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Tureck F, Chioro A, Tofani LFN, Lima CL, Vieira ADCS, Andreazza R. Innovations produced in Primary Health Care during the COVID-19 pandemic: an integrative literature review. CIENCIA & SAUDE COLETIVA 2024; 29:e07022023. [PMID: 38896673 DOI: 10.1590/1413-81232024296.07022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 06/21/2024] Open
Abstract
Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to keep up its provision of regular services as well. This article identifies the main arrangements made to provide PHC care in the context of the COVID-19 pandemic. An integrative literature review of articles found in PubMed, SciELO and LILACS databases was performed using the descriptors "Primary Health Care" and "COVID-19". Findings were analyzed considering three questions: Information and Communication Technologies (ICT), Organizations of Work Processes and Non-COVID Chronic Diseases. The use of different forms of ICT to provide PHC is highlighted regarding patients with respiratory symptoms and chronic patients. Changes in team composition, service flows, physical spaces and working hours were also introduced. Although strategies aimed at monitoring chronic patients and at remote care may have helped minimize deterioration of their health, the decrease in the number of visits performed during this period could have resulted in an increased demand for PHC in post-pandemic years.
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Affiliation(s)
- Fernando Tureck
- Escola de Medicina, Universidade do Contestado. Av. Nereu Ramos 1071, Jardim do Moinho. 89300-000 Mafra SC Brasil.
| | - Arthur Chioro
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Luís Fernando Nogueira Tofani
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Carolina Loyelo Lima
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Amanda da Cruz Santos Vieira
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Rosemarie Andreazza
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
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Costeira C, Dixe MA, Querido A, Rocha A, Vitorino J, Santos C, Laranjeira C. Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis. Healthcare (Basel) 2024; 12:188. [PMID: 38255076 PMCID: PMC10815185 DOI: 10.3390/healthcare12020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The COVID-19 pandemic imposed changes upon the capacity of healthcare systems, with significant repercussions on healthcare provision, particularly at end-of-life. This study aims to analyze the concept map of death unpreparedness due to the COVID-19 pandemic, capturing the relationships among the attributes, antecedents, consequences, and empirical indicators. Walker and Avant's method was used to guide an analysis of this concept. A literature search was performed systematically, between May 2022 and August 2023, using the following electronic databases on the Elton Bryson Stephens Company (EBSCO) host platform: Medical Literature Analysis and Retrieval System Online (Medline), Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, and Nursing and Allied Health Collection. Thirty-four articles were retrieved. The unexpected and unpredictable impositions associated with inexperience and unskillfulness in dealing with COVID-19 configured challenges for healthcare professionals, family/caregivers, and even the dying person. Nine key attributes emerged in three main domains: (1) Individual: (a) disease-related conditions, (b) separation distress, and (c) scarcity of death and grief literacy; (2) Relational: (a) Dying alone, (b) poor communication, and (c) existential issues; and (3) Contextual: (a) disrupted collective mourning and grieving, (b) disrupted compassionate care and, (c) pandemic social stigma. This study contributed a full definition of death unpreparedness in a global pandemic scenario such as COVID-19. In this sense, feeling unprepared or unready for death brought new challenges to the bioecological resources of those affected. It is essential to embrace strategies capable of providing emotional and spiritual support in the dying process and to respect patient wishes. The lessons learned from COVID-19 should be applied to events with a comparable impact to minimize their consequences.
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Affiliation(s)
- Cristina Costeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Maria Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
| | - Ana Querido
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Ana Rocha
- Nursing School of Coimbra, Avenida Bissaya Barreto s/n, 3004-011 Coimbra, Portugal;
| | - Joel Vitorino
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, 3000-075 Coimbra, Portugal
| | - Cátia Santos
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
| | - Carlos Laranjeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
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Ferguson E, Wiseman L, Stratton F, Evans C, Linton J, McLeod L, MacArthur J. Exploring the delivery of end-of-life care by community nurses. Br J Community Nurs 2023; 28:542-548. [PMID: 37930858 DOI: 10.12968/bjcn.2023.28.11.542] [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] [Indexed: 11/08/2023]
Abstract
AIMS To understand what aspects of care and support were important to bereaved relatives and to explore the experiences of nurses delivering end of life care. METHODS Interviews and focus groups were undertaken with 17 family members, 31 community nurses and 13 community hospital staff. A workshop was held with 6 family members, 13 community nurses and 3 hospital nurses to review findings and make recommendations for improvement. FINDINGS Four themes were identified: relationships and being treated as a whole person; being able to make choices; getting help when and where it is needed; specialist advice and care, especially at the very end of life. CONCLUSION Seeking feedback from relatives was valued both by family members and the staff and has provided an effective model to lead to focussed improvements.
