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Watkins VJ, Shee AW, Field M, Alston L, Hills D, Albrecht SL, Ockerby C, Hutchinson AM. Rural healthcare workforce preparation, response, and work during the COVID-19 pandemic in Australia: Lessons learned from in-depth interviews with rural health service leaders. Health Policy 2024; 145:105085. [PMID: 38820760 DOI: 10.1016/j.healthpol.2024.105085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Low population density, geographic spread, limited infrastructure and higher costs are unique challenges in the delivery of healthcare in rural areas. During the COVID-19 pandemic, emergency powers adopted globally to slow the spread of transmission of the virus included population-wide lockdowns and restrictions upon movement, testing, contact tracing and vaccination programs. The aim of this research was to document the experiences of rural health service leaders as they prepared for the emergency pandemic response, and to derive from this the lessons learned for workforce preparedness to inform recommendations for future policy and emergency planning. METHODOLOGY AND METHODS Interviews were conducted with leaders from two rural public health services in Australia, one small (500 staff) and one large (3000 staff). Data were inductively coded and analysed thematically. PARTICIPANTS Thirty-three participants included health service leaders in executive, clinical, and administrative roles. FINDINGS Six major themes were identified: Working towards a common goal, Delivery of care, Education and training, Organizational governance and leadership, Personal and psychological impacts, and Working with the Local Community. Findings informed the development of a applied framework. CONCLUSION The study findings emphasise the critical importance of leadership, teamwork and community engagement in preparing the emergency pandemic response in rural areas. Informed by this research, recommendations were made to guide future rural pandemic emergency responses or health crises around the world.
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Affiliation(s)
- Vanessa J Watkins
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety in the Institute for Health Transformation, Geelong, Victoria Australia.
| | - Anna Wong Shee
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Michael Field
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia; Western Alliance Academic Health Science Centre, Geelong, Victoria, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Danny Hills
- Federation University Australia, Health Innovation and Transformation Centre, Ballarat, Victoria, Australia
| | - Simon L Albrecht
- Deakin University, School of Psychology, Burwood, Victoria, Australia
| | | | - Alison M Hutchinson
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety in the Institute for Health Transformation, Geelong, Victoria Australia; Barwon Health, Geelong, Victoria, Australia
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Al Qaf'an E, Alford S, Porteous K, Lim D. Healthcare Decision-Making in a Crisis: A Qualitative Systemic Review Protocol. Emerg Med Int 2024; 2024:2038608. [PMID: 38715979 PMCID: PMC11074907 DOI: 10.1155/2024/2038608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/16/2024] [Accepted: 03/23/2024] [Indexed: 05/12/2024] Open
Abstract
Background. Throughout history, communities have faced outbreaks of infectious diseases and other natural and man-made disasters that pose significant threats to lives, public health, and business continuity. Many of these disasters are crises that require critical decisions to be made in a short, crucial time with limited information and unforeseen circumstances amidst panic, fear, and shock. The COVID-19 pandemic is a recent example, with public leaders responding to and formulating strategies to attenuate the relentless waves of transmission and surges in resource demands. The pandemic underscored the importance of understanding how healthcare leaders make decisions in-crisis and what factors healthcare leaders prioritize in their decision-making process. Methods/Design. PubMed(NLM), Embase(Ovid), Scopus(Elsevier), Business Source(EBSCOhost), and ProQuest will be searched for primary qualitative studies published in English to explore the multi-faceted decision-making processes of healthcare leaders during a public health crisis. A meta-ethnographic approach will synthesize insights into healthcare leaders' experiences and perspectives and generate a conceptual theory of decision-making in crisis. Discussion. Understanding how healthcare leaders make critical decisions during public health crises takes advantage of the lessons learned to inform how future health crises are managed. (This systematic review is registered in PROSPERO: CRD42023475382).
