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Stark S, Schaubroeck E, Kluge M, Burggraf L, Roos M, Borowski E, Van Poel E, Willems S, Kühlein T, Hueber S, Werner F. "The measures taken by the government overburdened the daily practice" - insights of the PRICOV-19 study on German general practitioners in times of COVID-19. BMC PRIMARY CARE 2023; 24:207. [PMID: 37821802 PMCID: PMC10568746 DOI: 10.1186/s12875-023-02115-4] [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: 12/16/2022] [Accepted: 07/18/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures? METHODS This study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models. RESULTS The response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures. CONCLUSION GPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans.
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Affiliation(s)
- Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marie Kluge
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Larissa Burggraf
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department for Sociology, University of Education, Schwäbisch Gmünd, Germany
| | - Marco Roos
- General Practice, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Eve Borowski
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susann Hueber
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Felix Werner
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Vanden Bossche D, Zhao QJ, Ares-Blanco S, Peña MPA, Decat P, Kondo N, Kroneman M, Nishioka D, Petrazzuoli F, Rortveit G, Schaubroeck E, Stark S, Pinto AD, Willems S. Addressing health inequity during the COVID-19 pandemic through primary health care and public health collaboration: a multiple case study analysis in eight high-income countries. Int J Equity Health 2023; 22:171. [PMID: 37653472 PMCID: PMC10472729 DOI: 10.1186/s12939-023-01968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions. METHODS We analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021. RESULTS Four themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries. CONCLUSIONS This study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC.
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Affiliation(s)
- Dorien Vanden Bossche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Q Jane Zhao
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Sara Ares-Blanco
- Federica Montseny Primary Care Centre, Madrid, Spain
- Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine), Madrid, Spain
| | - Maria Pilar Astier Peña
- Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine), Madrid, Spain
- Territorial Healthcare Quality Unit, Camp de Tarragona, Health Department Generalitat de Catalunya, Healthcare Institute of Catalonia, Tarragona, Spain
| | - Peter Decat
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Naoki Kondo
- Department of Social Epidemiology, University of Kyoto, Kyoto, Japan
| | - Madelon Kroneman
- Nivel (Netherlands Institute of Health Services Research), Utrecht, the Netherlands
| | - Daisuke Nishioka
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- St Michael's Hospital, Toronto, ON, Canada
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Ovington S, Anderson K, Choy M, Haesler E. Reflections of Australian general practitioners during the first year of the COVID-19 pandemic: a qualitative study. Aust J Prim Health 2023; 29:395-402. [PMID: 36716751 DOI: 10.1071/py22047] [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: 03/03/2022] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND General practitioners (GPs) have played an integral role in Australia's coronavirus disease 2019 (COVID-19) pandemic response. However, little is known about how GPs themselves have been impacted by the COVID-19 pandemic. This study aimed to increase our understanding of the experiences of GPs working during the COVID-19 pandemic. METHODS A qualitative study was conducted using semi-structured interviews. Using purposive sampling, 15 GPs from South-Eastern Australia were asked to reflect on their experiences during the first year of the COVID-19 pandemic. Interview transcripts underwent thematic analysis. RESULTS Five main themes were identified: fear of infection; uncertainty and information overload; impacts on the government-GP relationship; impacts on the patient-doctor relationship; and teamwork within practices and among GPs. CONCLUSIONS The 15 GPs interviewed in this study provided valuable insights into their experiences working during the first year of the COVID-19 pandemic. From these insights, four recommendations propose what could be done to help support GPs to respond to a pandemic while continuing to deliver primary health care.
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Affiliation(s)
- Seren Ovington
- Academic Unit of General Practice, Australian National University, Canberra, ACT 2605, Australia
| | - Katrina Anderson
- Academic Unit of General Practice, Australian National University, Canberra, ACT 2605, Australia
| | - Melinda Choy
- Academic Unit of General Practice, Australian National University, Canberra, ACT 2605, Australia
| | - Emily Haesler
- Academic Unit of General Practice, Australian National University, Canberra, ACT 2605, Australia; and Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6102, Australia; and Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Vic. 3086, Australia
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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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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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Stengel S, Roth C, Breckner A, Cordes L, Weber S, Ullrich C, Peters-Klimm F, Wensing M. Resilience of the primary health care system - German primary care practitioners' perspectives during the early COVID-19 pandemic. BMC PRIMARY CARE 2022; 23:203. [PMID: 35948965 PMCID: PMC9365682 DOI: 10.1186/s12875-022-01786-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 07/05/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Primary care is a relevant pillar in managing not only individual, but also societal medical crises. The COVID-19 pandemic has demanded a rapid response from primary care with interventions in the health care system. The aim of this paper was to explore the responses of primary care practitioners (PCP) during the early COVID-19 pandemic and to analyze these with a view on the resilience of the primary health care system from the PCPs perspective. METHODS Shortly after the first COVID-19 wave (July-October 2020) n = 39, semi-structured telephone interviews were conducted with PCP in practices and at Corona contact points (CCP) in Baden-Wuerttemberg (Germany). Qualitative content analysis was applied, and the evolved categories were related to in a framework for resilience. RESULTS Primary care had an overall strong ability to adapt and show resilience, albeit with wide variance in speed and scope of the responses. When coping with uncertainty, the reasons given by PCPs in favor of opening a CCP mainly involved intrinsic motivation and self-initiative; the reasons against doing so were i.e. the lack of personal protective equipment, problems with space, and worries about organizational burden. A strong association existed between the establishment of a CCP and the use of resources (i.e. existing networks, personal protective equipment, exercising an office of professional political function). Our study predominantly found adaptive aspects for measures taken at medical practices and transformative aspects for setting up outpatient infection centers. PCPs played an important role in the coordination process (i.e. actively transferring knowledge, integration in crisis management teams, inclusion in regional strategic efforts) reaching a high level in the dimensions knowledge and legitimacy. The dimension interdependence repeatedly came into focus (i.e. working with stakeholders to open CCP, interacting among different types of primary care facilities, intersectoral interfaces). A need for regional capacity planning was visible at the time of the interviews. CONCLUSIONS The results can be used for practical and research-based institutional and capacity planning, for developing resilience in primary care and for augmentation by perspectives from other stakeholders in the primary health care system.
