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Schaefer KR, Triplett B, Lorenzo O, Aregood M, Galbreath D, Dillard DA, Collier AF. Evaluating COVID-19 Response Within a Tribal Health Care Organization. Perm J 2023; 27:36-43. [PMID: 37731363 PMCID: PMC10723102 DOI: 10.7812/tpp/23.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Health care organizations of all types have adapted in response to COVID-19. Responding to the pandemic has varied across organizations and there are few standardized frameworks from which to evaluate an organizational response. This article reports COVID-19 responses by a tribal health care organization using a synthesized evaluation framework that integrated the organizational values and allowed for timely implementation of responses during this COVID-19 public health emergency. METHODS The authors categorized each COVID-19 response into six domains, including leadership practices, patient engagement, operations management, teamwork and communication, public health, and external partnerships. Responses were analyzed by domain and across time. RESULTS COVID-19 responses included medical alerts, modifying delivery of care, establishing testing and vaccination sites, additional benefits for employees, as well as new processes for communication between employees and senior leadership. COVID-19 responses were most frequently categorized into the operation management domain (80%). Many responses, especially those that considered patients, employees, and the community, also fit other domains. DISCUSSION Operation management was the most frequent domain because the pandemic emerged rapidly and required swift, agile, action-oriented responses from the tribal health care organization. The majority of COVID-19 responses involved multiple, not single, domains. CONCLUSION Our evaluation approach captured areas of importance to the tribal health organization and may be pertinent for other indigenous organizations and rural communities. It is especially important to consider tribal perspectives in response to COVID-19 because of the prior history with Western medicine and infectious diseases, and health care limitations experienced due to rurality.
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Affiliation(s)
| | | | | | | | | | - Denise A Dillard
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
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2
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Bousquat A, Giovanella L, Facchini L, Mendonça MHM, Nedel FB, Cury G, dos Santos Mota PH, Schenkman S, Chueiri PS, Alves MCGP. The Brazilian primary health care response to the COVID-19 pandemic: individual and collective approaches. Front Public Health 2023; 11:1212584. [PMID: 38145080 PMCID: PMC10748390 DOI: 10.3389/fpubh.2023.1212584] [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: 04/26/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives Brazil's PHC wide coverage has a potential role in the fight against COVID, especially in less developed regions. PHC should deal with COVID-19 treatment; health surveillance; continuity of care; and social support. This article aims to analyze PHC performance profiles during the pandemic, in these axes, comparing the five Brazilian macro-regions. Methods A cross-sectional survey study was carried out, using stratified probability sampling of PHC facilities (PHCF). A Composite Index was created, the Covid PHC Index (CPI). Factor analysis revealed that collective actions contrastingly behaved to individual actions. We verified differences in the distributions of CPI components between macro-regions and their associations with structural indicators. Results Nine hundred and seven PHCF participated in the survey. The CPI and its axes did not exceed 70, with the highest value in surveillance (70) and the lowest in social support (59). The Individual dimension scored higher in the South, whereas the Collective dimension scored higher in the Northeast region. PHCF with the highest CPI belong to municipalities with lower HDI, GDP per capita, population, number of hospitals, and ICU beds. Conclusion The observed profiles, individually and collectively-oriented, convey disputes on Brazilian health policies since 2016, and regional structural inequalities.
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Affiliation(s)
- Aylene Bousquat
- Department of Politics, Management and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Luiz Facchini
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | | | - Fulvio Borges Nedel
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Geraldo Cury
- Department of Social and Preventive Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Simone Schenkman
- Department of Politics, Management and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Patricia Sampaio Chueiri
- Faculdade Israelita de Ciências da Saúde Albert Einstein Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Maria Cecilia Goi Porto Alves
- Department of Health, Institute of Health, Government of the State of São Paulo, Institute of Health, São Paulo, Brazil
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3
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Mathews M, Meredith L, Ryan D, Hedden L, Lukewich J, Marshall EG, Buote R, Moritz L, Spencer S, Asghari S, Brown JB, Freeman TR, Gill PS, McCracken RK, McKay M, Ryan B, Sibbald SL, Wetmore S, Wong E. The roles of family physicians during a pandemic. Healthc Manage Forum 2023; 36:30-35. [PMID: 35848444 PMCID: PMC9297067 DOI: 10.1177/08404704221112311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Family physicians play important roles throughout all stages of a pandemic response; however, actionable descriptions outlining these roles are absent from current pandemic plans. Using a multiple case study design, we conducted a document analysis and interviewed 68 family physicians in four Canadian regions. We identified roles performed by family physicians in five distinct stages of pandemic response: pre-pandemic, phased closure and re-opening, acute care crisis, vaccination, and pandemic recovery. In addition to adopting public health guidance to ensure continued access to primary care services, family physicians were often expected to operationalize public health roles (eg, staffing assessment centres), modulate access to secondary/tertiary services, help provide surge capacity in acute care facilities, and enhance supports and outreach to vulnerable populations. Future pandemic plans should include family physicians in planning, explicitly incorporate family physician roles, and ensure needed resources are available to allow for an effective primary care response.
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Affiliation(s)
- Maria Mathews
- Western University, London, Ontario, Canada.,Maria Mathews, Western University, London, Ontario, Canada. E-mail:
| | | | - Dana Ryan
- Western University, London, Ontario, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julia Lukewich
- Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | | | | | | | - Sarah Spencer
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Shabnam Asghari
- Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | | | | | - Paul S. Gill
- Western University, London, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Eric Wong
- Western University, London, Ontario, Canada.,Thames Valley Family Health Team, London, Ontario, Canada.,St. Joseph’s Health Care London, London, Ontario, Canada
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4
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Matenge S, Sturgiss E, Desborough J, Hall Dykgraaf S, Dut G, Kidd M. Ensuring the continuation of routine primary care during the COVID-19 pandemic: a review of the international literature. Fam Pract 2022; 39:747-761. [PMID: 34611708 PMCID: PMC8515263 DOI: 10.1093/fampra/cmab115] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in the diversion of health resources away from routine primary care delivery. This disruption of health services has necessitated new approaches to providing care to ensure continuity. OBJECTIVES To summarize changes to the provision of routine primary care services during the pandemic. METHODS Rapid literature review using PubMed/MEDLINE, SCOPUS, and Cochrane. Eligible studies were based in primary care and described practice-level changes in the provision of routine care in response to COVID-19. Relevant data addressing changes to routine primary care delivery, impact on primary care functions and challenges experienced in adjusting to new approaches to providing care, were obtained from included studies. A narrative summary was guided by Burns et al.'s framework for primary care provision in disasters. RESULTS Seventeen of 1,699 identified papers were included. Studies reported on telehealth use and public health measures to maintain safe access to routine primary care, including providing COVID-19 screening, and establishing dedicated care pathways for non-COVID and COVID-related issues. Acute and urgent care were prioritized, causing disruptions to chronic disease management and preventive care. Challenges included telehealth use including disparities in access and practical difficulties in assessing patients, personal protective equipment shortages, and financial solvency of medical practices. CONCLUSIONS Substantial disruptions to routine primary care occurred due to the COVID-19 pandemic. Primary care practices' rapid adaptation, often with limited resources and support, demonstrates agility and innovative capacity. Findings underscore the need for timely guidance and support from authorities to optimize the provision of comprehensive routine care during pandemics.