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Affiliation(s)
- Ehmaidy Al Qaf'an
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, Ultimo, Australia
| | - Stewart Alford
- Kaplan Business School, Kaplan Australia, Brisbane, Australia
| | - Kimberley Porteous
- Education and Research Services (Health), UTS Library, University of Technology Sydney, Broadway, Ultimo, Australia
| | - David Lim
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, Ultimo, Australia
- Mparntwe Centre for Evidence in Health: A JBI Centre of Excellence, Alice Springs, Australia
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Lee GW, Vine K, Atkinson AR, Tong M, Longman J, Barratt A, Bailie R, Vardoulakis S, Matthews V, Rahman KM. Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6285. [PMID: 37444133 PMCID: PMC10341403 DOI: 10.3390/ijerph20136285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023]
Abstract
Climate change is exposing populations to increasing temperatures and extreme weather events in many parts of Australia. To prepare for climate challenges, there is a growing need for Local Health Districts (LHDs) to identify potential health impacts in their region and strengthen the capacity of the health system to respond accordingly. This rapid review summarised existing evidence and research gaps on the impact of climate change on health and health services in Northern New South Wales (NSW)-a 'hotspot' for climate disaster declarations. We systematically searched online databases and selected 11 peer-reviewed studies published between 2012-2022 for the Northern NSW region. The most explored health outcome was mental health in the aftermath of floods and droughts, followed by increased healthcare utilisation due to respiratory, cardiovascular and mortality outcomes associated with bushfire smoke or heat waves. Future research directions were recommended to understand: the compounding impacts of extreme events on health and the health system, local data needs that can better inform models that predict future health risks and healthcare utilisation for the region, and the needs of vulnerable populations that require a whole-of-system response during the different phases of disasters. In conclusion, the review provided climate change and health research directions the LHD may undertake to inform future adaptation and mitigation policies and strategies relevant to their region.
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Affiliation(s)
- Grace W. Lee
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia;
| | - Kristina Vine
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Amba-Rose Atkinson
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- School of Public Health, Faculty of Medicine, the University of Queensland, St. Lucia, QLD 4072, Australia
| | - Michael Tong
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
| | - Jo Longman
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- Sydney Environment Institute, University of Sydney, Camperdown, NSW 2006, Australia
| | - Alexandra Barratt
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia;
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Ross Bailie
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Sotiris Vardoulakis
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
| | - Veronica Matthews
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Kazi Mizanur Rahman
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Sydney Environment Institute, University of Sydney, Camperdown, NSW 2006, Australia
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Turner S, Isaac V, Lim D. A Qualitative Study of Rural and Remote Australian General Practitioners' Involvement in High-Acuity Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054548. [PMID: 36901557 PMCID: PMC10001441 DOI: 10.3390/ijerph20054548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/01/2023]
Abstract
This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners' involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic approaches incorporating Potter and Brough's capacity-building framework. Eighteen interviews were conducted. Barriers identified include the inability to avoid high-acuity work in rural and remote areas, pressure to handle complex presentations, lack of appropriate resources, lack of mental health support for clinicians, and impacts on social life. Enablers included a commitment to community, comradery in rural medicine, training, and experience. We concluded that general practitioners are a vital pillar of rural health service delivery and are inevitably involved in disaster and emergency response. While the involvement of rural general practitioners with high-acuity patients is complex, this study suggested that with the appropriate system, structure and role supports, rural general practitioners could be better empowered to manage high-acuity caseloads locally.