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Affiliation(s)
- Sandra Stengel
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany.
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Lara Cordes
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophia Weber
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
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Matenge S, Sturgiss E, Desborough J, Hall Dykgraaf S, Dut G, Kidd M. Ensuring the continuation of routine primary care during the COVID-19 pandemic: a review of the international literature. Fam Pract 2022; 39:747-761. [PMID: 34611708 PMCID: PMC8515263 DOI: 10.1093/fampra/cmab115] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in the diversion of health resources away from routine primary care delivery. This disruption of health services has necessitated new approaches to providing care to ensure continuity. OBJECTIVES To summarize changes to the provision of routine primary care services during the pandemic. METHODS Rapid literature review using PubMed/MEDLINE, SCOPUS, and Cochrane. Eligible studies were based in primary care and described practice-level changes in the provision of routine care in response to COVID-19. Relevant data addressing changes to routine primary care delivery, impact on primary care functions and challenges experienced in adjusting to new approaches to providing care, were obtained from included studies. A narrative summary was guided by Burns et al.'s framework for primary care provision in disasters. RESULTS Seventeen of 1,699 identified papers were included. Studies reported on telehealth use and public health measures to maintain safe access to routine primary care, including providing COVID-19 screening, and establishing dedicated care pathways for non-COVID and COVID-related issues. Acute and urgent care were prioritized, causing disruptions to chronic disease management and preventive care. Challenges included telehealth use including disparities in access and practical difficulties in assessing patients, personal protective equipment shortages, and financial solvency of medical practices. CONCLUSIONS Substantial disruptions to routine primary care occurred due to the COVID-19 pandemic. Primary care practices' rapid adaptation, often with limited resources and support, demonstrates agility and innovative capacity. Findings underscore the need for timely guidance and support from authorities to optimize the provision of comprehensive routine care during pandemics.
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Affiliation(s)
- Sethunya Matenge
- Department of Health Services Research and Policy, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Garang Dut
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Michael Kidd
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,Australian Government Department of Health, Canberra, ACT, Australia.,Department of Family and Community Medicine, The University of Toronto, Toronto, Canada.,Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia.,Southgate Institute for Equity, Health and Society, Flinders University, Adelaide, SA, Australia
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8
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Panthi S, Jaishi AR, Gautam S, Bhandari S, Bhatt N, Basnet LB, Sharma SK. Perception of Health Care Practitioners of Government Designated COVID-19 Hospitals of Nepal towards the Management of COVID-19 Pandemic: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:40-46. [PMID: 35199671 PMCID: PMC9157657 DOI: 10.31729/jnma.7093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Amidst the chaos of COVID-19, health care practitioners are persistently providing services and experiencing many challenges. This study aimed to determine the perception of health care practitioners of government designated COVID-19 hospitals of Nepal towards the management of COVID-19 pandemic. METHODS A descriptive cross-sectional study was conducted among the frontline health care practitioners working in the government designated COVID-19 hospitals in Nepal from 21st June, 2020 to 15th August, 2020. Ethical approval was obtained from the Ethical Review Board of the Nepal Health Research Council (Reference number: 347/2020 P). A total of 252 health care practitioners (doctors, nurses, and paramedics) working at the forefront in the emergency ward, general wards, intensive care units, isolation centers, fever clinics, laboratory, quarantine centers, help desks, etc. in the designated hospitals who consented to participate were included in the study. Convenience sampling was used. The data was analyzed using Statistical Package for the Social Sciences version 16.0. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS Only 41 (16.3%) (11.73-20.86 at 95% Confidence Interval) of the health care practitioners were found to have satisfactory perception towards the management of COVID-19 pandemic in Nepal. CONCLUSIONS The satisfactory perception of the health care practitioners in our study towards the management of COVID-19 pandemic in Nepal is lower as compared to the other studies in Nepal and abroad.
