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Del Monte M, Edwards AR, Waldron DB, Aird LD, Airhart CK, Robinson LB, Bright D, Calabrese TM, Diederich S, Fitzpatrick H, Frantz J, Haro TM, Hegland A, Ingstrup K, Jenco M, Kim S, Martin SS, Mazziotti D, Phillips M, Poslosky J, Salmon J, Walsh MC, White ML. Successes and Lessons Learned in Responding to the Needs of Pediatricians, Children, and Families During the COVID-19 Pandemic. Pediatrics 2024; 153:e2024066634. [PMID: 38485704 DOI: 10.1542/peds.2024-066634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 06/02/2024] Open
Abstract
The coronavirus disease 2019 pandemic has presented tremendous challenges to the United States health care system, as well as to individual physicians, communities, and families. Throughout the pandemic, the American Academy of Pediatrics (AAP) has striven to elevate the needs of infants, children, and adolescents, as well as the pediatricians who care for this population. Historically, these communities have often been overlooked and deprioritized in health care systems, and these deficits persisted into the pandemic. To fill this gap, the AAP took on an essential role in leading the national response for pediatrics. This article details the AAP pandemic response and includes the perspectives of multiple AAP leaders involved in the response and details on Academy advocacy with high-level staff and officials at federal agencies and the executive branch. The AAP provided initial guidance to pediatricians that predated the World Health Organization's declaration of a public health emergency. The Academy then developed entirely new approaches to meet the unprecedented needs of its practicing members and families by providing timely, rigorous information endorsed by pediatric experts. When coronavirus disease 2019 vaccines were developed, the AAP strongly advised the inclusion of those younger than 18 years in vaccine trials and advocated for equitable distribution plans. The AAP provided its members with strategies for combating misinformation. The Academy was at the forefront of advocating for the safe return to in-person schooling, recognizing that social isolation was contributing to the growing mental health crisis among youth. In 2021, the AAP, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a national emergency in child and adolescent mental health. In addition, the AAP implemented educational and training opportunities for clinicians and developed resources for youth and their families. After the end of the public health emergency, AAP members continue to use innovations and efficiencies developed as part of their pandemic response. The successes of the AAP pandemic response, alongside lessons learned, help define an important model for responding to future pandemics and public health emergencies in ways that support children, families, and the pediatric workforce.
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Leslie M, Hansen B, Abboud R, Claussen C, Aghajafari F. Thinking and Enacting the Patient Medical Home Under Pandemic Conditions: A Qualitative Study From Primary Care in Alberta, Canada. J Prim Care Community Health 2024; 15:21501319241236007. [PMID: 38627966 PMCID: PMC11022528 DOI: 10.1177/21501319241236007] [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: 11/17/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The COVID-19 (C19) pandemic shocked primary care systems around the world. Those systems responded by supporting patients in the community, and acute care facilities in crisis. In Canada, the Patient Medical Home (PMH) is a widely adopted care model that aims to operationalize the tenets and principles of Primary Health Care (PHC) as developed since the Alma-Ata Declaration. This paper describes how personnel working in and with Primary Care Networks (PCNs) in Alberta, Canada deployed the PMH model and its underlying PHC principles to frame and respond to the C19 shock. METHODS Using purposive and snowball sampling techniques, we interviewed 57 participants who worked in public health and primary care, including community-based family physicians. We used interpretive description to analyze the interviews. RESULTS PCN staff and physicians described how the PMH model was foundational to normal operations, and how C19 responses were framed by the patient-centric, team-delivered, and continuous care principles the model shares with PHC. Specifically, participants described ensuring access to care, addressing the social determinants of health, being patient centered, and redeploying and expanding PHC teams to accomplish these goals. DISCUSSION Delivering PHC through the PMH allowed physicians and allied health staff to deliver patient-centered, team-based, holistic bio-medical services to Albertans. In tailoring services to meet the specific social and health needs of the populations served by each PCN, healthcare providers were able to ensure relevant support remained available and accessible.
