Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden

Did the organization of primary care practices during the COVID-19 pandemic influence quality and safety? - an international survey

BACKGROUND

Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload.

OBJECTIVES

This study aimed to investigate the association between primary care practices' organization, and quality and safety changes during the COVID-19 pandemic.

DESIGN

Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as "Only GPs", comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and "Multiprofessional," comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936).

RESULTS

Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more "Multiprofessional" practices, whereas "Only GPs" were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic.

CONCLUSIONS

Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.

How general practitioners used job crafting strategies during the COVID-19 pandemic in Sweden

OBJECTIVE

General practitioners (GPs) played a crucial role in limiting the impact of the COVID-19 pandemic, and many GPs experienced they did not have the prerequisites to provide adequate care. However, GPs developed approaches that helped them to provide care to patients through various job crafting strategies. The aim of this study is to identify how job crafting strategies were deployed by GPs at the beginning of the COVID-19 pandemic in Sweden and the significance of the strategies on their work situation.

DESIGN

A qualitative design with semi-structured interviews. The data was analysed using qualitative content analysis with job crafting as the conceptual framework for the analysis process.

SETTING

Primary healthcare in five healthcare regions in Sweden.

SUBJECTS

Fourteen GPs participated in individual interviews.

RESULTS

In their endeavours to organise and provide care, GPs shaped the task, relational and cognitive boundaries of their work. GPs felt proud about finding new ways of working when given room to manoeuvre. Intensified collaboration between healthcare professionals made GPs more confident in their clinical work. GPs expressed that they consequently felt stronger in their professional role through what they accomplished in the organisation of care.

CONCLUSIONS/IMPLICATIONS

The results suggest that the job crafting strategies GPs used were meaningful to them in clinical practice. Knowledge about how GPs' job crafting strategies were deployed might be useful for healthcare organisations in preparing for future health crises. Taking advantage of GPs' experiences and strategies is considered important for promoting sustainable working conditions for GPs in the future.

Systematic Search and Scoping Review of Physicians' Intolerance of Uncertainty and Medical Decision-Making Uncertainties During the COVID-19 Pandemic: A Summary of the Literature and Directions for Future Research

Pandemic-related uncertainties and intolerance of uncertainty (IU) could negatively affect physicians' well-being and functioning, being associated with experiences of distress and problematic decision-making processes. To summarize the available quantitative and qualitative evidence of physicians' IU and decisional uncertainty during COVID-19 and problems associated with it, a systematic search was conducted to identify all relevant articles describing physician uncertainty with regard to medical decision making and well-being in COVID-19 pandemic conditions. Medical, psychological, and preprint databases were searched. Ten articles met all eligibility criteria, with eight describing quantitative and two describing qualitative research outcomes, assessed primarily in European regions and via online surveys. Associations between IU and symptoms of poor mental health and mental health risk factors were widespread, but inconsistencies emerged. Qualitative studies emphasized decisional uncertainty as a stressor for physicians, and quantitative studies suggest it may have fostered more unproven treatment choices. While the prevalence and impact of physician uncertainty under COVID-19 conditions requires further investigation, sighting available literature indicates that IU coincided with experiences of poor mental health and, at least towards the beginning of the pandemic, with willingness to endorse unproven treatments. Efforts to reduce uncertainty-related problems for physicians seem warranted, for example, through normalizing experiences of uncertainty or reducing avoidable uncertainty through maintaining open and timely communication channels.

Innovations produced in Primary Health Care during the COVID-19 pandemic: an integrative literature review

Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to keep up its provision of regular services as well. This article identifies the main arrangements made to provide PHC care in the context of the COVID-19 pandemic. An integrative literature review of articles found in PubMed, SciELO and LILACS databases was performed using the descriptors "Primary Health Care" and "COVID-19". Findings were analyzed considering three questions: Information and Communication Technologies (ICT), Organizations of Work Processes and Non-COVID Chronic Diseases. The use of different forms of ICT to provide PHC is highlighted regarding patients with respiratory symptoms and chronic patients. Changes in team composition, service flows, physical spaces and working hours were also introduced. Although strategies aimed at monitoring chronic patients and at remote care may have helped minimize deterioration of their health, the decrease in the number of visits performed during this period could have resulted in an increased demand for PHC in post-pandemic years.

Primary Health Care and Tuberculosis Detection during the COVID-19 Pandemic: Crucial Actions for Intensifying Efforts

BACKGROUND

Tuberculosis has been considered a global emergency since 1993, and controlling it has become even more challenging since 2020 due to the health and social crisis resulting from the COVID-19 pandemic. This study aimed to identify the impact of the COVID-19 pandemic on tuberculosis case detection activities within primary health Care in the largest city in Brazil.