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Affiliation(s)
| | - Leanne Wiseman
- District Nurse, Penicuik Health Centre, Midlothian, Scotland
| | - Fiona Stratton
- Chief Nurse Midlothian Health and Social Care Partnership, Fairfield House, Dalkeith, Scotland
| | - Catherine Evans
- Planning Officer - Older People, Midlothian Health and Social Care Partnership, Fairfield House, Dalkeith, Scotland
| | - Joanna Linton
- Student District Nurse, Bonnyrigg Health Centre, Midlothian, Scotland
| | - Laura McLeod
- Community Staff Nurse, Newbattle Medical Practice, Midlothian, Scotland
| | - Juliet MacArthur
- Chief Nurse Research and Development, NHS Lothian, Waverley Gate, Waterloo Place, Edinburgh, Scotland
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Bailey C, Guo P, MacArtney J, Finucane A, Meade R, Swan S, Wagstaff E. "Palliative care is so much more than that": a qualitative study exploring experiences of hospice staff and bereaved carers during the COVID-19 pandemic. Front Public Health 2023; 11:1139313. [PMID: 38026434 PMCID: PMC10662348 DOI: 10.3389/fpubh.2023.1139313] [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: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background The way in which end-of-life care was provided changed significantly during the first 2 years of the COVID-19 pandemic. The national lockdown restrictions reduced formal care support services and increased the burden on many carers taking on the caring role for the first time. We aimed to explore decision-making about the place of care during the COVID-19 pandemic and the impact on experience from the perspectives of carers and hospice staff caring for people at the end-of-life. Methods A qualitative study using virtual interviews was conducted between October 2020 and April 2021. Data were analyzed thematically using framework analysis, an analytical framework that enables qualitative research to be organized into defined themes derived from the research question. Findings were presented to stakeholders in policy roundtables between March 2022 and March 2023 and discussed collaboratively with staff, stakeholders, and the public to inform policy and practice change. Findings A total of 37 participants (15 bereaved carers and 22 staff) were recruited via hospice services in England and Scotland. Four key themes were identified: (1) changing preferences relating to decision-making about the place of care and the impact at the time of death and into bereavement; (2) missed opportunities related to not being there, not having others around, and being robbed of memory-making; (3) the lone carer during a period of high intensity and reduced home support; (4) process vs. person-centered care resulting from changing rules and restrictions and prioritization of regulations over essential palliative care. Conclusion The study provides valuable global implications for all involved in end-of-life care. Despite great efforts to provide dignified, quality care, palliative care during the pandemic changed, focusing on essential 'physical care'. The psychological suffering experienced by staff and carers may need longer-term support mechanisms put in place, which will benefit from a public health approach. Policymakers should consider improving carer identification and resources for wider end-of-life care education to support the needs of carers, health and social care staff, and citizens.
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Affiliation(s)
- Cara Bailey
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - Ping Guo
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - John MacArtney
- Unit of Primary Care, University of Warwick, Coventry, United Kingdom
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
- Marie Curie Hospice, Edinburgh, United Kingdom
| | - Richard Meade
- Clinical Psychology, Carers UK, Edinburgh, United Kingdom
| | - Susan Swan
- Maggie's Glasgow, Glasgow, United Kingdom
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Plagg B, Ballmann J, Ewers M. Hospice and Palliative Care during Disasters: A Systematic Review. Healthcare (Basel) 2023; 11:2382. [PMID: 37685416 PMCID: PMC10486474 DOI: 10.3390/healthcare11172382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Providing and maintaining hospice and palliative care during disasters poses significant challenges. To understand the impact of disasters on the provision of hospice and palliative care and the disaster preparedness initiatives in the field, a systematic review was undertaken. Eligibility criteria for the selection of studies were: peer-reviewed original research papers addressing HPC during disasters published between January 2001 and February 2023 in English. The databases CINAHL, MEDLINE, APA PsycInfo, APA PsycArticles, and SocINDEX were searched with textword and MeSh-terms between October 2022 and February 2023. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the studies. Content analysis was performed. The results are presented in the form of a narrative synthesis. Of 2581 studies identified, 57 met the inclusion criteria. Most studies were published recently on the impact of the COVID-19 pandemic. Four main themes were identified in the literature: disruption of the system, setting-specific differences, emotional challenges, and system adaptation. Overall, strategies to tackle hospice and palliative care needs have been poorly integrated in disaster preparedness planning. Our findings highlight the need to strengthen the resilience of hospice and palliative care providers to all types of disasters to maintain care standards.