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Affiliation(s)
- Sethunya Matenge
- Department of Health Services Research and Policy, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Garang Dut
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Michael Kidd
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,Australian Government Department of Health, Canberra, ACT, Australia.,Department of Family and Community Medicine, The University of Toronto, Toronto, Canada.,Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia.,Southgate Institute for Equity, Health and Society, Flinders University, Adelaide, SA, Australia
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5
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Dale JN, Morken T, Eliassen KE, Blinkenberg J, Rørtveit G, Hunskaar S, Rebnord IK, Baste V. Preparedness and management during the first phase of the COVID-19 outbreak - a survey among emergency primary care services in Norway. BMC Health Serv Res 2022; 22:896. [PMID: 35820916 PMCID: PMC9275270 DOI: 10.1186/s12913-022-08284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background The emergency primary care (EPC) services in Norway have been at the frontline of the COVID-19 pandemic. Knowledge about the EPC services’ management of the COVID-19 outbreak can be used to prepare for future outbreaks and improve patient management. The objectives of this study were to identify pandemic preparedness and management strategies in EPC centres in Norway during the COVID-19 outbreak. Methods Questions regarding patient management of the COVID-19 outbreak were included in data collection for the National Out-Of-Hours Services Registry. The data collection was web-based, and an invitation was sent by email to the managers of all EPC services in Norway in June 2020. The EPC services were asked questions about pre-pandemic preparedness, access to personal protective equipment (PPE), organizational measures taken, and how staffing was organized during the onset of the pandemic. Results There were 169 municipal and inter-municipal EPC services in Norway in 2020, and all responded to the questionnaire. Among the EPC services, 66.7% (n = 112) had a pandemic plan, but only 4.2% had performed training for pandemic preparedness. Further, fewer than half of the EPC centres (47.5%) had access to supplies of PPE, and 92.8% answered that they needed extra supplies of PPE. 75.3% of the EPC services established one or more respiratory clinics. Staffing with other personnel than usual was done in 44.6% (n = 74) of the EPC services. All EPC services except one implemented new strategies for assessing patients, while about half of the wards implemented new strategies for responding to emergency calls. None of the largest EPC services experienced that their pandemic plan was adequate, while 13.3% of the medium-sized EPC services and 48.9% of the small EPC services reported having an adequate pandemic plan. Conclusions Even though the EPC services lacked well-tested plans and had insufficient supplies of PPE at the outbreak of the COVID-19 pandemic, most services adapted to the pandemic by altering the ways they worked and by hiring health care professionals from other disciplines. These observations may help decision makers plan for future pandemics. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08284-9.
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Affiliation(s)
- Jonas Nordvik Dale
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Tone Morken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Knut Eirik Eliassen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jesper Blinkenberg
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rørtveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingrid Keilegavlen Rebnord
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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6
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White J, Cavenagh D, Byles J, Mishra G, Tooth L, Loxton D. The experience of delayed health care access during the COVID 19 pandemic in Australian women: A mixed methods exploration. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1384-e1395. [PMID: 34423499 PMCID: PMC8653352 DOI: 10.1111/hsc.13546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Delayed health care access is a potential collateral effect of pandemic conditions, health rationing strategies and social distancing responses. We investigated experiences of delayed health care access in Australian women during COVID-19. A mixed methods study used quantitative and free-text data from the Australian Longitudinal Study on Women's Health COVID-19 survey 4 (health care access or delay). Logistic regression models were used to estimate factors associated with delaying access to general practitioners (GPs), specialists and allied health services. Free-text comments were analysed thematically, employing a process of constant comparison. COVID-19 survey 4 was completed by 8,200 women and 2,727 provided free-text comments. Of the women who needed the health service, 25% (1,268/5,071) delayed seeing their GP, 23.6% (570/1,695) delayed seeing a specialist and 45% (791/1,757) delayed use of an allied health service. Younger age was most significantly associated with delaying attendance. Women born 1989-95 were significantly more likely to delay compared to women born 1946-51 (OR (95% CI): GP = 0.28 (0.22, 0.35)); Specialist = 0.65 (0.45, 0.92; Allied Health = 0.59 (0.42, 0.82)). Women born 1973-78 were also likely to delay GP visits (0.69, (0.58, 0.83)). Four qualitative themes emerged including: (1) Challenges negotiating care during a pandemic; (2) Ongoing uncertainty towards accessing health care when a specialist delays an appointment; (3) Accessing health care (or not) using Telehealth and (4) Managing complex care needs. COVID-19 has had a significant effect on access to health care. Women delayed seeking help for cancer screening, mental health, and other health conditions involving chronic and complex needs for health and social care. While there is a need to rationalise and optimise health access during a pandemic, our outcomes suggest a need for public health campaigns that clarify how to access care, engage with telehealth and respond to missed appointments.
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Affiliation(s)
- Jennifer White
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Dominic Cavenagh
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Julie Byles
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Gita Mishra
- School of Public HealthFaculty of MedicineThe University of QueenslandHerstonAustralia
| | - Leigh Tooth
- School of Public HealthFaculty of MedicineThe University of QueenslandHerstonAustralia
| | - Deborah Loxton
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
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7
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Davis S, Roberts L, Desborough J, Dykgraaf SH, Burns P, Kidd M, Maddox R, de Toca L, Lokuge K. Integrating General Practice Into the Australian COVID-19 Response: A Description of the General Practitioner Respiratory Clinic Program in Australia. Ann Fam Med 2022; 20:273-276. [PMID: 35606123 PMCID: PMC9199048 DOI: 10.1370/afm.2808] [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] [Received: 02/02/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022] Open
Abstract
Integrating primary care with the health response is key to managing pandemics and other health emergencies. In recognition of this, the Australian Government established a network of respiratory clinics led by general practitioners in response to the coronavirus disease 2019 (COVID-19) pandemic as part of broader measures aimed at supporting primary care. General practitioner (GP) respiratory clinics provide holistic face-to-face assessment and treatment to those with respiratory symptoms in an environment with strict protocols for infection prevention and control. This ensures that these patients are able to access high quality primary care while protecting the general practice workforce and other patients. The GP respiratory clinic model was developed and operationalized 10 days after the policy was announced, with the first 2 respiratory clinics opening on March 21, 2020. Subsequently a total of 150 respiratory clinics were opened and served over 800,000 patients within more than 99% of Australia's postcodes. These clinics used a standardized data collection tool that has provided the largest and most complete primary care surveillance database of respiratory illness in Australia. The success of the GP respiratory clinic model was made possible due to strong partnerships with Primary Health Networks and individual general practices that rapidly shifted operations to embrace this new approach. This article describes the development and early implementation of this model.
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Affiliation(s)
- Stephanie Davis
- Australian National University, Canberra, Acton, Australia .,Australian Government Department of Health, Canberra, Acton, Australia
| | - Leslee Roberts
- Australian Government Department of Health, Canberra, Acton, Australia
| | | | | | - Penelope Burns
- Australian National University, Canberra, Acton, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra, Acton, Australia
| | - Raglan Maddox
- Australian National University, Canberra, Acton, Australia
| | - Lucas de Toca
- Australian Government Department of Health, Canberra, Acton, Australia
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8
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Collins C, Petek D, Diaz E, Muñoz MA. General Practice/Family Medicine Research During the Pandemic: Showing The Links to the EGPRN Research Strategy. EURASIAN JOURNAL OF FAMILY MEDICINE 2022. [DOI: 10.33880/ejfm.2022110101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
General Practice/Family Medicine is at the forefront of the clinical response to the COVID-19 crisis just as it is known to be a critical component of healthcare systems globally.
A large number of COVID-19 related papers have been published and dedicated funding calls were available in many countries and across the European Union. However, General Practice/Family Medicine does not feature as strongly as it should in COVID-19 high impact publications or successful funding applications.
In this paper, we take a look at the findings on which the recommendations of the “European General Practice Research Network (EGPRN) Research Strategy for General Practice in Europe 2021” are based and highlight how these align with the COVID-19 experience of General Practice/Family research.
To elaborate on this, the issues identified and the recommendations of the EGPRN Research Strategy are grouped into three broad areas on which we need to focus – capacity, collaboration, and complexity (3-Cs).
Apparent or presumed deficiencies in these 3-Cs are possibly why the General Practice/Family research impact during COVID-19 does not match its position on the ground in fighting the pandemic and supporting patients. The EGPRN Research Strategy identifies how we might work to position ourselves better in the future and gain the recognition deserved, in terms of publications, research funding, and prominence.