METHODS

This is a cross-sectional and analytical study on the provision of tuberculosis detection actions in primary healthcare units during the pandemic period. A descriptive analysis was performed for characterization, and Generalized Mixed Models were used for evaluating associations, with a Bonferroni post hoc test applied.

RESULTS

The study sample comprised 80 health units in the municipality. There was a moderate alteration level in the provision of consultations for individuals with signs and symptoms of tuberculosis in 2020 (13.8%) and in 2021 (15.1%). Statistical significance (p < 0.05) was found between the pandemic period and detection actions, with a lower alteration level in 2022.

CONCLUSIONS

Tuberculosis detection activities underwent changes due to the COVID-19 pandemic, mainly in 2020, which was associated with alterations in consultation and case notification provision.

Quality of care in Belgian general practices during the COVID-19 pandemic: results of the cross-sectional PRICOV-19 study

BACKGROUND

The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries.

METHODS

The data collected from 479 Belgian practices during 2020-2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed.  Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system.

RESULTS

Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries.

CONCLUSIONS

Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care.

"Returning to the core tasks": a qualitative interview study about how general practitioners in home health care solved problems during the COVID-19 pandemic

OBJECTIVE

Optimizing care at home, or home health care (HHC), is necessary as the population of care-dependent older people receiving care at home steadily increases. The COVID-19 pandemic tested Swedish primary care professionals as they provided HHC for a population of very frail older homebound people, but a better understanding of what healthcare workers did to manage the crisis may be useful for the further development of HHC. In this study, we aimed to understand how HHC physicians solved the problems of providing home healthcare during the pandemic to learn lessons on how to improve future HHC.

METHODS

This is a qualitative study of individual interviews with 11 primary care physicians working in HHC (8 women) from 7 primary care practices in Region Stockholm, Sweden. Interviews were conducted between 1 December 2020, and 11 March 2021. The data were analyzed using inductive thematic analysis.

RESULTS

We generated an overarching theme in our analysis: Physicians focus on core tasks and professional values in response to crisis. This theme incorporated three underlying subthemes describing this response: physicians prioritize and resolve ethically challenging situations in new ways, cultivate the patient perspective, and build on existing teams.

CONCLUSION

This study indicates that a healthcare system that gives HHC physicians agency to focus on core tasks and professional values could promote person-centered care.

COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study

INTRODUCTION

A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors.

METHODS

Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors.

RESULTS

The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion.

CONCLUSIONS

COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.

"Who is Anders Tegnell?" Unanswered questions hamper COVID-19 vaccine uptake: A qualitative study among ethnic minorities in Sweden

BACKGROUND

Despite high COVID-19 vaccination coverage in many European countries, vaccination uptake has been lower among ethnic minorities, including in Sweden. This is in spite of the increased risk of contracting the virus and targeted efforts to vaccinate among first and second generation migrants. The aim of this study was to understand this dilemma by investigating ethnic minorities' perceptions and their experience of accessing the COVID-19 vaccine.

METHODS

This is a qualitative study drawing on 18 semi-structured interviews with health volunteers working in ethnic minority communities and with participants from the two largest ethnic minorities in Sweden (Syria and Somalia). Deductive qualitative analysis was completed using the 3C model by WHO (Complacency, Confidence and Convenience).

RESULTS

Complacency does not appear to be a barrier to intention to vaccinate. Participants are well aware of COVID-19 risk and the benefits of the vaccine. However, confidence in vaccine poses a barrier to uptake and there are a lot of questions and concerns about vaccine side effects, efficacy and related rumors. Confidence in health providers, particularly doctors is high but there was a sense of conflicting information. Accessing individually tailored health information and health providers is not convenient and a major reason for delaying vaccination or not vaccinating at all. Trust in peers, schools and faith-leaders is high and constitute pathways for effective health information sharing.

CONCLUSION

Ethnic minorities in Sweden are willing to get vaccinated against COVID-19. However, to increase vaccination uptake, access to individually tailored and face to face health information to answer questions about vaccine safety, efficacy, conflicting information and rumors is urgently required.

Exploring the effects of predominantly female jobs on demands and resources at work and consequently on health and performance in the Province of Québec, Canada

PURPOSE

Predominantly female jobs are undervalued because the importance of the skills (e.g., empathy, meticulousness, patience) they require is underestimated. Based on a sample of 1831 workers, this cross-sectional study aimed to determine the effect of predominantly female jobs on demands and resources at work. It also aimed to evaluate if demands and resources at work played a mediating role in the relationship between female jobs and psychological well-being, psychological distress, insomnia, and intention to quit.

