Primary care physicians' response to pandemic influenza in Hong Kong: a mixed quantitative and qualitative study

The roles and challenges of the primary health care systems in epidemic management: a scoping review

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.

Physicians' Health-Related Quality of Life and Its Associated Factors During COVID-19 Pandemic in Jordan: A Cross-Sectional Study

Healthcare workers worldwide have been exposed to extraordinary stress during COVID-19 pandemic. This study aimed to investigate health-related quality of life (HRQoL) level and its health and occupational associated factors among Jordanian physicians during COVID-19 pandemic. A cross-sectional design using an online survey was adopted targeting physicians at different Jordanian hospitals. The study survey included demographics, HRQoL measured by 12-item Short Form health survey (SF-12) mental and physical components, physicians' evaluation of work conditions during COVID-19, Neck Disability Index (NDI), Depression Anxiety Stress Scale (DASS 21), and International Physical Activity Questionnaire (IPAQ). Descriptive analyses were conducted to summarize primary data. Factors associated with HRQoL were determined using a multiple variable regression analysis. In total, 326 physicians successfully completed the survey, 44.2% were males with mean age of 32.08 (±6.93). SF-12 mental component mean was 52.13 (±20.84) and physical component mean was 69.24 (±18.1). Physicians HRQoL level was significantly associated with levels of stress (β = -0.23, 95% CI -1.05 to -0.27), depression (β = -0.22, 95% CI -1.09 to -0.28), neck disability (β = -0.30, 95% CI -1.08 to -0.57), health self-evaluation (β = 0.14, 95% CI 1.66-7.87), sleep self-evaluation (β = 0.09, 95% CI 0.16-3.58), and physical activity level (β = 0.09, 95% CI 0.00-0.001). Jordanian physicians' level of HRQoL was relatively low during COVID-19. Healthcare facilities administrators should take into consideration factors associated with physicians' HRQoL level when planning for future healthcare emergencies.

Primary health care response in the management of pandemics: Learnings from the COVID-19 pandemic

Primary care is an essential foundation for the global response to COVID-19 pandemic. It plays a significant role in the health care response: identifying and triaging potential COVID-19 cases, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, strengthening compliance with prevention and protection measures, and reducing the demand for hospital services. Primary care teams have continued to address citizens’ health problems during the pandemic, adapting to strict social control measures imposed by governments such as closing of borders, lockdowns and self-isolation of cases and contacts. We describe the COVID-19 response from primary care in Hong Kong and China, based on their recent pandemic experiences. We also present that of a European country, United Kingdom, less experienced in pandemic management, but with universal and highly developed primary care with great social recognition. Finally, we point out some crucial learning for future pandemic management, highlighting the crucial need to improve the relationship between primary care and public health to improve pandemics response.

Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics

BACKGROUND

COVID-19 is the fifth and most significant infectious disease epidemic this century. Primary health care providers, which include those working in primary care and public health roles, have critical responsibilities in the management of health emergencies.

OBJECTIVE

To synthesize accounts of primary care lessons learnt from past epidemics and their relevance to COVID-19.

METHODS

We conducted a review of lessons learnt from previous infectious disease epidemics for primary care, and their relevance to COVID-19. We searched PubMed/MEDLINE, PROQUEST and Google Scholar, hand-searched reference lists of included studies, and included research identified through professional contacts.

RESULTS

Of 173 publications identified, 31 publications describing experiences of four epidemics in 11 countries were included. Synthesis of findings identified six key lessons: (i) improve collaboration, communication and integration between public health and primary care; (ii) strengthen the primary health care system; (iii) provide consistent, coordinated and reliable information emanating from a trusted source; (iv) define the role of primary care during pandemics; (v) protect the primary care workforce and the community and (vi) evaluate the effectiveness of interventions.

CONCLUSIONS

Evidence highlights distinct challenges to integrating and supporting primary care in response to infectious disease epidemics that have persisted over time, emerging again during COVID-19. These insights provide an opportunity for strengthening, and improved preparedness, that cannot be ignored in a world where the frequency, virility and global reach of infectious disease outbreaks are increasing. It is not too soon to plan for the next pandemic, which may already be on the horizon.