Keywords: general practice, research, pandemics, publications, financing
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Affiliation(s)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana
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9
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Mitchell S, Harrison M, Oliver P, Gardiner C, Chapman H, Khan D, Boyd K, Dale J, Barclay S, Mayland CR. Service change and innovation in community end-of-life care during the COVID-19 pandemic: Qualitative analysis of a nationwide primary care survey. Palliat Med 2022; 36:161-170. [PMID: 34915759 PMCID: PMC8796165 DOI: 10.1177/02692163211049311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Primary healthcare teams (general practice and community nursing services) within the United Kingdom provided the majority of community end-of-life care during COVID-19, alongside specialist palliative care services. As international healthcare systems move to a period of restoration following the first phases of the pandemic, the impact of rapidly-implemented service changes and innovations across primary and specialist palliative care services must be understood. AIM To provide detailed insights and understanding into service changes and innovation that occurred in UK primary care to deliver end-of-life care during the first phase of the COVID-19 pandemic. DESIGN Cross-sectional online survey. Responses were analysed using descriptive statistics and thematic analysis. SETTING/PARTICIPANTS United Kingdom survey of general practitioners and community nurses, circulated via regional and national professional networks. RESULTS A total of 559 valid responses were received from 387 community nurses, 156 general practitioners and 16 'other'. Over a third of respondents (n = 224; 40.8%) experienced changes in the organisation of their team in order to provide end-of-life care in response to the COVID-19 pandemic. Three qualitative themes were identified: COVID-19 as a catalyst for change in primary palliative care; new opportunities for more responsive and technological ways of working; and pandemic factors that improved and strengthened interprofessional collaboration. CONCLUSION Opportunity has arisen to incorporate cross-boundary service changes and innovations, implemented rapidly at the time of crisis, into future service delivery. Future research should focus on which service changes and innovations provide the most benefits, who for and how, within the context of increased patient need and complexity.
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Affiliation(s)
| | | | | | | | - Helen Chapman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dena Khan
- Patient and Public Involvement Representative, Birmingham, England, UK
| | | | - Jeremy Dale
- University of Warwick, Coventry, England, UK
| | - Stephen Barclay
- University of Cambridge, Cambridge, UK
- University of East Anglia Norwich Medical School, UK
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10
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Buono N, Harris M, Farinaro C, Petrazzuoli F, Cavicchi A, D'Addio F, Scelsa A, Mirra B, Napolitano E, Soler JK. How are reasons for encounter associated with influenza-like illness and acute respiratory infection diagnoses and interventions? A cohort study in eight Italian general practice populations. BMC FAMILY PRACTICE 2021; 22:172. [PMID: 34454426 PMCID: PMC8401359 DOI: 10.1186/s12875-021-01519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/13/2021] [Indexed: 12/02/2022]
Abstract
Background Influenza-like illness (ILI) and Acute Respiratory Infections (ARI) are a considerable health problem in Europe. Most diagnoses are made by family physicians (FPs) and based on symptoms and clinical signs rather than on diagnostic testing. The International Classification of Primary Care (ICPC) advocates that FPs record patients’ ‘Reasons for Encounters’ (RfEs) as they are presented to them. This study analyses the association of patients’ RfEs with FPs’ diagnoses of ILI and ARI diagnoses and FPs’ management of those patients. Methods Cohort study of practice populations. Over a 4-month period during the winter season 2013–14, eight FPs recorded ILI and ARI patients’ RfEs and how they were managed. FPs recorded details of their patients using the ICPC format, collecting data in an Episode of Care (EoC) structure. Results There were 688 patients diagnosed as having ILI; between them they presented with a total of 2,153 RfEs, most commonly fever (79.7%), cough (59.7%) and pain (33.0%). The 848 patients with ARI presented with a total of 1,647 RfEs, most commonly cough (50.4%), throat symptoms (25.9%) and fever (19.9%). For patients with ILI, 37.0% of actions were related to medication for respiratory symptoms; this figure was 38.4% for patients with ARI. FPs referred six patients to specialists or hospitals (0.39% of all patients diagnosed with ILI and ARI). Conclusions In this study of patients with ILI and ARI, less than half received a prescription from their FPs, and the illnesses were mainly managed in primary care, with few patients’ needing referral. The ICPC classification allowed a standardised data collection system, providing documentary evidence of the management of those diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01519-4.
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Affiliation(s)
- Nicola Buono
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy.
| | - Michael Harris
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Carmine Farinaro
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Ferdinando Petrazzuoli
- Center for Primary Health Care Research, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Angelo Cavicchi
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Filippo D'Addio
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Amedeo Scelsa
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Baldassarre Mirra
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Enrico Napolitano
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Jean K Soler
- Mediterranean Institute of Primary Care, Attard, Malta
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11
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Mitchell S, Oliver P, Gardiner C, Chapman H, Khan D, Boyd K, Dale J, Barclay S, R Mayland C. Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey. BJGP Open 2021; 5:BJGPO.2021.0095. [PMID: 34117014 PMCID: PMC8450890 DOI: 10.3399/bjgpo.2021.0095] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. AIM To understand the views of GPs and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. DESIGN & SETTING A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks, during September and October 2020. METHOD Responses were analysed using descriptive statistics and an inductive thematic analysis. RESULTS Valid responses were received from 559 individuals (387 community nurses, 156 GPs, and 16 unspecified roles), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. CONCLUSION Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.
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Affiliation(s)
- Sarah Mitchell
- Yorkshire Cancer Research Senior Research Fellow, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Phillip Oliver
- Clinical Lecturer, Academic Unit of Medical Education, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Senior Research Fellow, Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Helen Chapman
- Queen's Nurse and Head of Integrated Community Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dena Khan
- Patient and Public Involvement Representative, University of Warwick, Warwick, UK
| | - Kirsty Boyd
- Reader in Palliative Care, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jeremy Dale
- Professor of Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Barclay
- Senior Lecturer in General Practice and Palliative Care, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Catriona R Mayland
- Yorkshire Cancer Research Senior Research Fellow, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey. BJGP Open 2021. [PMID: 34117014 DOI: 10.3399/bjgpo.2021.0095.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022] Open
Abstract
BACKGROUND Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. AIM To understand the views of GPs and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. DESIGN & SETTING A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks, during September and October 2020. METHOD Responses were analysed using descriptive statistics and an inductive thematic analysis. RESULTS Valid responses were received from 559 individuals (387 community nurses, 156 GPs, and 16 unspecified roles), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. CONCLUSION Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.
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Siebenhofer A, Huter S, Avian A, Mergenthal K, Schaffler-Schaden D, Spary-Kainz U, Bachler H, Flamm M. COVI-Prim survey: Challenges for Austrian and German general practitioners during initial phase of COVID-19. PLoS One 2021; 16:e0251736. [PMID: 34111120 PMCID: PMC8191874 DOI: 10.1371/journal.pone.0251736] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/30/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) represents a significant challenge to health care systems around the world. A well-functioning primary care system is crucial in epidemic situations as it plays an important role in the development of a system-wide response. METHODS 2,187 Austrian and German GPs answered an internet survey on preparedness, testing, staff protection, perception of risk, self-confidence, a decrease in the number of patient contacts, and efforts to control the spread of the virus in the practice during the early phase of the COVID-pandemic (3rd to 30th April). RESULTS The completion rate of the questionnaire was high (90.9%). GPs gave low ratings to their preparedness for a pandemic, testing of suspected cases and efforts to protect staff. The provision of information to GPs and the perception of risk were rated as moderate. On the other hand, the participants rated their self-confidence, a decrease in patient contacts and their efforts to control the spread of the disease highly. CONCLUSION Primary care is an important resource for dealing with a pandemic like COVID-19. The workforce is confident and willing to take an active role, but needs to be provided with the appropriate surrounding conditions. This will require that certain conditions are met. REGISTRATION Trial registration at the German Clinical Trials Register: DRKS00021231.
