Fighting against COVID-19: preparedness and implications on clinical practice in primary care in Shenzhen, China

Knowledge as a Predictor for Preparedness in Managing COVID-19 Among General Practitioners in Malaysia

Introduction The COVID-19 pandemic has changed the working environment for general practitioners (GPs). GPs had to adapt quickly when care mitigation for mild COVID-19 in the community began. We assessed Malaysian GPs' knowledge and preparedness to manage COVID-19. Method A cross-sectional online survey was conducted between May and October 2022 among the GPs. Emails were sent to GPs affiliated with the main GP organizations in Malaysia, such as the Academy of Family Physicians of Malaysia (AFPM). Additionally, participation was sought through social media groups, including the Association of Malaysian Islamic Doctors, the Federation of Private Medical Practitioners' Associations Malaysia, and the Primary Care Network. Data was collected using a self-administered questionnaire on items related to knowledge and preparedness to manage COVID-19. The content was validated by six experts. Multiple logistic regression was used to determine the predictors for preparedness. Results A total of 178 GPs participated in this study. The mean age of the GPs was 41.8 (SD 12.37) years, 54.5% were males, 47.8% had a postgraduate qualification, and 68% had up to 10 years of general practice experience. Their practices are commonly solo (55.1%), located within an urban area (56.2%) and 47.2% operate 7 days a week. A majority of GPs (n = 124, 69.7%) had a good level of knowledge of COVID-19. In contrast, about a third (n = 60, 33.7%) had a good level of preparedness to manage COVID-19. GPs with a good level of knowledge of COVID-19 had 1.96 times the odds of having a good level of preparedness as compared to GPs with lower knowledge (OR = 2.11 (95% CI: 1.06, 4.18, p = 0.03)). Conclusion A good level of knowledge is a predictor for preparedness to manage COVID-19. Relevant and targeted measures to enhance knowledge for better preparedness among the GPs to respond to future pandemics are needed.

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.

Impact of COVID-19 on Liver Transplant Activity in the USA: Variation by Etiology and Cirrhosis Complications

BACKGROUND AND AIMS

The COVID-19 pandemic has impacted the care of patients with liver disease. We examined impact of COVID-19 on liver transplant (LT) activity in the USA.

METHODS

LT listings in the United Network for Organ Sharing (UNOS) database (April 2018-May 2021) were analyzed to examine the impact of COVID-19 pandemic on the LT activity based on etiology: hepatitis C virus (HCV), alcohol-associated liver disease (ALD), alcoholic hepatitis (AH), and nonalcoholic steatohepatitis (NASH) complications: hepatocellular carcinoma (HCC) and acute-on-chronic liver failure (ACLF) grade 2 or 3) and Model for End-Stage Liver Disease (MELD) score. Joinpoint regression models assessed time trend changes on a log scale.

RESULTS

Of 23,871 recipients (8,995 in the COVID era, April 2018-February 2020), mean age 52 years, 62% men, 61% Caucasian, 32% ALD, 15% HCC, 30% ACLF grades 2-3, and mean MELD score 20.5), monthly LT changes were a decrease of 3.4% for overall LTs and 22% for HCC after September 2020, and increase of 4.5% for ALD since 11/2020 and 17% since 03/2021 for ACLF grade 2-3. Monthly MELD scores increased by 0.7 and 0.36 after June 2020 for HCV and HCC respectively.

CONCLUSIONS

The COVID-19 pandemic has impacted LT activity, with a decrease of LTs especially for HCC, and an increase of LTs for ALD and severe ACLF. Strategies are needed to reorganize cirrhosis patients to overcome the aftereffects of COVID-19 pandemic.

Burden of COVID-19 on primary care in Belgium: a prospective nationwide observational study from March to August 2020

BACKGROUND

The COVID-19 outbreak had an important impact on general practice, for example the lack of personal protective equipment (PPE) and the switch to telephone consultations. We installed a monitoring instrument and reported the burden the COVID-19 pandemic placed on Belgian general practitioners (GPs) during the first wave of the pandemic.

METHODS

We conducted an observational longitudinal prospective study from the 19^th of March until the 17^th of August 2020. Daily data were collected by using a structured electronic form integrated into the GPs' electronic medical records (EMRs). Data were collected on the GPs' need for support and workload, epidemiological indicators and the availability of PPE. Reports with graphical presentations were made for GP circles and primary care zones, and governments of different administrative levels had access to all data to guide their policy.

