village clinics. Face to face PHC provision was reduced and there was no substitution with consultations by phone or app, which practitioners attributed to the fact that most of their patients were elderly and not willing or able to switch. Practitioners saw COVID-19 as outside of their area of expertise and very different to the non-COVID-19 respiratory tract infections that they frequently treated pre-pandemic. They reported that antibiotic prescribing was reduced overall because far fewer patients were attending rural PHC facilities, but otherwise their antibiotic prescribing practices remained unchanged. CONCLUSIONS The COVID-19 pandemic had considerable impact on PHC in rural China. Practitioners took on substantial additional workload as part of epidemic control and fewer patients were seen in PHC. The reduction in patients seen and treated in PHC led to a reduction in antibiotic prescribing, although clinical practice remains unchanged. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and increased public health roles and, in the case of the village clinics, remain financially viable.
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Affiliation(s)
- Tingting Zhang
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Xingrong Shen
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Rong Liu
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Linhai Zhao
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Debin Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christie Cabral
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Alyahya SA, Al-Mansour KA, Alkohaiz MA, Almalki MA. Association between role conflict and ambiguity and stress among nurses in primary health care centers in Saudi Arabia during the coronavirus disease 2019 pandemic: A cross-sectional study. Medicine (Baltimore) 2021; 100:e27294. [PMID: 34664892 PMCID: PMC8447988 DOI: 10.1097/md.0000000000027294] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022] Open
Abstract
This study aimed to assess the association between role conflict and ambiguity among nurses in primary healthcare centers (PHCs) in Saudi Arabia and their stress levels during the coronavirus disease 2019 (COVID-19) pandemic.In this online cross-sectional study, sociodemographic and occupational characteristics, role conflict, and ambiguity of 432 nurses were assessed using the Bowling Scale for Role Conflict and Ambiguity and stress was assessed using the 10-item Perceived Stress Scale from September 27 to October 17, 2020. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for above-median stress levels of nurses with average and high (2nd and 3rd tertiles) role conflict and ambiguity compared with nurses with low role conflict and ambiguity (1st tertile).The mean (standard deviation) age of the nurses was 36.5 ± 6.6 years, and 25.9% of them were males. After adjusting for PHC type and working hours, nurses with average and high role conflict had significantly higher stress rates than those with low role conflict, with ORs (95% CIs) of 2.69 (1.62-4.46) and 6.31 (3.78-10.53), respectively. Similarly, nurses with average- and high-role ambiguity had significantly higher stress than those with low role ambiguity, with ORs (95% CIs) of 2.15 (1.30-3.55) and 7.68 (4.54-13.01), respectively. Increasing stress rates were detected across increasing categories of role conflict and ambiguity (P values for trend <.001).We found that role conflict and ambiguity were associated with stress among nurses in PHCs in Saudi Arabia during the COVID-19 pandemic.
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Affiliation(s)
| | - Khalid A. Al-Mansour
- General Administration for Primary Health Centers, Ministry of Health
- Department of Social Studies, College of Arts, King Saud University, Riyadh
| | | | - Mansour A. Almalki
- Department of Sociology and Social Work, Facility of Arts and Humanities, King Abdulaziz University, Jeddah, Saudi Arabia
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Smyrnakis E, Symintiridou D, Andreou M, Dandoulakis M, Theodoropoulos E, Kokkali S, Manolaki C, Papageorgiou DI, Birtsou C, Paganas A, Stachteas P, Vlachopoulos N, Pagkozidis I, Zeimbekis A, Roka V, Giakoumis A, Kotsani M, Avakian I, Makridou E, Gavana M, Haidich AB, Avgerinou C. Primary care professionals' experiences during the first wave of the COVID-19 pandemic in Greece: a qualitative study. BMC FAMILY PRACTICE 2021; 22:174. [PMID: 34474684 PMCID: PMC8412972 DOI: 10.1186/s12875-021-01522-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Background The coronavirus outbreak (COVID-19) tested health care systems worldwide. This qualitative study aimed to explore and understand the experiences, beliefs and concerns of Primary Care Professionals (PCPs) regarding the preparedness and response of primary care to the first wave of the pandemic in Greece, a country where a public structured primary care system has been developing. Methods We conducted