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Affiliation(s)
- Andrea Siebenhofer
- Institute of General Practice and Evidence based Health Services Research, Medical University Graz, Graz, Austria
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Sebastian Huter
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Avian
- Institute for Medical Informatics, and Statistics and Documentation, Medical University Graz, Graz, Austria
- * E-mail:
| | - Karola Mergenthal
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Dagmar Schaffler-Schaden
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ulrike Spary-Kainz
- Institute of General Practice and Evidence based Health Services Research, Medical University Graz, Graz, Austria
| | - Herbert Bachler
- Institute of General Practice, Medical University Innsbruck, Innsbruck, Austria
| | - Maria Flamm
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
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14
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Homeniuk R, Collins C. How COVID-19 has affected general practice consultations and income: general practitioner cross-sectional population survey evidence from Ireland. BMJ Open 2021; 11:e044685. [PMID: 38607944 PMCID: PMC8039245 DOI: 10.1136/bmjopen-2020-044685] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives How general practice is delivered in many countries has drastically changed due to the COVID-19 pandemic. This study aimed to answer the question of how general practice has changed in Ireland in response to COVID-19. Design The Irish College of General Practitioners surveyed its membership before and after the global pandemic hit Ireland using a cross-sectional online survey instrument. Setting This study focuses on primary care, specifically general practice, in Ireland. Participants In February 2020 before the global pandemic, 526 general practices across Ireland submitted responses to the survey; 538 general practices responded to the second survey during the pandemic in June 2020. This covers 32% and 33% of practices in Ireland, respectively. Main outcome measures The type of consultations by general practitioners (GPs) and practice nurses in both surveys is the main outcome measure reported in this paper. Other changes such as the perceived change in attendance by certain patient groups and practice income are also reported. Results Face-to-face consultations significantly (p<0.001) decreased from a median of 26 (IQR 21.3-30) to a median of 8 (IQR 6-13). GP telemedicine consultations increased (p<0.001) from a median of 2.4 (IQR 0-5.3) to a median of 11.3 (IQR 6-19). The majority of practices (80.0%) reported reduced practice profit. Respondents reported a decline in non-COVID-19-related consultations among certain patient cohorts-92.0% for children under 6 years old; 79.5% for patients over 70 years. Conclusions It is likely that the way general practice is delivered will not return to as it was before the COVID-19 pandemic and increased telemedicine can be expected. However, it is necessary to assess the impact of this shift on patient health and to assess healthcare provider and patient experience to ensure continued high-quality care and patient safety.
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Affiliation(s)
- Robyn Homeniuk
- Research Centre, Irish College of General Practitioners, Dublin, Ireland
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, Dublin, Ireland
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15
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Dutour M, Kirchhoff A, Janssen C, Meleze S, Chevalier H, Levy-Amon S, Detrez MA, Piet E, Delory T. Family medicine practitioners' stress during the COVID-19 pandemic: a cross-sectional survey. BMC FAMILY PRACTICE 2021; 22:36. [PMID: 33583410 PMCID: PMC7882249 DOI: 10.1186/s12875-021-01382-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/04/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic has shaken the world in early 2020. In France, General Practitioners (GPs) were not involved in the care organization's decision-making process before and during the first wave of the COVID-19 pandemic. This omission could have generated stress for GPs. We aimed first to estimate the self-perception of stress as defined by the 10-item Perceived Stress Score (PSS-10), at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes, a french administrative area severely impacted by COVID-19. Second, we aimed to identify factors associated with a self-perceived stress (PSS-10 ≥ 27) among socio-demographic characteristics of GPs, their access to reliable information and to personal protective equipment during the pandemic, and their exposure to well established psychosocial risk at work. METHODS We conducted an online cross-sectional survey between 8th April and 10th May 2020. The self-perception of stress was evaluated using the PSS-10, so to see the proportion of "not stressed" (≤20), "borderline" (21 ≤ PSS-10 ≤ 26), and "stressed" (≥27) GPs. The agreement to 31 positive assertions related to possible sources of stress identified by the scientific study committee was measured using a 10-point numeric scale. In complete cases, factors associated with stress (PSS-10 ≥ 27) were investigated using logistic regression, adjusted on gender, age and practice location. A supplementary analysis of the verbatims was made. RESULTS Overall, 898 individual answers were collected, of which 879 were complete. A total of 437 GPs (49%) were stressed (PSS-10 ≥ 27), and 283 GPs (32%) had a very high level of stress (PSS-10 ≥ 30). Self-perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements. However, in this context of health crisis, the primary source of stress was the diversity and quantity of information from diverse sources (614 GPs (69%, OR = 2.21, 95%CI [1.40-3.50], p < 0.001). Analysis of verbatims revealed that GPs felt isolated in a hospital-based model. CONCLUSION The first wave of the pandemic was a source of stress for GPs. The diversity and quantity of information received from the health authorities were among the main sources of stress.
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Affiliation(s)
- Marion Dutour
- Infectious disease department, Annecy-Genevois hospital, Annecy, France.
| | - Anna Kirchhoff
- Infectious disease department, Annecy-Genevois hospital, Annecy, France
| | - Cécile Janssen
- Infectious disease department, Annecy-Genevois hospital, Annecy, France
| | - Sabine Meleze
- Institut national d'études démographiques (Ined), UR 14, Aubervillers, France
| | | | | | | | - Emilie Piet
- Infectious disease department, Annecy-Genevois hospital, Annecy, France
| | - Tristan Delory
- Institut national d'études démographiques (Ined), UR 14, Aubervillers, France
- Clinical research unit, Annecy-Genevois hospital, Annecy, France
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16
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Kurotschka PK, Serafini A, Demontis M, Serafini A, Mereu A, Moro MF, Carta MG, Ghirotto L. General Practitioners' Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study. Front Public Health 2021; 9:623904. [PMID: 33614587 PMCID: PMC7888233 DOI: 10.3389/fpubh.2021.623904] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
Since February 2020, when coronavirus disease began to spread in Italy, general practitioners (GPs) were called to manage a growing number of health situations. The challenges experienced by Italian GPs remained unrevealed. This study aimed at exploring Italian GPs' care experiences and practices associated with critical incidents during the first wave of the pandemic. A qualitative study design involving the critical incident technique through an online survey was applied. Sociodemographic data and open-ended responses were collected. While participants' characteristics were analyzed through descriptive statistics, qualitative data were thematically analyzed employing the framework method. 149 GPs responded to the survey and 99 participants completed the survey (dropout rate = 33%). Eight themes emerged indicating factors related to the organization of the healthcare system and factors related to the clinical management of patients, that were perceived as impacting on the GPs' care provision. The analysis revealed difficulties in communicating with other local services. This, together with the lack of coordination among services, was reported as a major challenge. Primary care was perceived as having been undervalued and criticalities in the organization of GP courses, led in a bureaucratic fashion, posed at risk some trainees to be infected. The digital technologies adopted for remote patient consultations were seen as useful tools for daily practice helping the GPs to stay emotionally connected with their patients. Besides, the improvement in the GP–patient relationship in terms of solidarity between patients and doctors and compliance to rules, had a positive impact. Moreover, many respondents addressed the importance of professional collaboration and teamwork, in terms of both support in practical issues (to find PPE, diagnostics and guidelines) and emotional support. At the same time, the lack of resources (e.g., PPE, swabs) and of specific guidelines and protocols impacted on the care provision. Our findings suggest that GPs in Italy are at risk of being left behind within the epidemic management. Communication and coordination among services are essential and should be substantially improved, and primary care research should be initiated to collect the context-specific evidence necessary to enhance the system's preparedness to public health emergencies and the quality of primary care services.