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Affiliation(s)
- Barbara Plagg
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
- Institute of General Practice and Public Health, College of Health Care Professions–Claudiana, Lorenz-Böhler-Straße 13, 39100 Bolzano, Italy
| | - Julia Ballmann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
| | - Michael Ewers
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
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Wang Y, Chukwusa E, Koffman J, Curcin V. Public Opinions About Palliative and End-of-Life Care During the COVID-19 Pandemic: Twitter-Based Content Analysis. JMIR Form Res 2023; 7:e44774. [PMID: 37368840 PMCID: PMC10408639 DOI: 10.2196/44774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Palliative and end-of-life care (PEoLC) played a critical role in relieving distress and providing grief support in response to the heavy toll caused by the COVID-19 pandemic. However, little is known about public opinions concerning PEoLC during the pandemic. Given that social media have the potential to collect real-time public opinions, an analysis of this evidence is vital to guide future policy-making. OBJECTIVE This study aimed to use social media data to investigate real-time public opinions regarding PEoLC during the COVID-19 crisis and explore the impact of vaccination programs on public opinions about PEoLC. METHODS This Twitter-based study explored tweets across 3 English-speaking countries: the United States, the United Kingdom, and Canada. From October 2020 to March 2021, a total of 7951 PEoLC-related tweets with geographic tags were retrieved and identified from a large-scale COVID-19 Twitter data set through the Twitter application programming interface. Topic modeling realized through a pointwise mutual information-based co-occurrence network and Louvain modularity was used to examine latent topics across the 3 countries and across 2 time periods (pre- and postvaccination program periods). RESULTS Commonalities and regional differences among PEoLC topics in the United States, the United Kingdom, and Canada were identified specifically: cancer care and care facilities were of common interest to the public across the 3 countries during the pandemic; the public expressed positive attitudes toward the COVID-19 vaccine and highlighted the protection it affords to PEoLC professionals; and although Twitter users shared their personal experiences about PEoLC in the web-based community during the pandemic, this was more prominent in the United States and Canada. The implementation of the vaccination programs raised the profile of the vaccine discussion; however, this did not influence public opinions about PEoLC. CONCLUSIONS Public opinions on Twitter reflected a need for enhanced PEoLC services during the COVID-19 pandemic. The insignificant impact of the vaccination program on public discussion on social media indicated that public concerns regarding PEoLC continued to persist even after the vaccination efforts. Insights gleaned from public opinions regarding PEoLC could provide some clues for policy makers on how to ensure high-quality PEoLC during public health emergencies. In this post-COVID-19 era, PEoLC professionals may wish to continue to examine social media and learn from web-based public discussion how to ease the long-lasting trauma caused by this crisis and prepare for public health emergencies in the future. Besides, our results showed social media's potential in acting as an effective tool to reflect public opinions in the context of PEoLC.
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Affiliation(s)
- Yijun Wang
- Department of Population Health Sciences, King's College London, London, United Kingdom
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, King's College London, London, United Kingdom
| | - Jonathan Koffman
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Vasa Curcin
- Department of Population Health Sciences, King's College London, London, United Kingdom
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Cheng HL, Leung DYP, Chung MW, Ko PS. The Nature and Types of Community Palliative and end-of-Life Care Services: A Content Analysis of Service Provider Websites in Hong Kong. J Palliat Care 2023; 38:101-110. [PMID: 36112950 DOI: 10.1177/08258597221125285] [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: 11/16/2022]
Abstract
OBJECTIVE To analyze the nature and types of community palliative and end-of-life care (PEoLC) services in Hong Kong in order to inform future service development. METHODS This cross-sectional descriptive study systematically searched the eligible websites of service providers concerning community PEoLC services for patients and their family caregivers using the Hong Kong version of the Google Search engine in August 2021. Search terms included different traditional Chinese translations of palliative care, end-of- lifecare, and hospice care. For the included websites, information regarding the characteristics and types of PEoLC services were extracted and coded using content analysis. RESULTS Sixteen websites providing community PEoLC services were included in this analysis, which were almost all provided by non-governmental organizations (NGOs). Around half of the service providers targeted the geriatric group and served the population in some major geographic areas and districts only. Ten types of services were identified, including (1) information and advice; (2) psychological support; (3) dying and bereavement care; (4) spiritual support; (5) medical and nursing care; (6) leisure and social well-being activities; (7) support with household and other practical tasks; (8) referral resources; (9) financial support; and (10) caregiving skills training. CONCLUSION Existing community PEoLC services in Hong Kong are provided mainly by NGOs, with a focus on comprehensive care for patients in some areas and districts but few support services for caregivers. There is a need for continued efforts to optimize the PEoLC services to support patients and caregivers locally.