RESULTS

A total of 3.769 different GP centres participated, which included more than 10.000 GPs. Throughout the first three weeks, 20% declared they had insufficient resources (personnel and material) for the following week. Approximately 10% continued to report this during the entire study. The majority reported being able to complete their daily tasks without loss of quality. During the first week, 30% indicated an increased workload. Afterwards, this number decreased and stabilized to an average of 10-20%. More than 70% of the consultations in March 2020 were conducted by telephone. This percentage declined in April and stabilized at approximately 30% in June 2020. Consultations due to respiratory symptoms peaked at 4000/100,000 inhabitants at the beginning of the outbreak, then decreased over time along with the COVID-19 incidence. We noticed a lack of disinfectant hand gel, surgical masks and FFP2 masks, the latter remaining problematic in the long term.

CONCLUSION

We introduced an instrument in Belgian EMR systems to monitor the burden on GPs during the first wave of the COVID-19 pandemic. The lack of PPE and increased workload were considered to be the main obstacles. A large number of the GP offices switched to teleconsultations to provide healthcare. Our monitoring instrument provided information for policy makers to intervene on a local level.

COVI-Prim international: Similarities and discrepancies in the way general practices from seven different countries coped with the COVID-19 pandemic

Objectives

General practitioners (GPs) are frequently patients' first point of contact with the healthcare system and play an important role in identifying, managing and monitoring cases. This study investigated the experiences of GPs from seven different countries in the early phases of the COVID-19 pandemic.

Design

International cross-sectional online survey.

Setting

General practitioners from Australia, Austria, Germany, Hungary, Italy, Slovenia and Switzerland.

Participants

Overall, 1,642 GPs completed the survey.

Main outcome measures

We focused on how well-prepared GPs were, their self-confidence and concerns, efforts to control the spread of the disease, patient contacts, information flow, testing procedures and protection of staff.

Results

GPs gave high ratings to their self-confidence (7.3, 95% CI 7.1-7.5) and their efforts to control the spread of the disease (7.2, 95% CI 7.0-7.3). A decrease in the number of patient contacts (5.7, 95% CI 5.4-5.9), the perception of risk (5.3 95% CI 4.9-5.6), the provision of information to GPs (4.9, 95% CI 4.6-5.2), their testing of suspected cases (3.7, 95% CI 3.4-3.9) and their preparedness to face a pandemic (mean: 3.5; 95% CI 3.2-3.7) were rated as moderate. GPs gave low ratings to their ability to protect staff (2.2 95% CI 1.9-2.4). Differences were identified in all dimensions except protection of staff, which was consistently low in all surveyed GPs and countries.

Conclusion

Although GPs in the different countries were confronted with the same pandemic, its impact on specific aspects differed. This partly reflected differences in health care systems and experience of recent pandemics. However, it also showed that the development of structured care plans in case of future infectious diseases requires the early involvement of primary care representatives.

Initial risk perception and feeling of preparedness of primary care physicians regarding the COVID-19 pandemic in Belgium, France and Spain in February 2020

Background

The knowledge of risk perceptions in primary care could help health authorities to manage epidemics.

Methods

A European multi-center cross-sectional study was conducted in France, Belgium and Spain to describe the perceptions, the level of anxiety and the feeling of preparedness of primary healthcare physicians towards the COVID-19 infection at the beginning of the pandemic. The factors associated with the feeling of preparedness were studied using multivariate logistic regressions.

Results

A total of 511 physicians participated to the study (response rate: 35.2%). Among them, only 16.3% (n=82) were highly anxious about the pandemic, 50.6% (n=254) had the feeling to have a high level of information, 80.5% (n=409) found the measures taken by the health authorities suitable to limit the spread of COVID-19, and 45.2% (n=229) felt prepared to face the epidemic. Factors associated with feeling prepared were: being a Spanish practitioner (adjusted OR=4.34; 95%CI [2.47; 7.80]), being a man (aOR=2.57, 95%CI [1.69; 3.96]), finding the measures taken by authorities appropriate (aOR=1.72, 95%CI [1.01; 3.00]) and being highly informed (aOR=4.82, 95%CI [2.62; 9.19]).