semi-structured telephone interviews with 33 PCPs (General Practitioners, community General Internal Medicine Specialists, community Paediatricians and nurses) recruited from all regions of Greece after the first wave of the pandemic (June 2020). Interviews were transcribed verbatim, data were anonymised and analysed. Thematic analysis was applied developing a conceptual framework. Results Four main themes were identified: a) Primary care unit adaptation and issues faced during the pandemic; b) Management of suspected COVID-19 cases; c) Management of non-suspected cases; d) Consequences of the pandemic. In the first phase of the pandemic, remote management of suspected cases and their referral to the hospital were preferred as a result of a shortage of personal protective equipment and inaccessibility to coronavirus testing in primary care. Due to the discontinuation of regular medical services and the limited in-person contact between doctors and patients, chronic disease management and prevention programmes were left behind. Social and emotional consequences of the pandemic, such as workplace stigma, isolation and social seclusion, deriving from fear of viral transmission, as well as burnout symptoms and exhaustion were commonly experienced among PCPs. Positive consequences of the pandemic were considered to be the recognition of the importance of an empowered public healthcare system by citizens and the valuable insight, knowledge and experience professionals gained in times of crisis. Conclusions Primary care has a key role to play during and after the pandemic by using its information infrastructure to identify at-risk groups, detect new cases of COVID-19, provide care according to needs, and carry out vaccination programmes. Central coordination and empowerment of primary care will increase its effectiveness, via public awareness, holistic patient management, and unburdening of hospitals.
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Affiliation(s)
- Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | | | | | - Charis Birtsou
- Regional Practice of Lagadikia, Zagliveri Health Center, Prefecture of Thessaloniki, Greece
| | | | - Panagiotis Stachteas
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ilias Pagkozidis
- Aristotle University of Thessaloniki Primary Health Care Research Network, Thessaloniki, Greece
| | | | - Violeta Roka
- Farkadona Health Center, Prefecture of Trikala, Greece
| | | | - Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", F-54000, Nancy, France
| | - Ioanna Avakian
- Regional Practice of Zappeio, Farsala Health Center, Prefecture of Larissa, Greece
| | - Efthymia Makridou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Laboratory of Hygiene, Social and Preventive Medicine, and Medical Statistics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
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Zheng W, Kämpfen F, Huang Z. Health-seeking and diagnosis delay and its associated factors: a case study on COVID-19 infections in Shaanxi Province, China. Sci Rep 2021; 11:17331. [PMID: 34462494 PMCID: PMC8405662 DOI: 10.1038/s41598-021-96888-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022] Open
Abstract
This time-to-event study examines social factors associated with health-seeking and diagnosis of 165 COVID-19 cases in response to the pandemic spread in Shaanxi Province, China. In particular, we investigate the differential access to healthcare in terms of delayed time from symptom onset to first medical visit and subsequently to diagnosis by factors such as sex, age, travel history, and type of healthcare utilization. We show that it takes more time for patients older than 60 (against those under 30) to seek healthcare after developing symptoms (+ 2.5 days, [Formula: see text]), surveillance on people with living or travel history to Wuhan helps shorten the time to the first doctor visit (- 0.8 days) and diagnosis (- 2.2 days, [Formula: see text]). A delay cut is associated with the adoption of intermediary and large hospitals rather than community-based care as primary care choices (- 1.6 days, [Formula: see text] and - 2.2 days, [Formula: see text]). One unit increase of healthcare workers per 1000 people saves patients 0.5 days ([Formula: see text]) for diagnosis from the first doctor visit and 0.6 days ([Formula: see text]) in total. Our analysis of factors associated with the time delay for diagnosis may provide a better understanding of the health-seeking behaviors of patients and the diagnosis capacity of healthcare providers during the COVID-19 pandemic.
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Affiliation(s)
- Wenyuan Zheng
- School of Insurance, Southwestern University of Finance and Economics, Chengdu, 611130, China
| | - Fabrice Kämpfen
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zhiyong Huang
- Center of Health Governance and Policy, Southwestern University of Finance and Economics, Chengdu, 611130, China.