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Affiliation(s)
| | | | - Rida Abboud
- Co-RIG Project Consultant, Calgary, AB, Canada
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Calegari JG, Bisesti A, Pazzaglia S, Gambazza S, Binda F, Bruno M, Chiappa L, Piatti A, Tiwana N, Letzgus M, Castaldi S, Sottocorno M, Laquintana D. Setting up and managing the largest COVID-19 mass vaccination center in Lombardy, Italy. Front Public Health 2023; 11:1290350. [PMID: 38045968 PMCID: PMC10691470 DOI: 10.3389/fpubh.2023.1290350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Background The rapid global spread of severe acute respiratory syndrome coronavirus (SARS-CoV-2) was met with the rollout of vaccination campaigns at mass vaccination centers. The Palazzo delle Scintille, Milan, was designated by the Lombardy regional administration as a vaccination site with the target of processing about 9,000 users daily. Methods For this observational study, we compared data on vaccinations delivered at the Palazzo delle Scintille with coronavirus disease (COVID-19)-related regional data. Results Between 25 April 2021 and 28 February 2023, a total of 1,885,822 COVID-19 doses were administered; the mean hourly rate was 289 (247.2), the mean daily rate was 3185.5 (3104.5), the mean user age was 49.5 years (10.7). The Comirnaty vaccine (Pfizer-BioNTech) was most often given (1,072,030/1,885,822; 56.8%). Between 4 December 2021 and 15 January 2022, the daily dose rate was above the maximum daily capacity set by the regional administration. Conclusion The trend for daily dose rates administered at the Palazzo delle Scintille center was in line with COVID-19-related regional data. The center played a major role in the regional mass vaccination campaign.
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Affiliation(s)
- Jessica Graziella Calegari
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Bisesti
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Pazzaglia
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Bruno
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Chiappa
- Hospital Medical Direction, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Piatti
- Hospital Medical Direction, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Navpreet Tiwana
- Hospital Medical Direction, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Letzgus
- Hospital Medical Direction, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Quality Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marcello Sottocorno
- Department of Hospital Pharmacy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Cinquetti S, De Polo A, Marcotrigiano V, Battistin M, Bino E, De Mattia G, Fagherazzi J, Fiorito N, Manzi M, Voltolini A, Mognato M, Napoli C. Lessons Learned from the COVID-19 Vaccination Campaigns in Veneto Region: Population Vaccination Centers as Support for the Traditional Outpatient Model. Vaccines (Basel) 2023; 11:1695. [PMID: 38006027 PMCID: PMC10675498 DOI: 10.3390/vaccines11111695] [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: 10/09/2023] [Revised: 11/04/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The extraordinary vaccination campaigns of the COVID-19 pandemic era put organizational and operational systems to the test in numerous territorial contexts. In the Veneto region, the activation of population vaccination centers (CVPs) guaranteed the provision of vaccines to mountain areas. These centers, drive-in and building-based, improved the efficiency of dose administration in relation to similar conditions where healthcare workers (HCWs) were routinely involved in clinics. Overall, a comparison of the two models investigated, with the same numbers of HCWs involved and the same opening hours for the vaccination sites, has shown that the CVPs are able to guarantee three times as many vaccines administered, compared with the traditional outpatient model. This study aims to provide a detailed analysis of the adopted organizational model, highlighting the best practices and improvements required to guarantee a timely and effective public health response, and evaluating the opportunities to deploy these innovative methods actively in a standard context.
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Affiliation(s)
- Sandro Cinquetti
- Prevention Department, Local Health Authority “ULSS 1 Dolomiti”, 32100 Belluno, Italy;
| | - Anna De Polo
- Hygiene and Public Health Service, Prevention Department, Local Health Authority “ULSS 2 Marca Trevigiana”, 31100 Treviso, Italy;
| | | | - Marica Battistin
- Hygiene and Public Health Service, Prevention Department, Local Health Authority “ULSS 1 Dolomiti”, 32100 Belluno, Italy; (M.B.); (J.F.); (N.F.); (M.M.); (M.M.)