METHODS

Mediation analysis to test indirect effects was conducted using MPlus software.

RESULTS

Predominantly female jobs were directly associated with lower recognition and higher skill utilization and emotional demands. Also, predominantly female jobs were indirectly associated with health and performance via their effects on demands and resources at work. Therefore, these workers appear to face higher demands and lower resources, which in turn is harmful to them.

CONCLUSION

Consequently, we might conclude that in addition to the pay inequity that is still present between men and women, those who hold predominantly female jobs (mostly women) are more vulnerable to health and performance problems because of the working conditions (demands and resources) of these jobs. At the societal level, increased knowledge of predominantly female jobs could also be achieved by, for example, popularizing the training and skills they require. Information campaigns (not just to attract people but also to eliminate misunderstanding of these jobs) could be initiated by unions, professional associations, schools, private companies, guidance or employment counselors, government, etc. At the organizational level, action could be taken in terms of human resource management practices, including job evaluation and remuneration.

The role of primary care during the pandemic: shared experiences from providers in five European countries

BACKGROUND

The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience.

METHODS

The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care.

RESULTS

Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues.

CONCLUSION

Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.

Healthcare Professionals' Resilience During the COVID-19 and Organizational Factors That Improve Individual Resilience: A Mixed-Method Study

Healthcare workers are a susceptible population to be psychologically affected during health crises, such as the recent COVID-19 pandemic. Resilience has been pointed out in the literature as a possible protective factor against psychological distress in crisis situations. This can be influenced by internal and external factors, such as individual characteristics and organizational factors. Thus, this study aims to characterize the overall resilience levels among healthcare professionals in Portugal and to understand the perspectives of this healthcare workers regarding organizational factors that improve individual resilience. This is a mixed-method study: a first quantitative study using a cross-sectional design to administer the Resilience Scale for Adults (RSA) to 271 healthcare professionals (Mage 33.90, SD = 9.59 years, 90.80% female), followed by a qualitative study through 10 in-depth interviews. The mean score for the total RSA was 178.17 (SD = 22.44) out of a total of 231. Qualitative analysis showed 4 major themes on factors that enhance resilience: "Professional's Training," "Support and Wellbeing Measures," "Reorganization of Services" and "Professional Acknowledgment." The findings may contribute to the development of targeted interventions and support systems to enhance resilience and well-being among healthcare workers.

How does the work-life balance impact stress on primary healthcare workers during the COVID-19 pandemic?

BACKGROUND

Most studies in advanced care settings reported that the increasing workload increases the work-life imbalance and harms the mental health of health workers. The COVID-19 Pandemic's tracing, testing, treatment, and mass vaccination also have multiplied the primary healthcare workers' workload. Nevertheless, studies on primary care workers are scarce. This study aimed to investigate how the COVID-19-related work-life balance impact stress on primary healthcare workers in the third years of the pandemic.

METHODS

The study was a cross-sectional, web-based survey conducted on primary healthcare workers in Kediri Regency, Indonesia, with the highest Omicron case surge worldwide. It was conducted right after the surge between July and August 2022, the third year of the COVID-19 pandemic hit Indonesia. Under coordination with the local government health officials, primary healthcare workers were invited to participate in an online survey. The respondents were asked to evaluate their sociodemography, work conditions, personal life, and perceived stress (using the Perceived Stress Scale) during the pandemic. Their work-life balance was evaluated using the Work/Non-work Interference and Enhancement Scale. We used several hierarchical linear regression models to determine which variables contribute to work stress among primary healthcare workers.

RESULTS

Sociodemographic characteristics, including gender, age, marital status, years of professional experience, and educational level, were not significantly associated with stress levels among our respondents. Separately, work conditions and personal life variables did not associate with stress levels. However, primary healthcare workers' work and personal lives interfere with each other during the pandemic and are associated with their higher stress.

CONCLUSION

During the pandemic, the work life of primary health workers interferes with their personal life more than the interference of personal life on their work life. At the same time, the work life's enhancement on the personal life and vice versa were lower than its interference. Those conditions are associated with higher perceived stress of primary health workers.

Changes in physiotherapy services and use of technology for people with multiple sclerosis during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has led to reorganization or reduction of neurorehabilitation services for people with multiple sclerosis (PwMS). The aim of this study was to explore the changes in the organizational framework and technology usage in physiotherapy services for PwMS during the COVID-19 pandemic.

METHODS

This international cross-sectional survey study was designed, developed, and disseminated by RIMS European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation. Physiotherapists from nine countries (Australia, Belgium, Czech Republic, Ireland, Israel, Italy, Norway, Spain, Turkey) who provided physiotherapy services to PwMS, were invited to complete an online survey to compare physiotherapy delivery to PwMS prior to and during the pandemic period.