Factors influencing the willingness of primary care physicians to provide care during the coronavirus disease pandemic: a nationwide survey in Taiwan

OBJECTIVES

The COVID-19 pandemic continues to advance worldwide with tremendous impact on public health, economy and society. Primary healthcare is crucial in every country during the pandemic for an integrated and coordinated healthcare delivery system; hence, it is of paramount importance to maintain a sufficient frontline workforce. This study aimed to identify factors influencing the willingness of primary care physicians to provide care during the COVID-19 pandemic.

DESIGN

Cross sectional study.

SETTING

Nationwide survey PARTICIPANTS: Primary care physicians working in the community in Taiwan were selected using a cluster sampling method based on practice region from May to June 2020.

OUTCOME MEASURES

The willingness of primary care physicians to provide care during the COVID-19 pandemic.

RESULTS

This study surveyed 1000 primary care physicians nationwide, and 625 valid questionnaires were received and included in the final analysis, with an effective response rate of 62.5%. Factors significantly associated with physicians willingness to provide care during COVID-19 were 'joining the Community Healthcare Group (CHCG)' (p<0.001), 'perceived more overall benefits for providing care' (p<0.001) 'perceived less overall barriers to providing care' (p<0.001), 'higher knowledge scores about COVID-19' (p=0.049) and 'physician's major specialties' (p=0.009) in the multivariate logistic regression model.

CONCLUSIONS

Building a comprehensive primary care system such as Taiwan's CHCG, training of more family physicians or general practitioners, and protecting and supporting primary care physicians were important in response to infectious disease pandemics. The findings of this study inform the development of guidelines to support and maintain the primary healthcare workforces during the COVID-19 pandemic and for future events.

Health workforce management in the context of the COVID-19 pandemic: A survey of physicians in Serbia

BACKGROUND & AIM

The study describes the experiences and opinions of Serbian physicians regarding workforce management during the COVID-19 pandemic.

MATERIALS & METHODS

A total of 1553 licensed physicians (65% males; average age 44.0 years) responded to an online survey in September 2020. Differences in the respondents' general data and attitudes regarding workforce management and outbreak preparedness in Serbia were analysed in relation to their engagement during the COVID-19 pandemic (Pearson χ2 and the independent samples t-test, p < 0.05). The logistic regression model explained the need for changing health workforce management.

RESULTS

The results reveal that the physicians engaged in the fight against the spread of COVID-19 (64.4% of the respondents) more often than their counterparts, were clinicians from the public sector, younger, with less work experience, influenced negatively by the pandemic, and reassigned to other positions (p < 0.001). Health workers dissatisfied with workplace preparedness and those reassigned due to COVID-19 were by 2.61 times and 1.38 times, respectively, more likely than their counterparts to consider changes in health workforce management.

DISCUSSION & CONCLUSION

COVID-19 underlines the need for changes in health workforce management during public health emergencies. An internal incident management team and a panel of external experts may support health workforce management during the prolonged and rapidly changing crises.

Perceptions Among Medical Staff in Community Health Centres of Coping Capacity Regarding Infectious Disease Epidemics: A Cross-Sectional Study in Shanghai, China

Background

With the increasing risk of infectious disease outbreaks around the world, the role of community health centres (CHCs) in the prevention and control of epidemics has become increasingly prominent. This study aimed to examine the capacities, vulnerabilities, and obstacles related to coping with infectious disease epidemics in Chinese CHCs.

Methods

A cross-sectional study was conducted in Shanghai CHCs. Stratified random sampling was used to select 48 CHCs, and 2460 medical staff members responded to questionnaire surveys. ANOVA and multivariate analysis were used to evaluate the current situation and main obstacles regarding CHC medical staff members’ perceptions of their capacity to cope with infectious disease epidemics.