| | - Erica Bino
- Epidemiology Service, Prevention Department, Local Health Authority “ULSS 1 Dolomiti”, 32100 Belluno, Italy;
| | - Giulia De Mattia
- Prevention Department, Provincial Authority for Health Services, “APSS” Autonomous Province of Trento, 38123 Trento, Italy;
| | - Jacopo Fagherazzi
- Hygiene and Public Health Service, Prevention Department, Local Health Authority “ULSS 1 Dolomiti”, 32100 Belluno, Italy; (M.B.); (J.F.); (N.F.); (M.M.); (M.M.)
| | - Nahuel Fiorito
- Hygiene and Public Health Service, Prevention Department, Local Health Authority “ULSS 1 Dolomiti”, 32100 Belluno, Italy; (M.B.); (J.F.); (N.F.); (M.M.); (M.M.)
| | - Mattia Manzi
- Hygiene and Public Health Service, Prevention Department, Local Health Authority “ULSS 1 Dolomiti”, 32100 Belluno, Italy; (M.B.); (J.F.); (N.F.); (M.M.); (M.M.)
| | - Anna Voltolini
- Postgraduate Specialization in Hygiene and Preventive Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy;
| | - Martina Mognato
- Hygiene and Public Health Service, Prevention Department, Local Health Authority “ULSS 1 Dolomiti”, 32100 Belluno, Italy; (M.B.); (J.F.); (N.F.); (M.M.); (M.M.)
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy;
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Tetui M, Tennant R, Adil M, Bala A, Burns C, Waite N, Grindrod K. "Flying a plane and building it at the same time": Lessons learned from the dynamic implementation of mass vaccination clinics in the Region of Waterloo, Ontario, Canada. Health Res Policy Syst 2023; 21:102. [PMID: 37784061 PMCID: PMC10546698 DOI: 10.1186/s12961-023-01036-z] [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: 12/15/2022] [Accepted: 08/12/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Vaccination plays a critical role during pandemics, and mass vaccination clinics are often an imperative public health measure. These clinics usually consist of multi-disciplinary teams, which can pose significant coordination challenges, yet also present an opportunity for collectively contributing towards mitigating the impact of infection within communities. This study explores the coordination dynamics of the Region of Waterloo's coronavirus disease of 2019 (COVID-19) mass vaccination clinics in Ontario, Canada, between July 2021 and April 2022. METHODS This qualitative study included 16 purposively selected participants working in mass vaccination clinics. Participants were individually interviewed for 40-60 min. An inductive and iterative thematic analysis was undertaken, including open coding, grouping, labelling, regrouping and making sense of the themes. RESULTS Three interrelated themes were created: (1) unpredictable work environment, which was comprised of changing clinic processes and the impact of clinic adjustments to the running of the clinics; (2) clinic cohesion challenges, which included staff role disparities, limited job preparation and clinic system silos; and (3) adaptable and supportive work environment, which was comprised of staff adaptability, dispositional flexibility and a supportive work environment. While the first two themes created a precarious situation in the clinics, the third countered it, leading to a largely successful clinic implementation. CONCLUSIONS The rapid evolution and high transmissibility of COVID-19 in communities required a public health response that felt like flying and building a plane simultaneously - a seemingly impossible yet necessary task. However, an adaptable and supportive work environment was critical for establishing an atmosphere that can overcome challenges from a constantly changing pandemic and the guidance of public health officials. Such lessons gained from understanding the dynamic experiences in mass vaccination clinics are essential for improving the development and operation of future immunization campaigns.