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Affiliation(s)
- Sinead Turner
- Riverland Mallee Coorong Local Health Network, Berri, SA 5343, Australia
| | - Vivian Isaac
- School of Allied Health, Exercise and Sports Sciences, Faculty of Science and Health, Charles Sturt University, Albury, NSW 2640, Australia
| | - David Lim
- Translational Health Research Institute, School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
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Petrazzuoli F, Collins C, Van Poel E, Tatsioni A, Streit S, Bojaj G, Asenova R, Hoffmann K, Gabrani J, Klemenc-Ketis Z, Rochfort A, Adler L, Windak A, Nessler K, Willems S. Differences between Rural and Urban Practices in the Response to the COVID-19 Pandemic: Outcomes from the PRICOV-19 Study in 38 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3674. [PMID: 36834369 PMCID: PMC9958860 DOI: 10.3390/ijerph20043674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
This paper explores the differences between rural and urban practices in the response to the COVID-19 pandemic, emphasizing aspects such as management of patient flow, infection prevention and control, information processing, communication and collaboration. Using a cross-sectional design, data were collected through the online PRICOV-19 questionnaire sent to general practices in 38 countries. Rural practices in our sample were smaller than urban-based practices. They reported an above-average number of old and multimorbid patients and a below-average number of patients with a migrant background or financial problems. Rural practices were less likely to provide leaflets and information, but were more likely to have ceased using the waiting room or to have made structural changes to their waiting room and to have changed their prescribing practices in terms of patients attending the practices. They were less likely to perform video consultations or use electronic prescription methods. Our findings show the existence of certain issues that could impact patient safety in rural areas more than in urban areas due to the underlying differences in population profile and supports. These could be used to plan the organization of care for similar future pandemic situations.
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Affiliation(s)
- Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, 21428 Malmö, Sweden
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Gazmend Bojaj
- Department of Management of Health Services and Institution, Heimerer College, 1000 Pristina, Kosovo
| | - Radost Asenova
- Department of Urology and General Practice, Faculty of Medicine, Medical University Plovdiv, 4003 Plovdiv, Bulgaria
| | - Kathryn Hoffmann
- Department of Social- and Preventive Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | - Zalika Klemenc-Ketis
- Department of Family Medicine, Medical Faculty, University of Maribor, Tabroska 8, 2000 Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski Nasip 58, 1000 Ljubljana, Slovenia
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Andrée Rochfort
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Dewi SP, Kasim R, Sutarsa IN, Hunter A, Dykgraaf SH. Effects of climate-related risks and extreme events on health outcomes and health utilization of primary care in rural and remote areas: a scoping review. Fam Pract 2023; 40:486-497. [PMID: 36718099 DOI: 10.1093/fampra/cmac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Rural populations are at risk of climate-related impacts due to ecological and geographical determinants, potentially leading to greater morbidity and health utilization. They are often highly dependent on primary care services. However, no rural- or primary care specific synthesis of these issues has ever been conducted. This review aimed to identify, characterize, and summarize existing research on the effects of climate-related events on utilization and health outcomes of primary care in rural and remote areas and identify related adaptation strategies used in primary care to climate-related events. METHODS A scoping review following PRISMA-ScR guidelines was conducted, examining peer-reviewed English-language articles published up to 31 October 2022. Eligible papers were empirical studies conducted in primary care settings that involved climate-related events as exposures, and health outcomes or utilization as study outcomes. Two reviewers independently screened and extracted relevant information from selected papers. Data were analysed using content analysis and presented using a narrative approach. RESULTS We screened 693 non-duplicate papers, of those, 60 papers were analysed. Climate-related events were categorized by type, with outcomes described in terms of primary, secondary, and tertiary effects. Disruption of primary care often resulted from shortages in health resources. Primary care may be ill-prepared for climate-related events but has an important role in supporting the development of community. CONCLUSIONS Findings suggest various effects of climate-related events on primary care utilization and health outcomes in rural and remote areas. There is a need to prepare rural and remote primary care service before and after climate-related events.