Results

The scores for regulation awareness (mean= 3.64, SD= 0.02) and detection/reporting ability (mean= 3.66, SD= 0.02) were lower than the score for the ability to handle an epidemic (mean= 3.79, SD= 0.02). After controlling for covariates, working in a traditional Chinese medicine (β= −0.63, P= 0.002) or medical technology department (β= −0.60, P= 0.002), not having participated in emergency exercises (β= −0.78, P< 0.001), and not having participated in emergency training (β= −0.59, P= 0.01) were associated with lower scores on all three domains. Those with senior professional titles reported relatively high levels of ability to handle an epidemic (β= 0.21, P= 0.01). Female workers reported relatively low regulation awareness (β= −0.11, P= 0.02) and detection/reporting ability (β= −0.11, P= 0.01).

Conclusion

The three emergency response abilities of CHC medical workers differed based on the medical worker’s sex, department, and title, indicating the need for targeted scientific emergency exercises and training for infectious disease outbreaks. Moreover, there is a need to improve the relevant policies and equipment.

Pandemic-related attitudes, stressors and work outcomes among medical assistants during the SARS-CoV-2 ("Coronavirus") pandemic in Germany: A cross-sectional Study

Background

The SARS-CoV-2 virus has spread rapidly around the globe since December 2019 creating much uncertainty among medical staff. Due to close patient contact, medical assistants are at increased risk of an infection. Several studies have investigated psychological consequences of the SARS-CoV-2 pandemic on medical staff, yet studies in the outpatient setting are scarce and studies addressing medical assistants are lacking. This study aimed to investigate pandemic-related stressors, attitudes, and work outcomes among medical assistants and to identify possible determinants.

Methods

The population under study were medical assistants across entire Germany. A self-devised online questionnaire was published between April 7th, 2020, and April 14th. including questions on pandemic-related stressors, attitudes and work outcomes. Additionally, symptoms of depression and anxiety disorder were measured by PHQ-2 and GAD-2, respectively. Logistic regression was performed to identify possible determinants.

Results

2150 medical assistants provided complete data (98.0% female, mean age 37.6 years). Major stressors were uncertainty about the temporal scope of the pandemic (95.1% agreement), about how to act correctly (77.5%), feelings of not being allowed to let patients down (75.9%), uncertainty about one’s financial situation (67.4%) and about contact persons for further information (67.1%). One third (29.9%) of the study population screened positively for depression and 42.6% for anxiety disorder. Feeling burdened by one’s financial situation was significantly associated with working in specialist practices (1.32 [1.08–1.62]), caring for children (1.51 [1.22–1.87]), depression (1.28 [1.01–1.62]), and anxiety disorder (1.93 [1.55–2.39]). Feeling burdened by thoughts about virus contraction at work was also significantly associated with working in specialist practices (1.33 [1.07–1.64]), caring for children (1.33 [1.07–1.66]), depression (1.54 [1.18–2.00]), and anxiety (4.71 [3.71–5.98]).

Conclusions

This study provides novel evidence regarding major SARS-CoV-2 pandemic-related stressors among medical assistants and suggests need for special support for medical assistants caring for children and working in specialist practices.

COVID-19: Notes From the Front Line, Singapore's Primary Health Care Perspective

Coronavirus disease 2019 (COVID-19) is a rapidly progressing global pandemic against which nations are struggling for containment. Singapore is known to have promptly instituted aggressive public health and containment measures. A key pillar sustaining this is the response of its primary health care network. It is important for health care systems worldwide to recognize the value of a strong coordinated response to this crisis from a primary health perspective. There are best practices for early isolation and containment of suspect cases while protecting health care workers and limiting cross infections that are transferable across nations. We describe our framework for how our primary care clinics respond to this pandemic in the hope others may find solutions to their unique needs. Moving forward, there is a pressing need for more studies to enhance our understanding of the response of primary care during these public health crises.