Conclusions

Regarding the dramatic evolution of the pandemic in Europe in the weeks following the study, it appears that information available at this time and transmitted to the physicians could have given a wrong assessment of the spread and the severity of the disease. It seems essential to better integrate the primary care physicians into the information, training and protection channels. A comparison between countries could help to select the most effective measures in terms of information and communication.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01588-5.

Challenges and experiences of general practitioners during the course of the Covid-19 pandemic: a northern Italian observational study-cross-sectional analysis and comparison of a two-time survey in primary care

BACKGROUND

General practitioners (GPs) have been among the frontline workers since the outbreak of the Covid-19 pandemic. Reflecting and analyzing the ongoing pandemic response of general practice provides essential information and serves as a precondition for outlining future health policy strategies.

OBJECTIVE

To investigate the effects of the pandemic on GPs' daily work and well-being and to describe needs for improvement in primary care highlighted by the pandemic.

METHODS

A 2-time cross-sectional online survey involving GPs in a northern Italian region was conducted in September 2020 and March/April 2021.

RESULTS

Eighty-four GPs (29.6% of invited GPs) participated in the first survey, and 41 GPs (14.4%) in the second survey. Most GPs experienced a notable workload increase which was tendentially higher during the advanced stages of the pandemic. A notable increase between the first and the second survey was noted regarding the frequency of Covid-related patient contacts and phone calls. Communication with health authorities and hospitals was rated as improvable. Psychological distress among GPs tended to increase over time; female GPs were more affected in the first survey. Most practices introduced major changes in their workflow, mainly appointment-based visits and separating Covid-19-suspected patients. Availability of protective equipment considerably increased over time. In the second survey, the GPs felt more prepared to self-protection and outpatient treatment of Covid-affected patients.

CONCLUSION

The work of GPs has been substantially impacted by the ongoing Covid-19 pandemic. Efforts should be undertaken to efficiently strengthen primary care which plays an important role in pandemic events.

Preparedness of Primary Care Centers for COVID-19 epidemic in Aseer region, KSA

Objective

The objective of this study is to assesses the preparedness of primary care centers (PHCs) in Aseer region, KSA, for the coronavirus disease 2019 (COVID-19) pandemic.

Methods

This survey was conducted during April 2020 in PHCs. The questionnaire was developed by the investigators and sent via e-mail to health care providers of primary health care centers (PHCCs). The questionnaire consisted of five parts to assesses readiness of PHCs, knowledge, attitude, and practice of health care providers (HCPs) concerning the COVID-19 pandemic. Data entry and analysis were managed by SPSS version 20.

Results

Three hundred and seventy-one HCPs participated in this study. Most of them were males (58%), doctors or nurses (81%). Almost all PHCCs have adequate infection control resources, with some shortage in sterilization rooms. Most of participants received on-job training (85%) and had good knowledge about COVID-19. Attitudes of participants showed variation toward COVID-19; 74% were afraid to be infected, 54% were afraid to care for infected patients, 58% were ready for vaccination, and 80% thought that COVID-19 has a huge negative impact on the health care system. Compliance with preventive measures ranged from 66% for keeping social distance to 90% for using personal protective equipment. Most of the participants had positive contributions regarding health education of individuals and communities using different methods including the new social media (80%).

Conclusion

This study revealed that PHCCs in Aseer region were well equipped and HCPs were well prepared to deal with the COVID-19 pandemic. There are some shortage in a few items of infection control at PHCCs and gaps in knowledge and practice among HCPs which need continuous assessment and monitoring to overcome such barriers.

Changes in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID)

INTRODUCTION

Through the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA.

METHODS

Visit definitions were agreed on centrally, implemented locally across the various settings in INTRePID countries, and weekly visit counts were shared centrally for analysis. We evaluated the weekly rate of primary care physician visits during 2019 and 2020. Rate ratios (RRs) of total weekly visit volume and the proportion of weekly visits that were virtual in the pandemic period in 2020 compared with the same prepandemic period in 2019 were calculated.