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Affiliation(s)
- Peter Konstantin Kurotschka
- Department of Medical Sciences and Public Health, Faculty of Medicine and Surgery, University of Cagliari, Cagliari, Italy
| | | | | | | | - Alessandro Mereu
- Azienda Unità Sanitaria Locale Toscana Centro, Sesto Fiorentino, Firenze, Italy
| | - Maria Francesca Moro
- Mailman School of Public Health, Columbia University, New York City, NY, United States
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, Faculty of Medicine and Surgery, University of Cagliari, Cagliari, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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17
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Mughal F, Khunti K, Mallen C. The impact of COVID-19 on primary care: Insights from the National Health Service (NHS) and future recommendations. J Family Med Prim Care 2021; 10:4345. [PMID: 35165652 PMCID: PMC7612361 DOI: 10.4103/jfmpc.jfmpc_756_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
COVID-19 has changed health systems and services. In this commentary, we outline the impact COVID-19 has had on the delivery of primary health care, and on primary care teams, and describe the NHS response. We highlight the challenges of managing long-COVID and identify areas of importance for primary care in a post-COVID context. We describe ongoing public health measures and list recommendations for primary care for COVID-19 and future unknown pandemics. We conclude with salient points on the future of primary care.
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18
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Haldane V, Zhang Z, Abbas RF, Dodd W, Lau LL, Kidd MR, Rouleau K, Zou G, Chao Z, Upshur REG, Walley J, Wei X. National primary care responses to COVID-19: a rapid review of the literature. BMJ Open 2020; 10:e041622. [PMID: 33293398 PMCID: PMC7725079 DOI: 10.1136/bmjopen-2020-041622] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this review, conducted in April 2020, is to examine available national primary care guidelines for COVID-19 and to explore the ways in which these guidelines support primary care facilities in responding to the demands of the COVID-19 pandemic. DESIGN Rapid review and narrative synthesis. DATA SOURCES PubMed, Embase and Google, as well as the websites of relevant national health departments, were searched from 1 January 2020 to 24 April 2020. ELIGIBILITY CRITERIA Documents included must be issued by a national health authority, must be specific to COVID-19 care, directed at healthcare workers or managers, and must refer to the role of primary care in the COVID-19 response. RESULTS We identified 17 documents from 14 countries. An adapted framework on primary care challenges and responses to pandemic influenza framed our analysis. Guidelines generally reported on COVID-19 service delivery and mostly made specific recommendations for ensuring continued delivery of essential primary care services through telehealth or other virtual care modalities. Few offered guidance to support surveillance as a public health function. All offered guidance on implementing outbreak control measures, largely through flexible and coordinated organisational models with partners from various sectors. There was a lack of guidance to support supply chain management and practice resilience in primary care, and lack of personal protective equipment represents a serious threat to the provision of quality care during the pandemic. CONCLUSIONS Current national primary care guidelines for COVID-19 provide guidance on infection control and minimising the risk of spread in primary care practices, while supporting the use of new technology and coordinated partnerships. However, to ensure primary care practice resilience and quality of care are upheld, guidelines must offer recommendations on supply chain management and operational continuity, supported by adequate resources.
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Affiliation(s)
- Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Raja Faisal Abbas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Warren Dodd
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lincoln L Lau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- International Care Ministries, Manila, Philippines
| | - Michael R Kidd
- Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Rouleau
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guanyang Zou
- School of Economics and Management, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhuo Chao
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - 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
| | - John Walley
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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19
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Mitchell S, Maynard V, Lyons V, Jones N, Gardiner C. The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic. Palliat Med 2020; 34:1182-1192. [PMID: 32736494 PMCID: PMC7528540 DOI: 10.1177/0269216320947623] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The increased number of deaths in the community happening as a result of COVID-19 has caused primary healthcare services to change their traditional service delivery in a short timeframe. Services are quickly adapting to new challenges in the practical delivery of end-of-life care to patients in the community including through virtual consultations and in the provision of timely symptom control. AIM To synthesise existing evidence related to the delivery of palliative and end-of-life care by primary healthcare professionals in epidemics and pandemics. DESIGN Rapid systematic review using modified systematic review methods, with narrative synthesis of the evidence. DATA SOURCES Searches were carried out in Medline, Embase, PsychINFO, CINAHL and Web of Science on 7th March 2020. RESULTS Only five studies met the inclusion criteria, highlighting a striking lack of evidence base for the response of primary healthcare services in palliative care during epidemics and pandemics. All were observational studies. Findings were synthesised using a pandemic response framework according to 'systems' (community providers feeling disadvantaged in terms of receiving timely information and protocols), 'space' (recognised need for more care in the community), 'staff' (training needs and resilience) and 'stuff' (other aspects of managing care in pandemics including personal protective equipment, cleaning care settings and access to investigations). CONCLUSIONS As the COVID-19 pandemic progresses, there is an urgent need for research to provide increased understanding of the role of primary care and community nursing services in palliative care, alongside hospices and community specialist palliative care providers.
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Affiliation(s)
- Sarah Mitchell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | | | - Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Clare Gardiner
- Division of Nursing and Midwifery, Health Sciences School, Sheffield, UK
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20
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Halcomb E, McInnes S, Williams A, Ashley C, James S, Fernandez R, Stephen C, Calma K. The Experiences of Primary Healthcare Nurses During the COVID-19 Pandemic in Australia. J Nurs Scholarsh 2020; 52:553-563. [PMID: 32735758 PMCID: PMC7436753 DOI: 10.1111/jnu.12589] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The COVID-19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID-19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment. DESIGN AND METHODS Nurses employed in primary healthcare across Australia were invited to participate in a cross-sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses' employment, work role, and access to personal protective equipment. FINDINGS Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID-19, they expressed concern about work-related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic. CONCLUSIONS This is the first study of primary healthcare nurses' experiences during the COVID-19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health. CLINICAL RELEVANCE Understanding the implications of COVID-19 on the primary healthcare nursing workforce is vital to ensure staff retention and care quality. Ensuring that the community remains healthy and supported at home is vital to both reduce the burden on the health system and reduce secondary mortality.
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Affiliation(s)
- Elizabeth Halcomb
- Xi Omicron, Professor of Primary Health Care Nursing, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia
| | - Susan McInnes
- Xi Omicron, Lecturer, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia
| | - Anna Williams
- Senior Lecturer/Discipline Lead Primary Health Care and Chronic Illness, School of Nursing, University of Notre Dame, Sydney, NSW, Australia
| | - Christine Ashley
- Project Officer, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia
| | - Sharon James
- Xi Omicron, PhD Candidate/Sessional Tutor, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Bega, NSW, Australia
| | - Ritin Fernandez
- Professor of Nursing, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, and Centre for Research in Nursing and Health, Level 1 Research and Education Building, St George Hospital, Kogarah, NSW, Australia
| | - Catherine Stephen
- Xi Omicron, PhD Candidate/Sessional Tutor, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Bega, NSW, Australia.,Xi Omicron, PhD Candidate/Sessional Tutor, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia
| | - Kaara Calma
- Xi Omicron, PhD Candidate/Sessional Tutor, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Bega, NSW, Australia.,Xi Omicron, PhD Candidate/Sessional Tutor, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia
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21
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Desborough J, Hall Dykgraaf S, de Toca L, Davis S, Roberts L, Kelaher C, Kidd M. Australia's national COVID-19 primary care response. Med J Aust 2020; 213:104-106.e1. [PMID: 32623740 PMCID: PMC7361540 DOI: 10.5694/mja2.50693] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jane Desborough
- College of Health and Medicine, Australian National University, Canberra, ACT
| | - Sally Hall Dykgraaf
- College of Health and Medicine, Australian National University, Canberra, ACT
| | - Lucas de Toca
- COVID-19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT
| | - Stephanie Davis
- COVID-19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Leslee Roberts
- COVID-19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT
| | - Catherine Kelaher
- Chief Medical Officer Group, Australian Government Department of Health, Canberra, ACT
| | - Michael Kidd
- College of Health and Medicine, Australian National University, Canberra, ACT.,COVID-19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT
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Abstract
PurposeTo assess perceptions and attitudes toward disasters and disaster planning among outpatient primary care leaders. METHODS Written surveys and semi-structured interviews of non-physician clinical managers and physician medical directors were conducted using the 2009 H1N1 pandemic as a case-based scenario at 5 university-affiliated family medicine clinics. Domains assessed included perceived pandemic threat; value, existence, and barriers to creating personal disaster plans; staff absenteeism estimates; barriers to work attendance. Quantitative and qualitative data were analyzed using descriptive statistics and content analysis with identification and coding of common themes, respectively. RESULTS All 12 invited leaders participated and believed a personal disaster plan was important but only 2 had plans. None had ever discussed with their staff the importance of having a personal disaster plan. Two common barriers in creating a plan were low threat perception level and never considering the possibility of pandemic influenza. Only half of respondents could list common barriers preventing staff from working. Staff were confident employees would come to work during a disaster. CONCLUSION Outpatient primary care leaders may hold misconceptions regarding future disasters, underestimate their potential impact on clinics, and lack personal preparedness. Further investigation and interventions are needed to ensure clinics can be prepared so they can function and help hospital and emergency services when disasters strike. (Disaster Med Public Health Preparedness. 2018;12:644-648).