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Affiliation(s)
- Sagar Panthi
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | | | - Siddhartha Bhandari
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | | | - Sanjib Kumar Sharma
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Desborough J, Dykgraaf SH, Phillips C, Wright M, Maddox R, Davis S, Kidd M. Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics. Fam Pract 2021; 38:811-825. [PMID: 33586769 PMCID: PMC7928916 DOI: 10.1093/fampra/cmaa142] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Sally Hall Dykgraaf
- Australian National University Rural Clinical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine Australian National University, Canberra, Australia
| | - Michael Wright
- Centre for Health Economics Research and Evaluation (CHERE), University Technology Sydney, Sydney, Australia
| | - Raglan Maddox
- COVID-19 Primary Care Response Group, Australian Department of Health, Canberra, Australia
- National Centre for Epidemiology and Public Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Stephanie Davis
- COVID-19 Primary Care Response Group, Australian Department of Health, Canberra, Australia
- National Centre for Epidemiology and Public Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- World Health Organization Collaborating Centre on Family Medicine and Primary Care, Geneva, Switzerland
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
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10
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Kandouci C, Meçabih F, Meçabih I, Kadari C, Megherbi N, Achouri MY, Kandouci A, Ben Abdelaziz A. Psychosocial impact of COVID-19 among health workers in Algeria. LA TUNISIE MEDICALE 2021; 99:1015-1029. [PMID: 35288905 PMCID: PMC9390127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The current COVID-19 pandemic has put health care professionals in the face of increasing psychological distress, with a high risk of infection. PURPOSE To estimate the prevalence of anxiety-depressive disorders among health professionals in Algeria and determine their associated risk factors. METHOD A cross-sectional descriptive study was conducted from January 11 to March 09, 2021 and concerned healthcare professionals in Algeria, through an online self-assessment. The mental health rating scales used were GAD-7 (7 items) for Anxiety, and CES-D (20 items) for Depression. Resilience was estimated by the RISC-CD (10 items). An original questionnaire was used to assess three factors: fear of infection and death, isolation and stigmatization, as well as motivation and escape behaviour at work. RESULTS A total of 1005 health professionals were included in the study, of which 51.5% were doctors, 75.6% were women and 41.1% were at the first front of the fight against COVID-19. The prevalence of Anxiety and Depression was 23.8% and 44.6% respectively. Health professionals with a high resilience score were those who were in direct contact with COVID-19 3.75 [1.11-12.7] and those who feared contracting the disease 1.22 [1.14-1.31]. Among the study population, 508 employees (50.5%) were free from anxiety-depressive disorder: Good mental health of health personnel, has been determined by the male sex 1,55 [1,07, 2,24], without co-morbidity 0,57 [0,39, 0,83], without direct intervention in the fight against COVID-19 0.63 [0.45, 0.89], having a low score of Depression and Anxiety with respectively 0.43 [0.36- 0.50], 0.50 [0.41- 0.58] while denouncing a high Resilience score 1.03 [1.01- 1.05]. CONCLUSION In Algeria, the fight against the COVID-19 pandemic has had an impact on the mental health of health professionals, hence the urgent need for intervention programs, for strengthening their mental health in a more sustainable and effective struggle.
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Affiliation(s)
- Chahrazed Kandouci
- 1: Faculté de médecine. Laboratoire de recherche en environnement et santé.Université DjillaliLiabes. Sidi Bel Abbès Algérie
| | - Fethi Meçabih
- 2: Département de pharmacie, faculté de médecine d’Alger Algérie
| | - Imene Meçabih
- 3: Département de pharmacie, faculté de médecine, université DjillaliLiabes. Sidi Bel Abbès Algérie
| | - Chifaa Kadari
- 3: Département de pharmacie, faculté de médecine, université DjillaliLiabes. Sidi Bel Abbès Algérie
| | - Nihed Megherbi
- 3: Département de pharmacie, faculté de médecine, université DjillaliLiabes. Sidi Bel Abbès Algérie
| | - Mohamed Yacine Achouri
- 3: Département de pharmacie, faculté de médecine, université DjillaliLiabes. Sidi Bel Abbès Algérie
| | - Abdelkarimn Kandouci
- 1: Faculté de médecine. Laboratoire de recherche en environnement et santé.Université DjillaliLiabes. Sidi Bel Abbès Algérie
| | - Ahmed Ben Abdelaziz
- 4: Faculté de médecine de Sousse.Université de Sousse. Laboratoire de Recherche LR19SP01 (Tunisie)
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11
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Ghidinelli F, Martire F. COVID-19 and primary care: A perspective from Italy. VACUNAS 2021; 22:209-211. [PMID: 34366752 PMCID: PMC8332744 DOI: 10.1016/j.vacun.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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COVID-19 and primary care: A perspective from Italy. VACUNAS (ENGLISH EDITION) 2021. [PMCID: PMC8556733 DOI: 10.1016/j.vacune.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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COVID-19 Publications in Family Medicine Journals in 2020: A PubMed-Based Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157748. [PMID: 34360040 PMCID: PMC8345810 DOI: 10.3390/ijerph18157748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 01/14/2023]
Abstract
Family medicine physicians have been on the front lines of the novel coronavirus disease 2019 (COVID-19) pandemic; however, research and publications in family medicine journals are rarely discussed. In this study, a bibliometric analysis was conducted on COVID-19-related articles published in PubMed-indexed English language family medicine journals in 2020, which recorded the publication date and author’s country and collected citations from Google Scholar. Additionally, we used LitCovid (an open database of COVID-19 literature from PubMed) to determine the content categories of each article and total number of global publications. We found that 33 family medicine journals published 5107 articles in 2020, of which 409 (8.0%) were COVID-19-related articles. Among the article categories, 107 were original articles, accounting for only 26.2% of the articles. In terms of content, the main category was prevention, with 177 articles, accounting for 43.3% of the articles. At the beginning of the epidemic, 10 articles were published in family medicine journals in January 2020, accounting for 11% of all COVID-19-related articles worldwide; however, this accounted for <0.5% of all disciplinary studies in the entire year. Therefore, family medicine journals indeed play a sentinel role, and the intensities and timeliness of COVID-19 publications deserve further investigation.