RESULTS

The survey was completed by 215 physiotherapists. Accessibility, the average number, length and perceived effectiveness of physiotherapy sessions provided to PwMS were significantly reduced during the COVID-19 pandemic (p=0.001). Physiotherapists increased the advice of mobile apps, recorded videos for rehabilitation and exercise websites during the pandemic (p<0.001) while the use of telerehabilitation and virtual reality technology did not change.

CONCLUSION

There was of a reduction in the number, duration and perceived effectiveness of rehabilitation sessions for people with multiple sclerosis during the COVID-19 pandemic while use of remote technologies for physiotherapy did not change. To ensure the continuity of physiotherapy for PwMS with complex healthcare needs also during pandemics, the provision of guidelines and training in telehealth technologies in professional education becomes crucial.

COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave

General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.

Health Consequences of the COVID-19 Pandemic among Health-Care Workers: A Comparison between Groups Involved and Not Involved in COVID-19 Care

Health consequences have been reported among health-care workers (HCWs) exposed to COVID-19. Sweden chose to manage the pandemic with a lower and more equal long-lasting work strain and shorter periods of recovery than in other countries. Few studies have examined the health consequences among HCWs working in such conditions. This study compared the health consequences after the first wave of the COVID-19 pandemic between HCWs involved in the care of COVID-19 patients and other HCWs and between occupational groups working in COVID-19 care. Multinomial logistic regression and univariate general linear models were used to identify differences. The levels of depression, emotional and physical fatigue, sleep quality, and general health were measured 6 months after the onset of the pandemic in 3495 HCW employed in Sweden. HCWs directly involved in COVID-19 care reported significantly poorer sleep quality and higher scores on emotional and physical exhaustion than those not involved in such care. Health consequences did not differ significantly between different occupational groups involved in COVID-19 care except for specialist nurses/midwives. HCWs more frequently involved in COVID-19 care reported higher levels of emotional and physical fatigue and poorer sleep but less severe than those reported in more severely affected countries.

Primary healthcare providers challenged during the COVID-19 pandemic: a qualitative study

BACKGROUND

Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and long-lasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers' experiences with coronavirus pandemic preparedness and response in Armenia.

METHODS

We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the "SPSS22.0.0.0" software.

RESULTS

Five main themes of primary healthcare providers' experiences were drawn out based on the study findings: 1) the gap in providers' risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers' experiences during the pandemic. The study highlighted the health systems' unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers' behalf.

CONCLUSION

The study discovered that PHC providers have a very important role in healthcare system's preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment.

Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study

OBJECTIVE

When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change.

DESIGN

Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September-December 2020, the second round from January-April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2-4 months apart. To analyze the data, we used thematic analysis.

RESULTS

The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal.

CONCLUSIONS

Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.Key PointsFacing the COVID-19 pandemic, the primary health care service in Norway had to reorganize to ensure safe patient treatment and maintain infection control.Several GPs experienced challenges in collaboration with the municipalities.There is a need for clarification of responsibilities between GPs and the municipality.

The Moral, Ethical, Personal, and Professional Challenges Faced by Physicians during the COVID-19 Pandemic

The COVID-19 pandemic, apart from the main problems concerning the health and life of patients, sparked a discussion about physicians’ moral and social professional attitudes. During a pandemic, physicians have the same ethical, moral, and medical responsibilities, however, the situation is different since they are self-exposed to a danger, which may influence their willingness to work. The problem of the professional moral attitudes of health care workers, recurring in ethical discussions, prompts us to define the limits of the duties of physicians in the event of a pandemic, hence this research aimed to assess these duties from an ethical perspective and to define their boundaries and scope. The study was conducted in May and June 2020 in the city of Lublin, covering all medical centers, and the questionnaire was completed by 549 physicians. The research was conducted in four areas: emergency standby in the event of a disaster, even if it is not requested; willingness to work overtime in the event of a disaster, even without payment; willingness to take health risks by caring for people who are infectious or exposed to hazardous substances; readiness to be transferred to other departments in the event of a disaster. Although most of the respondents declared to be agreed on personal sacrifices in the performance of professional duties, they were not prepared for a high level of personal risk when working in a pandemic. Excessive workload, its overwhelming nature, and personal risk are not conducive to readiness to work overtime, especially without pay. Research shows how important it is to respect the rights and interests of all parties involved in a pandemic. Physicians’ duty to care for a patient is also conditioned by the duty to protect themselves and should not be a tool for intimidating and depersonalizing their social and professional lives.