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Turner S, Botero-Tovar N, Herrera MA, Borda Kuhlmann JP, Ortiz F, Ramírez JC, Maldonado LF. Systematic review of experiences and perceptions of key actors and organisations at multiple levels within health systems internationally in responding to COVID-19. Implement Sci 2021; 16:50. [PMID: 33962635 PMCID: PMC8103061 DOI: 10.1186/s13012-021-01114-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 has presented challenges to healthcare systems and healthcare professionals internationally. After one year of the pandemic, the initial evidence on health system responses begins to consolidate, and there is a need to identify and synthesise experiences of responding to COVID-19 among healthcare professionals and other health system stakeholders. This systematic review of primary qualitative studies depicts the experiences and perceptions of organisations and actors at multiple levels of health systems internationally in responding to COVID-19. METHODS Six main databases of biomedical information, public health and health administration research were searched over the period October 1, 2019, to October 21, 2020. Information extracted from included studies was analysed thematically. RESULTS Thirty-four studies were eligible for data extraction. Nine of those studies, of lower methodological quality, were removed from the thematic analysis of study results. Considering the professional level experiences, predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, recognition of ´unseen´ healthcare workers, and positive changes and emergent solutions amid the crisis. Organisational level findings of the studies included provision of psychological support, COVID-19 as "catalyst" for change, and exercise of more "open" leadership by managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were roles identified at the local health system level. CONCLUSIONS The experiences of frontline healthcare workers have been the focus of attention of the majority of primary qualitative studies as of October 2020. However, organisational and wider system level studies indicate that some responses to COVID-19 have been characterised by increased emphasis on coordination activities by local health system actors, making service adaptations at pace, and reliance on expanded roles of front-line workers. The need for theory-informed qualitative studies was identified at the organisational level. TRIAL REGISTRATION CRD42020202875.
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Affiliation(s)
- Simon Turner
- School of Management, University of los Andes, Bogotá, Colombia
| | | | | | | | - Francisco Ortiz
- School of Management, University of los Andes, Bogotá, Colombia
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Fang M, Xia B, Tian T, Hao Y, Wu Z. Drivers and mediators of healthcare workers' anxiety in one of the most affected hospitals by COVID-19: a qualitative analysis. BMJ Open 2021; 11:e045048. [PMID: 33674377 PMCID: PMC7938469 DOI: 10.1136/bmjopen-2020-045048] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To report the driving and mediating factors of healthcare workers' anxiety during the COVID-19 pandemic. DESIGN Qualitative indepth interview study. SETTING The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. PARTICIPANTS 53 healthcare workers who were or were not diagnosed with COVID-19. RESULTS During the COVID-19 pandemic, healthcare workers were initially not sufficiently psychologically prepared. Then they suffered from severe anxiety and apprehension during the peak stage, regardless of whether they were infected with SARS-CoV-2 or not. These negative emotions were exacerbated by four drivers, namely infection risk, supplies, isolation and media. As the epidemic gradually came under control, healthcare workers experienced less anxiety from these factors, but became concerned about their low financial status. To reduce anxiety, healthcare workers diverted their attention from the risk of infection through personal entertainment and religious beliefs and focused on treating their patients. Furthermore, assistance from other people, including colleagues, families, friends, patients and society, helped protect healthcare workers from anxiety. CONCLUSIONS Personal and social support can relieve healthcare workers' anxiety to some extent during the different stages of an epidemic. Both protective equipment and financial allowance motivate healthcare workers to focus on patient care, although the latter matters more as the epidemic comes under control.
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Affiliation(s)
- Mengling Fang
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Xia
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tian Tian
- Department of Digestion, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Hao
- Department of Digestion, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhenghao Wu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Fiest KM, Parsons Leigh J, Krewulak KD, Plotnikoff KM, Kemp LG, Ng-Kamstra J, Stelfox HT. Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review. BMC Psychiatry 2021; 21:91. [PMID: 33568141 PMCID: PMC7875435 DOI: 10.1186/s12888-021-03090-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout. The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health. METHODS We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 17, 2020. Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers. RESULTS From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review. Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries. Psychological symptoms of anxiety (14.3-92.3%), stress (11.9-93.7%), depression (17-80.5%), post-traumatic stress disorder (13.2-75.2%) and burnout (14.7-76%) were commonly reported among physicians, regardless of infectious disease outbreak or country. Younger, female (vs. male), single (vs. married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms. INTERPRETATION Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist. Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada.
| | - Jeanna Parsons Leigh
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada
- School of Health Administration, Faculty of Health and Department of Critical Care Medicine, Faculty of Medicine, Dalhousie University, 5850 College Street, Halifax, Nova Scotia, B3H4R2, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Kara M Plotnikoff
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Laryssa G Kemp
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Joshua Ng-Kamstra
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada
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