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Laar A, DeBruin D. Ethics-sensitivity of the Ghana national integrated strategic response plan for pandemic influenza. BMC Med Ethics 2015; 16:30. [PMID: 25947354 PMCID: PMC4427965 DOI: 10.1186/s12910-015-0025-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many commentators call for a more ethical approach to planning for influenza pandemics. In the developed world, some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI). METHODS We critically analyzed the Ghana NISPPI's sensitivity to ethics issues to determine how well it reflects ethical commitments and principles identified in our review of global pandemic preparedness literature, existing pandemic plans, and relevant ethics frameworks. RESULTS This paper reveals that important ethical issues have not been addressed in the Ghana NISPPI. Several important ethical issues are unanticipated, unacknowledged, and unplanned for. These include guidelines on allocation of scarce resources, the duties of healthcare workers, ethics-sensitive operational guidelines/protocols, and compensation programs. The NISPPI also pays scant attention to use of vaccines and antivirals, border issues and cooperation with neighboring countries, justification for delineated actions, and outbreak simulations. Feedback and communication plans are nebulous, while leadership, coordination, and budgeting are quite detailed. With respect to presentation, the NISPPI's text is organized around five thematic areas. While each area implicates ethical issues, NISPPI treatment of these areas consistently fails to address them. CONCLUSIONS Our analysis reveals a lack of consideration of ethics by the NISPPI. We contend that, while the plan's content and fundamental assumptions provide support for implementation of the delineated public health actions, its consideration of ethical issues is poor. Deficiencies include a failure to incorporate guidelines that ensure fair distribution of scarce resources and a lack of justification for delineated procedures. Until these deficiencies are recognized and addressed, Ghana runs the risk of rolling out unjust and ethically indefensible actions with real negative effects in the event of a pandemic. Soliciting inputs from the public and consultation with ethicists during the next revision of the NISPPI will be useful in addressing these issues.
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Affiliation(s)
- Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Box LG 13, Legon, Accra, Ghana.
| | - Debra DeBruin
- Center for Bioethics, University of Minnesota, 410 Church Street S.E MN, 55455-0346, Minneapolis, USA.
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Geller G, Dvoskin R, Thio CL, Duggal P, Lewis MH, Bailey TC, Sutherland A, Salmon DA, Kahn JP. Genomics and infectious disease: a call to identify the ethical, legal and social implications for public health and clinical practice. Genome Med 2014; 6:106. [PMID: 25593592 PMCID: PMC4295297 DOI: 10.1186/s13073-014-0106-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Advances in genomics are contributing to the development of more effective, personalized approaches to the prevention and treatment of infectious diseases. Genetic sequencing technologies are furthering our understanding of how human and pathogen genomic factors - and their interactions - contribute to individual differences in immunologic responses to vaccines, infections and drug therapies. Such understanding will influence future policies and procedures for infectious disease management. With the potential for tailored interventions for particular individuals, populations or subpopulations, ethical, legal and social implications (ELSIs) may arise for public health and clinical practice. Potential considerations include balancing health-related benefits and harms between individuals and the larger community, minimizing threats to individual privacy and autonomy, and ensuring just distribution of scarce resources. In this Opinion, we consider the potential application of pathogen and host genomic information to particular viral infections that have large-scale public health consequences but differ in ELSI-relevant characteristics such as ease of transmission, chronicity, severity, preventability and treatability. We argue for the importance of anticipating these ELSI issues in advance of new scientific discoveries, and call for the development of strategies for identifying and exploring ethical questions that should be considered as clinical, public health and policy decisions are made.
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Affiliation(s)
- Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA ; Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA ; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Rachel Dvoskin
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Priya Duggal
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Michelle H Lewis
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Theodore C Bailey
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Andrea Sutherland
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Daniel A Salmon
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA ; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Jeffrey P Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
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Jaakkimainen RL, Bondy SJ, Parkovnick M, Barnsley J. How infectious disease outbreaks affect community-based primary care physicians: comparing the SARS and H1N1 epidemics. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:917-925. [PMID: 25316747 PMCID: PMC4196817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare how the infectious disease outbreaks H1N1 and severe acute respiratory syndrome (SARS) affected community-based GPs and FPs. DESIGN A mailed survey sent after the H1N1 outbreak compared with the results of similar survey completed after the SARS outbreak. SETTING Greater Toronto area in Ontario. PARTICIPANTS A total of 183 randomly selected GPs and FPs who provided office-based care. MAIN OUTCOME MEASURES The perceptions of GPs and FPs on how serious infectious disease outbreaks affected their clinical work and personal lives; their preparedness for a serious infectious disease outbreak; and the types of information they want to receive and the sources they wanted to receive information from during a serious infectious disease outbreak. The responses from this survey were compared with the responses of GPs and FPs in the greater Toronto area who completed a similar survey in 2003 after the SARS outbreak. RESULTS After the H1N1 outbreak, GPs and FPs still had substantial concerns about the effects of serious infectious disease outbreaks on the health of their family members. Physicians made changes to various office practices in order to manage and deal with patients with serious infectious diseases. They expressed concerns about the effects of an infectious disease on the provision of health care services. Also, physicians wanted to quickly receive accurate information from the provincial government and their medical associations. CONCLUSION Serious community-based infectious diseases are a personal concern for GPs and FPs, and have considerable effects on their clinical practice. Further work examining the timely flow of relevant information through different health care sectors and government agencies still needs to be undertaken.
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Affiliation(s)
- R Liisa Jaakkimainen
- Associate Professor in, and holds a Clinician Investigator award from, the Department of Family and Community Medicine at the University of Toronto in Ontario.
| | - Susan J Bondy
- Associate Professor at the Dalla Lana School of Public Health at the University of Toronto
| | - Meredith Parkovnick
- Research assistant with the Primary Care Research Unit in the Department of Family and Community Medicine at Sunnybrook Health Sciences Centre in Toronto
| | - Jan Barnsley
- Associate Professor at the Institute for Health Policy, Management and Evaluation at the University of Toronto
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Response of general practitioners to infectious disease public health crises: an integrative systematic review of the literature. Disaster Med Public Health Prep 2014; 7:522-33. [PMID: 24274132 DOI: 10.1017/dmp.2013.82] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Previous research has identified gaps in pandemic response planning for primary care. Identifying the challenges that general practitioners (GPs) face during public health crises of infectious diseases will help to improve prepandemic planning. In this integrative systematic review, we identified research-based evidence to (1) challenges that GPs have when participating in pandemics or epidemics and (2) whether GPs from different countries encountered different challenges. METHODS A systematic search was conducted in MEDLINE, PubMed, Scopus, EMBASE, PsycINFO, Cochrane Library, and ProQuest Dissertations and Theses databases during October to November 2012 to identify studies relevant to experience by GPs during epidemics or pandemics. RESULTS Six quantitative, 2 mixed method, and 2 qualitative studies met the inclusion criteria. The challenges identified were not exclusive to specific countries and encompassed different responses to outbreaks. These challenges included difficulties with information access; supply and use of personal protective equipment; performing public health responsibilities; obtaining support from the authorities; appropriate training; and the emotional effects of participating in the response to an infectious disease with unknown characteristics and lethality. CONCLUSION GPs' response to public health crises in different countries presents potential for improving pandemic preparedness.