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14
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Fan J, Senthanar S, Macpherson RA, Sharpe K, Peters CE, Koehoorn M, McLeod CB. An Umbrella Review of the Work and Health Impacts of Working in an Epidemic/Pandemic Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136828. [PMID: 34202087 PMCID: PMC8297139 DOI: 10.3390/ijerph18136828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022]
Abstract
This umbrella review of reviews examined the evidence on the work and health impacts of working in an epidemic/pandemic environment, factors associated with these impacts, and risk mitigation or intervention strategies that address these factors. We examined review articles published in MEDLINE, PsycINFO and Embase between 2000 and 2020. Data extracted from the included reviews were analyzed using a narrative synthesis. The search yielded 1524 unique citations, of which 31 were included. Included studies were focused on health care workers and the risk of infection to COVID-19 or other respiratory illnesses, mental health outcomes, and health care workers’ willingness to respond during a public health event. Reviews identified a variety of individual, social, and organizational factors associated with these work and health outcomes as well as risk mitigation strategies that addressed study outcomes. Only a few reviews examined intervention strategies in the workplace such as physical distancing and quarantine, and none included long-term outcomes of exposure or work during an epidemic/pandemic. Findings suggest a number of critical research and evidence gaps, including the need for reviews on occupational groups potentially exposed to or impacted by the negative work and health effects of COVID-19 in addition to health care workers, the long-term consequences of transitioning to the post-COVID-19 economy on work and health, and research with an equity or social determinants of health lens.
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Affiliation(s)
- Jonathan Fan
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (R.A.M.); (K.S.); (M.K.); (C.B.M.)
- Correspondence: (J.F.); (S.S.)
| | - Sonja Senthanar
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (R.A.M.); (K.S.); (M.K.); (C.B.M.)
- Correspondence: (J.F.); (S.S.)
| | - Robert A. Macpherson
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (R.A.M.); (K.S.); (M.K.); (C.B.M.)
| | - Kimberly Sharpe
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (R.A.M.); (K.S.); (M.K.); (C.B.M.)
| | - Cheryl E. Peters
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
- CAREX Canada, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
| | - Mieke Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (R.A.M.); (K.S.); (M.K.); (C.B.M.)
| | - Christopher B. McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (R.A.M.); (K.S.); (M.K.); (C.B.M.)
- Institute for Work & Health, Toronto, ON M5G 1S5, Canada
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15
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Siebenhofer A, Huter S, Avian A, Mergenthal K, Schaffler-Schaden D, Spary-Kainz U, Bachler H, Flamm M. COVI-Prim survey: Challenges for Austrian and German general practitioners during initial phase of COVID-19. PLoS One 2021; 16:e0251736. [PMID: 34111120 PMCID: PMC8191874 DOI: 10.1371/journal.pone.0251736] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/30/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) represents a significant challenge to health care systems around the world. A well-functioning primary care system is crucial in epidemic situations as it plays an important role in the development of a system-wide response. METHODS 2,187 Austrian and German GPs answered an internet survey on preparedness, testing, staff protection, perception of risk, self-confidence, a decrease in the number of patient contacts, and efforts to control the spread of the virus in the practice during the early phase of the COVID-pandemic (3rd to 30th April). RESULTS The completion rate of the questionnaire was high (90.9%). GPs gave low ratings to their preparedness for a pandemic, testing of suspected cases and efforts to protect staff. The provision of information to GPs and the perception of risk were rated as moderate. On the other hand, the participants rated their self-confidence, a decrease in patient contacts and their efforts to control the spread of the disease highly. CONCLUSION Primary care is an important resource for dealing with a pandemic like COVID-19. The workforce is confident and willing to take an active role, but needs to be provided with the appropriate surrounding conditions. This will require that certain conditions are met. REGISTRATION Trial registration at the German Clinical Trials Register: DRKS00021231.