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Affiliation(s)
- Hui-Lin Cheng
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Doris Yin Ping Leung
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Ming Wai Chung
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Po Shan Ko
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
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Frey R, Balmer D. The challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic: An integrative review. Palliat Support Care 2023:1-13. [DOI: 10.1017/s1478951523000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Abstract
Objectives
The growing demand for palliative care has been accelerated due to the COVID-19 pandemic. However, providing community-based palliative care was also more difficult to do safely and faced several challenges. The goal of this integrative review was to identify, describe, and synthesize previous studies on the challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic.
Methods
Searches were carried out on the Ovid MEDLINE, CINAHL, PsycINFO, Social Care Online, PubMed, Embase, and Expanded Academic databases. Journals typically reporting palliative care and community health studies were also searched (Palliative Medicine, Journal of Pain and Symptom Management, and Health & Social Care in the Community). All articles were peer-reviewed and published in English between December 2019 and September 2022.
Results
Database and hand searches identified 1231 articles. After duplicates were removed and the exclusion criteria applied, 27 articles were included in the final review. Themes in the research findings centered on 6 interconnected categories. The challenges imposed by the pandemic (lack of resources, communication difficulties, access to education and training, and interprofessional coordination), as well as the varying levels of success of the health-care responses, impacted the well-being of health professionals and, in turn, the well-being and care of patients and families.
Significance of results
The pandemic has provided the impetus for rethinking flexible and innovative approaches to overcome the challenges of delivering community palliative care. However, existing governmental and organizational policies require revision to improve communication and effective interprofessional collaboration, and additional resources are needed. A blended model of virtual and in-person palliative care delivery may provide the best solution to community palliative care delivery moving forward.
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Antunes BCP, Bowers B, Barclay S, Gallagher J, Conci R, Polak L. Community-based anticipatory prescribing during COVID-19: a qualitative study. BMJ Support Palliat Care 2022:bmjspcare-2022-003597. [PMID: 35649716 DOI: 10.1136/bmjspcare-2022-003597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To understand healthcare professionals' experiences of delivering anticipatory prescribing (AP) during the first wave of the UK COVID-19 pandemic. METHODS Semistructured qualitative interviews were conducted with a purposive sample of 16 healthcare professionals involved in community palliative care. Data were analysed inductively using thematic analysis. RESULTS Some of practitioners' fears about the pandemic's impact on delivering AP had not been realised during the first wave. Among patients with COVID-19 for whom community end-of-life care was deemed appropriate, deaths were perceived to be relatively easy to palliate with standard medications. These deaths were typically too rapid for AP to be appropriate or feasible. For non-COVID deaths, providing timely AP was more challenging: although community nurses and some palliative specialists continued to visit patients regularly, general practitioners did many fewer visits, moving abruptly to mainly remote consultations. This left some community nurses feeling undersupported, and prompted some palliative specialists to increase their direct involvement in AP. Several other changes were widely welcomed: collaboration to maintain drug supplies, adoption of online meetings and paperless practice, enhanced specialist helplines and a new policy allowing reuse of medication in care homes. The inclusion of more non-injectable options in AP protocols allowed clinicians to offer selected patients more choice, but few had yet done this in practice. No participants reported changing their prepandemic practice regarding administration of AP by lay caregivers. CONCLUSIONS Accomplishing AP during a pandemic was challenging, requiring healthcare professionals to make rapid changes to their systems and practices. Some changes may produce lasting improvements.
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Affiliation(s)
| | - Ben Bowers
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Joshua Gallagher
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Riccardo Conci
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Louisa Polak
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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