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Tomizuka T, Kanatani Y, Kawahara K. Insufficient preparedness of primary care practices for pandemic influenza and the effect of a preparedness plan in Japan: a prefecture-wide cross-sectional study. BMC FAMILY PRACTICE 2013; 14:174. [PMID: 24252688 PMCID: PMC3840630 DOI: 10.1186/1471-2296-14-174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/18/2013] [Indexed: 11/10/2022]
Abstract
Background Cases of emerging infectious diseases, including H5N1 influenza, H7N9 influenza, and Middle East Respiratory Syndrome, have been reported in recent years, and the threat of pandemic outbreaks persists. In Japan, primary care is the frontline against emerging infectious diseases in communities. Although the importance of pandemic preparedness in primary care has been highlighted previously, few studies have thus far investigated the preparedness among primary care practices (PCPs) or differences in the preparedness of different institutional settings. We examined PCP preparedness and response to the 2009 influenza pandemic in Japan, and explored the role of a pandemic preparedness plan during the pandemic. Methods We used a survey questionnaire to assess how well individual PCPs in Okinawa, Japan, were prepared for the 2009 influenza pandemic. The questionnaire was mailed to all eligible PCPs (N = 465) in Okinawa, regardless of their institutional setting. In addition, we assessed the differences in the preparedness of clinics and hospitals and determined whether the national preparedness plan affected individual preparedness and response. Data were analyzed using descriptive and logistic regression analyses. Results A total of 174 (37.4%) PCPs responded to our survey. In general, high-level personal protective equipment (PPE) such as N95 masks (45.4%), gowns (30.5%), and eye protection (21.3%) was stocked at a low rate. Clinic-based PCPs were significantly less prepared than hospital-based PCPs to provide N95 masks (OR 0.34), gowns (OR 0.15), and eye protection (OR 0.18). In addition, only 32.8% of PCPs adopted an adequate business continuity plan (BCP). After controlling for institutional setting, reading the national preparedness plan was significantly associated with establishment of a BCP (OR 5.86), and with knowledge of how to transfer a swab specimen to a local medical laboratory (OR 5.60). Conclusions With regard to PPE availability, PCPs (especially clinic-based PCPs) were not adequately prepared for the influenza pandemic. Awareness of the national pandemic preparedness plan is likely to promote prefecture-wide implementation of BCPs and surveillance activity.
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Affiliation(s)
- Taro Tomizuka
- Department of Health Policy Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
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Capacity and adaptations of general practice during an influenza pandemic. PLoS One 2013; 8:e69408. [PMID: 23874960 PMCID: PMC3715475 DOI: 10.1371/journal.pone.0069408] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/09/2013] [Indexed: 11/19/2022] Open
Abstract
Background GPs play a major role in influenza epidemics, and most patients with influenza-like-illness (ILI) are treated in general practice or by primary care doctors on duty in out-of-hours services (OOH). Little is known about the surge capacity in primary care services during an influenza pandemic, and how the relationship between them changes. Aim To investigate how general practice and OOH services were used by patients during the 2009 pandemic in Norway and the impact of the pandemic on primary care services in comparison to a normal influenza season. Materials Data from electronic remuneration claims from all OOH doctors and regular GPs for 2009. Methods We conducted a registry-based study of all ILI consultations in the 2009 pandemic with the 2008/09 influenza season (normal season) as baseline for comparison. Results The majority (82.2%) of ILI consultations during the 2009 pandemic took place in general practice. The corresponding number in the 2008/09 season was 89.3%. Compared with general practice, the adjusted odds ratio for ILI with all other diagnoses as reference in OOH services was 1.23 (95% CI, 1.18, 1.27) for the 2008/2009 season and 1.87 (95% CI, 1.84, 1.91) for the pandemic influenza season. In total there was a 3.3-fold increase in ILI consultations during the pandemic compared to the 2008/09 season. A 5.5-fold increase of ILI consultations were observed in OOH services in comparison to the 2008/09 season. Children and young adults with ILI were the most frequent users of OOH services during influenza periods. Conclusions The autumn pandemic wave resulted in a significantly increased demand on primary care services. However, GPs in primary care services in Norway showed the ability to increase capacity in a situation with increased patient demand.
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Tuells J, Caballero P, Nolasco A. Creencias, actitudes e influencia de los medios de comunicación en trabajadores sanitarios españoles durante la gripe pandémica A (H1N1) 2009. Enferm Infecc Microbiol Clin 2013; 31:369-74. [DOI: 10.1016/j.eimc.2012.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/09/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022]
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Factors associated with the willingness of health care personnel to work during an influenza public health emergency: an integrative review. Prehosp Disaster Med 2012; 27:551-66. [PMID: 23031432 DOI: 10.1017/s1049023x12001331] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The first decade of the 21st century has witnessed three major influenza public health emergencies: (1) the severe acute respiratory syndrome of 2002-2003; (2) the avian flu of 2006; and (3) the 2009 H1N1 pandemic influenza. An effective public health response to an influenza public health emergency depends on the majority of uninfected health care personnel (HCP) continuing to report to work. The purposes of this study were to determine the state of the evidence concerning the willingness of HCP to work during an influenza public health emergency, to identify the gaps for future investigation, and to facilitate evidence-based influenza public health emergency planning. METHODS A systemic literature review of relevant, peer-reviewed, quantitative, English language studies published from January 1, 2001 through June 30, 2010 was conducted. Search strategies included the Cochrane Library, PubMed, PubMed Central, EBSCO Psychological and Behavioral Sciences Collection, Google Scholar, ancestry searching of citations in relevant publications, and information from individuals with a known interest in the topic. RESULTS Thirty-two studies met the inclusion criteria. Factors associated with a willingness to work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical or emergency department, working full-time, prior influenza education and training, prior experience working during an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective equipment (PPE), and confidence in one's employer. Factors found to be associated with less willingness were: being female, being in a supportive staff position, working part-time, the peak phase of the influenza emergency, concern for family and loved ones, and personal obligations. Interventions that resulted in the greatest increase in the HCP's willingness to work were preferential access to Tamiflu for the HCP and his/her family, and the provision of a vaccine for the individual and his/her family. CONCLUSIONS Understanding the factors that contribute to the willingness of HCP to report to work during an influenza public health emergency is critical to emergency planning and preparedness. Information from this review can guide emergency policy makers, planners, and implementers in both understanding and influencing the willingness of HCP to work during an influenza public health emergency.
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Wong SYS, Kung K, Wong MCS, Wong C, Tsui W, Chan K, Liang J, Lee NLS, Cheung AWL, Wong ELY. Primary care physicians' response to pandemic influenza in Hong Kong: a mixed quantitative and qualitative study. Int J Infect Dis 2012; 16:e687-91. [PMID: 22789752 PMCID: PMC7128972 DOI: 10.1016/j.ijid.2012.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/28/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The current study was conducted to use a developed framework to appraise the public primary care response to pandemic 2009 influenza A H1N1 virus in Hong Kong in 2009. METHODS A cross-sectional survey was conducted of 300 doctors working in public primary care clinics. In addition, a qualitative study was conducted in two selected general outpatient clinics (GOPCs) with 10 doctors between September and December 2009. RESULTS We found that there was an increase in clinical service demand for public primary care doctors and that there was lower compliance with hand washing as compared to the wearing of masks among GOPC doctors during the study period. CONCLUSIONS Since hand hygiene and influenza vaccination are effective methods to prevent the spread of influenza infection, future studies should explore the reasons for non-compliance with these preventive behaviors among doctors. More education and training in dealing with influenza A H1N1 infection may be needed.