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Affiliation(s)
- Andrea Siebenhofer
- Institute of General Practice and Evidence based Health Services Research, Medical University Graz, Graz, Austria
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Sebastian Huter
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Avian
- Institute for Medical Informatics, and Statistics and Documentation, Medical University Graz, Graz, Austria
- * E-mail:
| | - Karola Mergenthal
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Dagmar Schaffler-Schaden
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ulrike Spary-Kainz
- Institute of General Practice and Evidence based Health Services Research, Medical University Graz, Graz, Austria
| | - Herbert Bachler
- Institute of General Practice, Medical University Innsbruck, Innsbruck, Austria
| | - Maria Flamm
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
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16
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Eisele M, Pohontsch NJ, Scherer M. Strategies in Primary Care to Face the SARS-CoV-2 / COVID-19 Pandemic: An Online Survey. Front Med (Lausanne) 2021; 8:613537. [PMID: 34150788 PMCID: PMC8206267 DOI: 10.3389/fmed.2021.613537] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/10/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Primary care plays a key role in pandemics like the SARS-CoV-2 pandemic in 2020. We aimed to investigate the challenges faced and the solutions implemented in primary care. Methods: One hundred and twenty-one general practitioners in Germany completed the online survey. We used open questions to examine challenges experienced and solutions implemented during the early pandemic and chose qualitative content analysis to extract and describe the meaning of the answers. We derived deductive categories from the research questions and formed inductive categories during the material reviews. Results: Main challenges were: insufficient information, lack of protective equipment, need to restructure practice procedures and insufficient individual and structural pandemic preparedness, resulting in secondary challenges: fear of infection, impaired patient care, aggravated steering of patients, difficult cooperation with external entities and a not viable hygiene concept advised by authorities. Strategies to address these challenges included establishing regular team-meetings to develop new solutions, focusing on few reliable sources of information, working in alternating shifts, increasing telemedicine, establishing window and open-air practices and building networks with other health care providers. Respondents criticized the lack of consideration of their experiences in planning pandemic measures within primary care. Conclusions: General practitioners successfully applied pragmatic and creative strategies in their practices during the early phase of the pandemic. Among these, communication within and between practices emerged as a key strategy. These strategies should be provided with pandemic preparedness plans. The lacking consideration of the primary care providers' experiences in planning and implementing pandemic measures needs to be addressed by stakeholders.
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Affiliation(s)
- Marion Eisele
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Giezendanner S, Fischer R, Diaz Hernandez L, Zeller A. The use of health care during the SARS-CoV-2 pandemic: repeated cross-sectional survey of the adult Swiss general population. BMC Public Health 2021; 21:853. [PMID: 33941109 PMCID: PMC8091147 DOI: 10.1186/s12889-021-10854-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The distribution of health care resources during a pandemic is challenging. The aim of the study was to describe the use of health care in a representative sample of the Swiss population during the SARS-CoV-2 pandemic in 2020, and to compare it to data from a survey conducted in 2018. METHODS We conducted an observational, population-based, nationwide, repeated cross-sectional survey of the adult Swiss general population in 2018 and in March and April 2020 during the first wave of the SARS-CoV-2 pandemic. Recruitment and data acquisition was conducted by the Link Institute in Lucerne in representative samples of Swiss citizens in 2020 and in 2018. Variables of interest were estimates of health problems, health seeking behaviour, medication and health care use in the population. RESULTS In total, we included data of 1980 individuals (in 2018 N = 958 and in 2020 N = 1022). Across both rounds of data collection the median age was 46 years (range = 18-79 years) and 50% were women. Per 1000 adults, half had at least one symptom and a quarter sought medical advice across both surveys. The most frequently consulted health providers in 2020 were general practitioners (GP) (180/1000), specialist physicians (41/1000), pharmacies (38/1000), the internet (26/1000) and accident and emergency units (25/1000). Compared to 2018, we noted a significant increase in the use of health providers during the pandemic, which was independent of demographic variables for the following health care providers: use of internet (OR = 9.8), pharmacy (OR = 2.64), accident and emergency units (OR = 2.54), and a significant decrease in the number of people who consulted specialist physicians (OR = 0.46). Overall, 76/1000 contacted their GP in relation to COVID-19. CONCLUSIONS Compared to 2018, GPs remained the most important source of medical advice for the population during the first wave of the COVID-19 pandemic in Switzerland. While the self-appraisal of health problems and of the need for medical advice remained constant, individuals seemed to change their provider choice during the pandemic, with an increased utilisation of accident and emergency units and pharmacies, which represent easily accessible and low-threshold medical services.