Acceptance and uptake of influenza vaccines in Asia: A systematic review

In Asia, the public health burden of influenza is significant despite the existence of efficacious influenza vaccines. Annual seasonal influenza vaccination can reduce the incidence of influenza significantly, yet influenza vaccination coverage remains low in this part of the world. As a densely populated region with varying climatic zones and a larger proportion of developing countries compared to the West, Asia is at increased risk of influenza. To provide a more comprehensive and nuanced understanding of the Asian region, the key objective of this systematic review is to examine the determinants of vaccination uptake in Asia, beyond that of existing studies that have largely been western-centric. We carried out a systematic review of peer-reviewed scientific research, examining the key determinants, acceptance and uptake of influenza vaccinations across Asia. A comprehensive search strategy was defined to capture studies that met the inclusion criteria of articles published in English, from 2008 to 2018, focusing on adult populations within Asia. A total of 83 relevant studies were appraised in this review. Analyses of the extant data confirmed that vaccination rates within Asia are low, and that most countries lack scientific research on vaccination behaviours. Studies were categorised into four different population groups: healthcare workers, high risk groups, general population and uniform groups. The motivators and deterrents for vaccine uptake varied according to population groups and characteristics. Both general populations and healthcare workers were concerned with vaccine safety and efficacy, and recommendations from health authorities were influential in vaccine uptake within the other populations. The findings suggest that further research is needed within a broader range of Asian countries to garner greater in-depth knowledge of vaccination behaviours in the region. In particular, influenza vaccination programs within Asia should focus on improving engagement more effectively, through greater relatability and transparency of data when educating the public.

Response of general practitioners to infectious disease public health crises: an integrative systematic review of the literature

OBJECTIVE

Previous research has identified gaps in pandemic response planning for primary care. Identifying the challenges that general practitioners (GPs) face during public health crises of infectious diseases will help to improve prepandemic planning. In this integrative systematic review, we identified research-based evidence to (1) challenges that GPs have when participating in pandemics or epidemics and (2) whether GPs from different countries encountered different challenges.

METHODS

A systematic search was conducted in MEDLINE, PubMed, Scopus, EMBASE, PsycINFO, Cochrane Library, and ProQuest Dissertations and Theses databases during October to November 2012 to identify studies relevant to experience by GPs during epidemics or pandemics.

RESULTS

Six quantitative, 2 mixed method, and 2 qualitative studies met the inclusion criteria. The challenges identified were not exclusive to specific countries and encompassed different responses to outbreaks. These challenges included difficulties with information access; supply and use of personal protective equipment; performing public health responsibilities; obtaining support from the authorities; appropriate training; and the emotional effects of participating in the response to an infectious disease with unknown characteristics and lethality.

CONCLUSION

GPs' response to public health crises in different countries presents potential for improving pandemic preparedness.

Effect of multipurpose solutions against Acinetobacter carrying QAC genes

PURPOSE

Acinetobacter has low virulence but causes infections in subjects with reduced immunity. It has been reported in ocular infections including those of patients using contact lenses. Treatment is difficult because Acinetobacter is frequently multidrug resistant. Antibiotic-resistant strains frequently also harbor genes for antiseptic resistance (quaternary ammonium compound [QAC]) genes. Because Acinetobacter is part of the normal flora, it may contaminate contact lens and accessories. This study aims to investigate carriage rates of QAC genes in household and clinical isolates of Acinetobacter and to determine the effectiveness of two multipurpose solutions (MPSs) for soft lenses against organisms carrying QAC genes.

METHODS

DNA was extracted from 11 bathroom isolates and 15 clinical isolates and amplified by polymerase chain reaction to determine the presence of qacEΔ1. Gene-positive and gene-negative control strains were used to challenge the two MPSs, and minimum inhibitory concentrations (MICs) of these organisms to benzalkonium chloride and chlorhexidine gluconate were determined.

RESULTS

More than 90% of isolates carried qacEΔ1. The MICs of clinical isolates were higher than those of isolates of bathrooms. Both MPSs were able to produce a 3-log reduction in the numbers of all isolates.

CONCLUSIONS

Although most isolates carried qacEΔ1 and elevated MICs to benzalkonium chloride and chlorhexidine gluconate were observed, all were susceptible to both MPSs tested. However, if there were to be poor compliance with care procedures, it is probable that such organisms could survive in the presence of diluted or expired solutions.