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Affiliation(s)
- Samuel Y S Wong
- Division of Family Medicine and Primary Health Care, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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Pearce C, Shearer M, Phillips C, Hall S, Kljakovic M, Glasgow NJ, Dugdale P, Patel M. Views of GPs and practice nurses on support needed to respond to pandemic influenza: a qualitative study. AUST HEALTH REV 2011; 35:111-5. [PMID: 21367342 DOI: 10.1071/ah09788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 06/06/2010] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Five years ago Australia, and the world, placed itself on heightened alert for pandemic influenza, based on concerns about the potential spread of the avian influenza virus. This prompted a flurry of preparation activity involving general practice, with information from various sources; government, colleges and divisions of general practice. METHOD To assess how general practitioners and practice nurses perceive this information, practice nurses and general practitioners were interviewed as part of a larger project exploring the role of the Australian general practice sector in an influenza pandemic. Results were validated by two focus groups and scenario sessions. FINDINGS Participants perceived that non-government organisations rarely gave useful information during a pandemic outbreak. Local divisions were perceived as having a practical and useful role, providing hands-on support to practices during a pandemic outbreak. Our participants did not perceive any coordination in the delivery of information sent by all the organisations involved in a pandemic response and therefore rejected our second hypothesis. CONCLUSIONS More planning needs to go into the coordinated response of the general practice sector to a pandemic, and such a response should include the support of local Divisions, both as a conduit for information and to assist practices to develop response plans.
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Affiliation(s)
- Christopher Pearce
- Melbourne East GP Network, Suite 13, Level 1, 317-321 Whitehorse Road, Nunawading, VIC 3131, Australia
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Wong SYS, Wong ELY, Chor J, Kung K, Chan PKS, Wong C, Griffiths SM. Willingness to accept H1N1 pandemic influenza vaccine: a cross-sectional study of Hong Kong community nurses. BMC Infect Dis 2010; 10:316. [PMID: 21034439 PMCID: PMC2988052 DOI: 10.1186/1471-2334-10-316] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 10/29/2010] [Indexed: 11/18/2022] Open
Abstract
Background The 2009 pandemic of influenza A (H1N1) infection has alerted many governments to make preparedness plan to control the spread of influenza A (H1N1) infection. Vaccination for influenza is one of the most important primary preventative measures to reduce the disease burden. Our study aims to assess the willingness of nurses who work for the community nursing service (CNS) in Hong Kong on their acceptance of influenza A (H1N1) influenza vaccination. Methods 401 questionnaires were posted from June 24, 2009 to June 30, 2009 to community nurses with 67% response rate. Results of the 267 respondents on their willingness to accept influenza A (H1N1) vaccine were analyzed. Results Twenty-seven percent of respondents were willing to accept influenza vaccination if vaccines were available. Having been vaccinated for seasonable influenza in the previous 12 months were significantly independently associated with their willingness to accept influenza A (H1N1) vaccination (OR = 4.03; 95% CI: 2.03-7.98). Conclusions Similar to previous findings conducted in hospital healthcare workers and nurses, we confirmed that the willingness of community nurses to accept influenza A (H1N1) vaccination is low. Future studies that evaluate interventions to address nurses' specific concerns or interventions that aim to raise the awareness among nurses on the importance of influenza A (H1N1) vaccination to protect vulnerable patient populations is needed.
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Affiliation(s)
- Samuel Y S Wong
- School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, PR China.
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Wong ELY, Wong SYS, Kung K, Cheung AWL, Gao TT, Griffiths S. Will the community nurse continue to function during H1N1 influenza pandemic: a cross-sectional study of Hong Kong community nurses? BMC Health Serv Res 2010; 10:107. [PMID: 20433691 PMCID: PMC2907760 DOI: 10.1186/1472-6963-10-107] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 04/30/2010] [Indexed: 12/03/2022] Open
Abstract
Background Healthcare workers have been identified as one of the high risk groups for being infected with influenza during influenza pandemic. Potential levels of absenteeism among healthcare workers in hospital settings are high. However, there was no study to explore the attitudes of healthcare workers in community setting towards the preparedness to the novel H1N1 influenza pandemic. The aim of this study was to explore the willingness of community nurses in Hong Kong to work during H1N1 influenza pandemic. Methods A cross-sectional survey was conducted among all 401 community nurses employed by the Hospital Authority in Hong Kong when the WHO pandemic alert level was 6. Results The response rate of this study was 66.6%. 76.9% participants reported being "not willing" (33.3%) or "not sure" (43.6%) to take care of patients during H1N1 influenza pandemic. The self-reported reasons for being unwilling to report to duty during H1N1 influenza pandemic were psychological stress (55.0%) and fear of being infected H1N1 influenza (29.2%). The reported unwillingness to report to duty was marginally significantly associated with the request for further training of using infection control clinical guideline (OR: 0.057; CI: 0.25-1.02). Those who reported unwillingness or not being sure about taking care of the patients during H1N1 influenza pandemic were more depressed (p < 0.001) and found work more emotionally stressful (p < 0.001). Conclusions Interventions to provide infection control training and address community nurses' psychological needs might increase their willingness to provide care to patients in the community during H1N1 influenza pandemic. This would help to ensure an effective and appropriate health system response during the H1N1 influenza pandemic.
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Affiliation(s)
- Eliza L Y Wong
- School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, School of Public Health Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
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Dawson W, Yamamoto K. Home educating in an extended family culture and aging society may fare best during a pandemic. PLoS One 2009; 4:e7221. [PMID: 19784366 PMCID: PMC2745700 DOI: 10.1371/journal.pone.0007221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 08/15/2009] [Indexed: 11/18/2022] Open
Abstract
Large cities can contain populations that move rapidly from one section to another in an efficient transportation network. An emerging air-borne or contact based pathogen could use these transportation routes to rapidly spread an infection throughout an entire population in a short time. Further, in many developed countries, the aging population is increasing. The family structure in these societies may also affect the course of a disease. To help understand the impact of an epidemic on family structure in a networked population, an individual based computer model that randomly generates networked cities with a specified range of population and disease characteristics and individual schedules, infectivity, transmission and hygiene factors was developed. Several salient issues emerged. First, a city of highly active individuals may in fact diminish the number of fatalities because the average duration of the interactions between agents is reduced. Second, home schooling can significantly improve survival because the institutional clustering of weak individuals is minimized. Third, the worst scenario for an aging population is the nuclear family where the aged population is confined to large housing facilities. Naturally, hygiene is the first barrier to infection. The results suggest that societies where extended families and small groups manage most of their own affairs may also be the most suitable for defense against a pandemic. This may prove applicable in city planning and policy making.
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Affiliation(s)
- Wayne Dawson
- Research Institute, International Medical Center of Japan, Shinjuku-ku, Tokyo, Japan.
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Gault G, Larrieu S, Durand C, Josseran L, Jouves B, Filleul L. Performance of a syndromic system for influenza based on the activity of general practitioners, France. J Public Health (Oxf) 2009; 31:286-92. [PMID: 19269992 DOI: 10.1093/pubmed/fdp020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In France, as in other industrialized countries, syndromic surveillance systems for the early detection of illnesses have proliferated, but few validation studies on these systems performances exist. In Bordeaux, a south-western city in France, a system using a network of general practitioners house calls, such as SOS Médecins, provided local health data used to guide health service response, in particular in case of flu-like pandemic. We explored the capacity of SOS Médecins system to identify and follow influenza outbreaks using data from the Sentinel network, considered as being a gold standard for tracking seasonal influenza in France. METHODS Data from SOS Médecins were analysed and compared with data from the Sentinel network. The sensitivity and specificity of SOS Médecins system were evaluated for different simulated thresholds. RESULTS A relationship between the number of visits for influenza from SOS Médecins and the number of influenza cases from the Sentinel network was observed; data from the two systems were highly correlated. We showed the capacity of SOS Médecins system to identify outbreaks with a sensitivity and specificity of 93%. CONCLUSION The sensitivity and specificity of SOS Médecins for early outbreak detection showed the value of these data in monitoring influenza activity.
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Affiliation(s)
- G Gault
- Regional Epidemiology Unit Aquitaine, Espace Rodesse, 103 bis rue de Belleville, BP 922, 33062 Bordeaux Cedex, France.
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