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Affiliation(s)
- Stéphanie Giezendanner
- Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Laura Diaz Hernandez
- Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
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Dinić M, Šantrić Milićević M, Mandić‐Rajčević S, Tripković K. Health workforce management in the context of the COVID-19 pandemic: A survey of physicians in Serbia. Int J Health Plann Manage 2021; 36:92-111. [PMID: 33817831 PMCID: PMC8251267 DOI: 10.1002/hpm.3141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Stefan Mandić‐Rajčević
- Faculty of MedicineInstitute of Social Medicine and the Centre‐School of Public Health and Health ManagementUniversity of BelgradeBelgradeSerbia
| | - Katica Tripković
- Department for Analysis, Planning and Organization of Health CareInstitute of Public Health of BelgradeBelgradeSerbia
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19
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Family Physicians' Standpoint and Mental Health Assessment in the Light of COVID-19 Pandemic-A Nationwide Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042093. [PMID: 33669982 PMCID: PMC7924834 DOI: 10.3390/ijerph18042093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 12/23/2022]
Abstract
During the coronavirus disease 2019 (COVID-19) outbreak, family physicians (FPs) are the backbone of the healthcare system with considerable impact on the general population, and their well-being is of great importance. The aim of this investigation was to assess FPs mental health, as well as knowledge, attitudes and practices (KAPs) regarding the pandemic, and opinions on non-communicable disease (NCD) health care provided to patients. A cross-sectional study was carried out with a sample of 613 FPs. Anxiety and depression levels were estimated with the Hospital Anxiety and Depression Scale, subjective perceived stress with the Perceived Stress Scale, while trauma-related symptoms were assessed using the Impact on Event Scale-COVID19. KAPs toward the pandemic and opinions regarding NCD patients were evaluated with questionnaires accordingly. Results have shown that age (β = -0.02, p = 0.013) and personal risk of COVID‑19 (β = 1.05, p < 0.001) were significant independent correlates of the knowledge score. A total of 87.7% FPs expressed moderate/high perceived stress, 45.2% moderate/severe trauma-related symptoms, 60.4% borderline/abnormal anxiety levels, and 52.4% borderline/abnormal depression levels. Knowledge score was an independent predictor of perceived stress (β = -0.33, p = 0.023) and anxiety (β = -0.31, p = 0.006) levels. Limited accessibility to healthcare services and decreased number of newly-diagnosed NCD cases were mostly agreed on. The pandemic puts a considerable strain on FPs mental health, as well as on public health measures, due to the decreased overall quality of NCD patient health care. Educational programs may bridge the gaps between FPs' knowledge. Thus lowering anxiety and improving patient care.
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20
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Kurotschka PK, Serafini A, Demontis M, Serafini A, Mereu A, Moro MF, Carta MG, Ghirotto L. General Practitioners' Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study. Front Public Health 2021; 9:623904. [PMID: 33614587 PMCID: PMC7888233 DOI: 10.3389/fpubh.2021.623904] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
Since February 2020, when coronavirus disease began to spread in Italy, general practitioners (GPs) were called to manage a growing number of health situations. The challenges experienced by Italian GPs remained unrevealed. This study aimed at exploring Italian GPs' care experiences and practices associated with critical incidents during the first wave of the pandemic. A qualitative study design involving the critical incident technique through an online survey was applied. Sociodemographic data and open-ended responses were collected. While participants' characteristics were analyzed through descriptive statistics, qualitative data were thematically analyzed employing the framework method. 149 GPs responded to the survey and 99 participants completed the survey (dropout rate = 33%). Eight themes emerged indicating factors related to the organization of the healthcare system and factors related to the clinical management of patients, that were perceived as impacting on the GPs' care provision. The analysis revealed difficulties in communicating with other local services. This, together with the lack of coordination among services, was reported as a major challenge. Primary care was perceived as having been undervalued and criticalities in the organization of GP courses, led in a bureaucratic fashion, posed at risk some trainees to be infected. The digital technologies adopted for remote patient consultations were seen as useful tools for daily practice helping the GPs to stay emotionally connected with their patients. Besides, the improvement in the GP–patient relationship in terms of solidarity between patients and doctors and compliance to rules, had a positive impact. Moreover, many respondents addressed the importance of professional collaboration and teamwork, in terms of both support in practical issues (to find PPE, diagnostics and guidelines) and emotional support. At the same time, the lack of resources (e.g., PPE, swabs) and of specific guidelines and protocols impacted on the care provision. Our findings suggest that GPs in Italy are at risk of being left behind within the epidemic management. Communication and coordination among services are essential and should be substantially improved, and primary care research should be initiated to collect the context-specific evidence necessary to enhance the system's preparedness to public health emergencies and the quality of primary care services.