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Affiliation(s)
- Moses Tetui
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Ryan Tennant
- Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Maisha Adil
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Arthi Bala
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Catherine Burns
- Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Nancy Waite
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
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Aggarwal M, Kokorelias KM, Glazier RH, Katz A, Shiers-Hanley JE, Upshur REG. What is the role of primary care in the COVID-19 vaccine roll-out and the barriers and facilitators to an equitable vaccine roll-out? A rapid scoping review of nine jurisdictions. BMJ Open 2023; 13:e065306. [PMID: 37076148 PMCID: PMC10123853 DOI: 10.1136/bmjopen-2022-065306] [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: 04/21/2023] Open
Abstract
OBJECTIVES This study aimed to: (1) examine the experience of nine global jurisdictions that engaged primary care providers (PCPs) to administer COVID-19 vaccines during the pandemic; (2) describe how vaccine hesitancy and principles of equity were incorporated in the COVID-19 vaccine roll-out strategies and (3) identify the barriers and facilitators to the vaccine roll-out. DESIGN Rapid scoping review. DATA SOURCES Searches took place in MEDLINE, CINAHL, Embase, the Cochrane Library, SCOPUS and PsycINFO, Google, and the websites of national health departments. Searches and analyses took place from May 2021 to July 2021. RESULTS Sixty-two documents met the inclusion criteria (35=grey literature; 56% and 27=peer reviewed; 44%). This review found that the vaccine distribution approach started at hospitals in almost all jurisdictions. In some jurisdictions, PCPs were engaged at the beginning, and the majority included PCPs over time. In many jurisdictions, equity was considered in the prioritisation policies for various marginalised communities. However, vaccine hesitancy was not explicitly considered in the design of vaccine distribution approaches. The barriers to the roll-out of vaccines included personal, organisational and contextual factors. The vaccine roll-out strategy was facilitated by establishing policies and processes for pandemic preparedness, well-established and coordinated information systems, primary care interventions, adequate supply of providers, education and training of providers, and effective communications strategy. CONCLUSIONS Empirical evidence is lacking on the impact of a primary care-led vaccine distribution approach on vaccine hesitancy, adoption and equity. Future vaccine distribution approaches need to be informed by further research evaluating vaccine distribution approaches and their impact on patient and population outcomes.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kristina Marie Kokorelias
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Richard H Glazier
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alan Katz
- Department of Community Health Sciences, Rady Faculty of Health Sciences University, Winnipeg, Manitoba, Canada
| | | | - Ross E G Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Leslie M, Hansen B, Abboud R, Claussen C, McBrien K, Hu J, Ward R, Aghajafari F. Building a Data Bridge: Policies, Structures, and Governance Integrating Primary Care Into the Public Health Response to COVID-19. Ann Fam Med 2023; 21:4-10. [PMID: 36690483 PMCID: PMC9870644 DOI: 10.1370/afm.2900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The effective integration of primary care into public health responses to the COVID-19 pandemic, particularly through data sharing, has received some attention in the literature. However, the specific policies and structures that facilitate this integration are understudied. This paper describes the experiences of clinicians and administrators in Alberta, Canada as they built a data bridge between primary care and public health to improve the province's community-based response to the pandemic. METHODS Fifty-seven semistructured qualitative interviews were conducted with a range of primary care and public health stakeholders working inside the Calgary Health Zone. Interpretive description was used to analyze the interviews. RESULTS SARS-CoV-2 test results produced by the local public laboratory were, initially, only available to central public health clinicians and not independent primary care physicians. This enabled centrally managed contact tracing but meant primary care physicians were unaware of their patients' COVID-19 status and unable to offer in-community follow-up care. Stakeholders from both central public health and independent primary care were able to leverage a policy commitment to the Patient Medical Home (PMH) care model, and a range of existing organizational structures, and governance arrangements to create a data bridge that would span the gap. CONCLUSIONS Primary care systems looking to draw lessons from the data bridge's construction may consider ways to: leverage care model commitments to integration and adjust or create organization and governance structures which actively draw together primary care and non-primary care stakeholders to work on common projects. Such policies and structures develop trusting relationships, open the possibility for champions to emerge, and create the spaces in which integrative improvisation can take place.
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Affiliation(s)
- Myles Leslie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian Hansen
- Zone Business Unit, Calgary and Area Primary Care Networks, Calgary, Alberta, Canada
| | - Rida Abboud
- Co-RIG Project Consultant, Calgary, Alberta, Canada
| | - Caroline Claussen
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kerry McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jia Hu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- 19 to Zero, Toronto, Ontario, Canada
| | - Rick Ward
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Calgary Zone Primary Care Division, Alberta Health Services, Calgary, Alberta, Canada
| | - Fariba Aghajafari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Greenhalgh T. COVID-19 and Primary Care: Taking Stock. Ann Fam Med 2023; 21:1-3. [PMID: 36690476 PMCID: PMC9870637 DOI: 10.1370/afm.2935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 01/24/2023] Open
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