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Affiliation(s)
- Sari Puspa Dewi
- Rural Clinical School, School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australia.,Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Rosny Kasim
- Rural Clinical School, School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australia
| | - I Nyoman Sutarsa
- Rural Clinical School, School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australia.,Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Arnagretta Hunter
- Rural Clinical School, School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australia
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Corpuz JC. Disaster Response during Super Typhoons in the Philippines. Prehosp Disaster Med 2022; 38:1-2. [PMID: 36537802 DOI: 10.1017/s1049023x22002333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jeff Clyde Corpuz
- Department of Theology and Religious Education, De La Salle University, Manila1004, Philippines
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Mental Health Response to Disasters: Is There a Role for a Primary Care-Based Clinician? Prehosp Disaster Med 2022; 37:706-711. [PMID: 36073167 PMCID: PMC9470519 DOI: 10.1017/s1049023x22001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction: Following natural disasters, rural general practitioners (GPs) are expected to undertake several roles, including identifying those experiencing psychological distress and providing evidence-informed mental health care. This paper reports on a collaborative mental health program developed to support a rural GP practice (population <1,500) and a disaster response service. Methods: The program provided specialized disaster mental health care via the placement of a clinician in the GP facility. In collaboration with the GP practice, the program offered opportunistic screening using the Primary Care Posttraumatic Stress Disorder (PTSD) Scale (PC-PTSD) for probable PTSD as the primary measure and the Kessler 6 (K6) as a secondary measure. Those scoring higher than two on the PC-PTSD scale were referred to the mental health clinician (MHC) for further assessment and treatment. Results: Sixty screening assessments were completed. Fourteen patients (male = 3; female = 11) scored higher than two on the PC-PTSD. The referred group PC-PTSD mean score was 3.14 and K6 mean score of 19. Those not referred had a PC-PTSD mean score = 0.72 and K6 mean score = 7.30. The treatment and non-treatment groups differed significantly (PC-PTSD: P <.00001 and K6: P <.00001). A prior history of trauma exposure was notable in the intervention group. Eight reported a history of domestic violence, seven histories of sexual abuse, five childhood sexual abuse, and eight intimate partner violence (IPV). Conclusion: A post-disaster integrated GP and mental health program in a rural community can assist in identifying individuals experiencing post-disaster psychological distress using opportunistic psychological screening. The findings indicate that collaborative mental health programs may effectively support rural communities post-disaster.
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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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To Watch Before or Listen While Doing? A Randomized Pilot of Video-Modelling versus Telementored Tube Thoracostomy. Prehosp Disaster Med 2022; 37:71-77. [PMID: 35177133 DOI: 10.1017/s1049023x22000097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND New care paradigms are required to enable remote life-saving interventions (RLSIs) in extreme environments such as disaster settings. Informatics may assist through just-in-time expert remote-telementoring (RTM) or video-modelling (VM). Currently, RTM relies on real-time communication that may not be reliable in some locations, especially if communications fail. Neither technique has been extensively developed however, and both may be required to be performed by inexperienced providers to save lives. A pilot comparison was thus conducted. METHODS Procedure-naïve Search-and-Rescue Technicians (SAR-Techs) performed a tube-thoracostomy (TT) on a surgical simulator, randomly allocated to RTM or VM. The VM group watched a pre-prepared video illustrating TT immediately prior, while the RTM group were remotely guided by an expert in real-time. Standard outcomes included success, safety, and tube-security for the TT procedure. RESULTS There were no differences in experience between the groups. Of the 13 SAR-Techs randomized to VM, 12/13 (92%) placed the TT successfully, safely, and secured it properly, while 100% (11/11) of the TT placed by the RTM group were successful, safe, and secure. Statistically, there was no difference (P = 1.000) between RTM or VM in safety, success, or tube security. However, with VM, one subject cut himself, one did not puncture the pleura, and one had barely adequate placement. There were no such issues in the mentored group. Total time was significantly faster using RTM (P = .02). However, if time-to-watch was discounted, VM was quicker (P = .000). CONCLUSIONS Random evaluation revealed both paradigms have attributes. If VM can be utilized during "travel-time," it is quicker but without facilitating "trouble shooting." On the other hand, RTM had no errors in TT placement and facilitated guidance and remediation by the mentor, presumably avoiding failure, increasing safety, and potentially providing psychological support. Ultimately, both techniques appear to have merit and may be complementary, justifying continued research into the human-factors of performing RLSIs in extreme environments that are likely needed in natural and man-made disasters.
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