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Affiliation(s)
- Peter Konstantin Kurotschka
- Department of Medical Sciences and Public Health, Faculty of Medicine and Surgery, University of Cagliari, Cagliari, Italy
| | | | | | | | - Alessandro Mereu
- Azienda Unità Sanitaria Locale Toscana Centro, Sesto Fiorentino, Firenze, Italy
| | - Maria Francesca Moro
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, Faculty of Medicine and Surgery, University of Cagliari, Cagliari, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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21
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Asdaq SMB, Alajlan SA, Mohzari Y, Asad M, Alamer A, Alrashed AA, Nayeem N, Nagaraja S. COVID-19 and Psychological Health of Female Saudi Arabian Population: A Cross-Sectional Study. Healthcare (Basel) 2020; 8:healthcare8040542. [PMID: 33316891 PMCID: PMC7763354 DOI: 10.3390/healthcare8040542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/27/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022] Open
Abstract
The influence of the COVID-19 pandemic is unprecedented on physical and mental health. This study aimed to determine the impact of the COVID-19 event on mental health among Saudi Arabian females of Riyadh by a cross-sectional study design. The samples of the study were recruited using convenience and snowball sampling methods. The questionnaire is composed of items related to sociodemographic profile, general mental status, negative attitude scale, impact of event (COVID-19 pandemic) scale (R) and negative health impact. The data obtained were analyzed using multivariate regression analysis. Out of the 797 samples (34.58 ± 12.89 years), 457 (57.34%) belonged to an age group of ≥25 years. The average BMI of the participants was 26.73 (kg/m2). Significantly (p = 0.000), a large proportion of the participants were overweight and unemployed. Age group (>25 years) have more odds for abnormal mental status (OR; 1.592), development of negative attitudes (OR; 1.986), the intense impact of COVID-19 events (OR; 1.444) and susceptibility to attain negative health impacts (OR; 1.574). High body weight is another risk factor for altered mental status, negative attitude and developing impact of COVID-19 quickly. Overall, the COVID-19 pandemic was directly associated with stress (53%), anxiety (63%) and depression (44%) in our sample population. There is an urgent need for psychological counseling for the distressed population.
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Affiliation(s)
| | | | - Yahya Mohzari
- Pharmacy Department, Clinical Pharmacy Section, King Saud Medical City, Riyadh 12746, Saudi Arabia;
| | - Mohammed Asad
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Shaqra University, Shaqra 11911, Saudi Arabia;
| | - Ahmad Alamer
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA;
- Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Ahmed A. Alrashed
- Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh 11564, Saudi Arabia;
| | - Naira Nayeem
- Department of Pharmaceutical Chemistry, Northern Border University, Arar 73214, Saudi Arabia;
| | - Sreeharsha Nagaraja
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
- Department of Pharmaceutics, Vidya Siri College of Pharmacy, Off Sarjapura Road, Bengaluru 560 035, Karnataka, India
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Samad N, Sodunke TE, Banna HA, Sapkota A, Fatema AN, Iskandar K, Jahan D, Hardcastle TC, Nusrat T, Chowdhury TS, Haque M. Convalescent Plasma Therapy for Management of COVID-19: Perspectives and Deployment in the Current Global Pandemic. Risk Manag Healthc Policy 2020; 13:2707-2728. [PMID: 33262668 PMCID: PMC7695687 DOI: 10.2147/rmhp.s281388] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022] Open
Abstract
The world is striving against the severe crisis of the COVID-19 pandemic. Healthcare professionals are struggling to treat their patients based on nonspecific therapies. Amidst this uncertainty, convalescent plasma therapy (CPT) has appeared to be an interim adjuvant therapy for severely ill patients of COVID-19 until long-term clinical trial treatment options are available. Considering the transfusion-related hazards, especially lung injuries and microbial transmission, where sensitivity is not ensured, rigorous trials should be conducted to determine this therapy's efficacy. Moreover, the ratio of recovered cases to plasma donors is not satisfying, which questioning this therapy's availability and accessibility. Although some countries are making the treatment free, the attributable cost mandates a justification for its suitability and sustainability. Our article aimed to review the published facts and findings of CPT's effectiveness in lowering the mortality rate of COVID-19. This pandemic showed that healthcare systems worldwide need core reform. A unified global collaboration must align and coordinate to face the current pandemic and enhance world readiness for future outbreaks based on health equity and equality.