RESULTS

In 2019 and 2020, there were 80 889 386 primary care physician visits across INTRePID. During the pandemic, average weekly visit volume dropped in China, Singapore, South Korea, and the USA but was stable overall in Australia (RR 0.98 (95% CI 0.92 to 1.05, p=0.59)), Canada (RR 0.96 (95% CI 0.89 to 1.03, p=0.24)), Norway (RR 1.01 (95% CI 0.88 to 1.17, p=0.85)), Sweden (RR 0.91 (95% CI 0.79 to 1.06, p=0.22)) and the UK (RR 0.86 (95% CI 0.72 to 1.03, p=0.11)). In countries that had negligible virtual care prepandemic, the proportion of visits that were virtual were highest in Canada (77.0%) and Australia (41.8%). In Norway (RR 8.23 (95% CI 5.30 to 12.78, p<0.001), the UK (RR 2.36 (95% CI 2.24 to 2.50, p<0.001)) and Sweden (RR 1.33 (95% CI 1.17 to 1.50, p<0.001)) where virtual visits existed prepandemic, it increased significantly during the pandemic.

CONCLUSIONS

The drop in primary care in-person visits during the pandemic was a global phenomenon across INTRePID countries. In several countries, primary care shifted to virtual visits mitigating the drop in in-person visits.

GP wellbeing during the COVID-19 pandemic: a systematic review

BACKGROUND

Doctors' organisations in the UK have reported worrying levels of work-related stress and burnout in the GP workforce for some time, and the COVID-19 pandemic has presented clear new challenges.

AIM

To synthesise international evidence exploring the impact of COVID-19 on primary care doctors' mental health and wellbeing, and identify risk factors associated with their psychological wellbeing during this time.

DESIGN AND SETTING

Mixed-methods systematic review.

METHOD

Six bibliographic databases, Google Scholar, and MedRxiv were searched on 19 November 2020 and 3 June 2021 to identify studies of GP psychological wellbeing during the pandemic. Reference checking was also conducted. Two reviewers selected studies, extracted data, and assessed the quality of studies using standardised tools. Heterogeneity in outcomes, setting, and design prohibited statistical pooling; studies were combined using a convergent integrated thematic synthesis.

RESULTS

Thirty-one studies were included. Multiple sources of stress were identified including changed working practices; risk, exposure, and inadequate personal protective equipment (PPE); information overload; pandemic preparedness; and cohesion across sectors. Studies demonstrated an impact on psychological wellbeing, with some GPs experiencing stress, burnout, anxiety, depression, fear of COVID-19, lower job satisfaction, and physical symptoms. Studies reported gender and age differences: women GPs had poorer psychological outcomes across all domains, and older GPs reported greater stress and burnout. Use of outcome measures and reporting practice varied greatly.

CONCLUSION

This review of international evidence demonstrates that the COVID-19 pandemic has adversely affected GPs' wellbeing around the world. Further research could explore gender and age differences, identifying interventions targeted to these groups.

Willingness and SARS-CoV-2 Vaccination Coverage among Healthcare Workers in China: A Nationwide Study

Background: The SARS-CoV-2 vaccine has been widely rolled out globally in the general populations. However, specific data on vaccination confidence, willingness or coverage among health care workers (HCWs) has been less reported. Methods: A cross-sectional online survey was conducted to specify the basic data and patterns of vaccination confidence, willingness and coverage among HCWs nationwide. Results: In total, 2386 out of 2583 (92.4%) participants were enrolled for analysis, and the rates of confidence in vaccine, professional institutes and government were 75.1%, 85.2% and 85.4%, respectively. The overall vaccination coverage rate was 63.6% which was adjusted as 82.8% for participants under current medical conditions or having contraindications. Confidence in vaccine safety was shown to be the most related factor to willingness among doctors, nurses, medical technicians and hospital administrators, while confidence in vaccine effectiveness as well as trust in government played the key role in formulating public health employees' willingness. 130 (7.1% of 1833) participants reporting willingness still not been vaccinated regardless of contraindications. Multivariate analysis among willingness participants showed that males, aged over 30 years, public health employees and higher vaccination confidence had significantly higher vaccination rates with ORs (95% confidence intervals) as 1.64 (1.08-2.49), 3.14 (2.14-4.62), 2.43 (1.46-4.04) or 2.31 (1.24-4.33). Conclusions: HCWs' confidence, willingness and coverage rates to the vaccine were generally at high levels. Heterogeneity among HCWs should be considered for future vaccination promotion strategies. The population's confidence in vaccination is not only the determinant to their willingness, but also guarantees their actual vaccine uptake.