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Affiliation(s)
- Nandeeta Samad
- Department of Public Health, North South University, Dhaka1229, Bangladesh
| | | | - Hasan Al Banna
- Institute of Social Welfare and Research, University of Dhaka, Dhaka1000, Bangladesh
| | - Ashmita Sapkota
- Department of Microbiology, Mahidol University, Ratchathewi, Bangkok10400, Thailand
| | | | - Katia Iskandar
- School of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Dilshad Jahan
- Department of Hematology, Asgar Ali Hospital, Dhaka1204, Bangladesh
| | - Timothy Craig Hardcastle
- Department of Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Umbilo, Berea4001, South Africa
| | - Tanzina Nusrat
- Department of Microbiology, Chittagong Medical College, Chattogram4203, Bangladesh
| | | | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur57000, Malaysia
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Primary Care Practitioners' Barriers to and Experience of COVID-19 Epidemic Control in China: a Qualitative Study. J Gen Intern Med 2020; 35:3278-3284. [PMID: 32869200 PMCID: PMC7458355 DOI: 10.1007/s11606-020-06107-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) emerged in December 2019 and posed numerous challenges to China's health system. Almost 4 million primary care practitioners (PCPs) participated in controlling the outbreak. However, PCPs' barriers to and experience of the epidemic control remain unknown and are essential for improving countermeasures. OBJECTIVE To better understand the barriers PCPs faced in COVID-19 epidemic control and their psychological and occupational impacts, and explore potential solutions. DESIGN This qualitative study was conducted through semi-structured, in-depth interviews from February 12, to March 10, 2020. PARTICIPANTS A purposive sample of frontline PCPs affiliated with either community health centers or township health centers in four provinces of China were recruited. APPROACH Interviews were conducted by telephone, and then recorded, transcribed, and content analyzed. Themes surrounding PCPs' barriers to COVID-19 epidemic control, their experience, and potential solutions were iteratively identified using the constant comparative method. KEY RESULTS Of the 21 PCPs interviewed, 10 (48%) were women and 5 (24%) worked in rural areas. Barriers to epidemic control in primary care included inappropriate PCP scheduling and role ambiguity, difficult tasks and inadequate capacities, and inexperienced community workers and insufficient cooperation. Some PCPs perceived respect and a sense of accomplishment and were preoccupied with the outbreak, while others were frustrated by fatigue and psychological distress. PCPs reported potential solutions for improving countermeasures, such as improving management, optimizing workflows, providing additional support, facilitating cooperation, and strengthening the primary care system. CONCLUSIONS Due to their roles in controlling the COVID-19 epidemic, PCPs in China faced a series of barriers that affected them physically and mentally. Support for PCPs should help them to overcome these barriers and work efficiently. The current findings provide insight into the challenges and potential solutions for strengthening the preparedness and response of China's primary care system in future disease outbreaks.
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Stuijfzand S, Deforges C, Sandoz V, Sajin CT, Jaques C, Elmers J, Horsch A. Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: a rapid review. BMC Public Health 2020; 20:1230. [PMID: 32787815 PMCID: PMC7422454 DOI: 10.1186/s12889-020-09322-z] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Epidemics or pandemics, such as the current Coronavirus Disease 2019 (COVID-19) crisis, pose unique challenges to healthcare professionals (HCPs). Caring for patients during an epidemic/pandemic may impact negatively on the mental health of HCPs. There is a lack of evidence-based advice on what would be effective in mitigating this impact. OBJECTIVES This rapid review synthesizes the evidence on the psychological impact of pandemics/epidemics on the mental health of HCPs, what factors predict this impact, and the evidence of prevention/intervention strategies to reduce this impact. METHOD According to rapid review guidelines, systematic searches were carried out in Embase.com , PubMed, APA PsycINFO-Ovid SP, and Web of Science (core collection). Searches were restricted to the years 2003 or later to ensure inclusion of the most recent epidemic/pandemics, such as Severe Acute Respiratory Syndrome (SARS). Papers written in French or English, published in peer-reviewed journals, and of quantitative design using validated measures of mental health outcomes were included. Of 1308 papers found, 50 were included. The full protocol for this rapid review was registered with Prospero (reg.no. CRD42020175985). RESULTS Results show that exposed HCPs working with patients during an epidemic/pandemic are at heightened risk of mental health problems in the short and longer term, particularly: psychological distress, insomnia, alcohol/drug misuse, and symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, burnout, anger, and higher perceived stress. These mental health problems are predicted by organizational, social, personal, and psychological factors and may interfere with the quality of patient care. Few evidence-based early interventions exist so far. DISCUSSION HCPs need to be provided with psychosocial support to protect their mental wellbeing if they are to continue to provide high quality patient care. Several recommendations relevant during and after an epidemic/pandemic, such as COVID-19, and in preparation for a future outbreak, are proposed.
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Affiliation(s)
- Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Vania Sandoz
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Consuela-Thais Sajin
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Cecile Jaques
- Medical Library, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jolanda Elmers
- Medical Library, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Avenue Pierre-Decker 2, 1011 Lausanne, Switzerland
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25
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Verhoeven V, Tsakitzidis G, Philips H, Van Royen P. Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs. BMJ Open 2020; 10:e039674. [PMID: 32554730 PMCID: PMC7306272 DOI: 10.1136/bmjopen-2020-039674] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline. DESIGN, SETTING, PARTICIPANTS We performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis. RESULTS Changes in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak-as well as the measures taken to control it-will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves. CONCLUSIONS The current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.
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Affiliation(s)
- Veronique Verhoeven
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
| | - Giannoula Tsakitzidis
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
| | - Hilde Philips
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
| | - Paul Van Royen
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
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Lim WH, Wong WM. COVID-19: Notes From the Front Line, Singapore's Primary Health Care Perspective. Ann Fam Med 2020; 18:259-261. [PMID: 32393562 PMCID: PMC7214001 DOI: 10.1370/afm.2539] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Wei Han Lim
- Division of Primary Care, Raffles Medical Group, Singapore
| | - Wei Mon Wong
- Division of Primary Care, Raffles Medical Group, Singapore
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