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Rico-Blazquez M, Esteban-Sepúlveda S, Sánchez-Ruano R, Aritztegui-Echenique AM, Artigues-Barbera EM, Brito-Brito PR, Casado-Ramirez E, Cidoncha-Moreno MÁ, Fabregat-Julve MI, Feria-Raposo I, Hernandez-Pascual M, Lozano-Hernández C, Moreno-Casbas MT, Otones-Reyes P, Palmar-Santos AM, Pedraz-Marcos A, Romero-Rodriguez EM, Solé-Agustí MC, Taltavull-Aparicio JM, Vidal-Thomas MC, Gonzalez-Chorda VM. Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol. Front Public Health 2024; 12:1389641. [PMID: 38952731 PMCID: PMC11215124 DOI: 10.3389/fpubh.2024.1389641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024] Open
Abstract
Aims To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain. Design Multicentric, mixed method concurrent study. Methods This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022). Discussion The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic. Trial Registration Identifier: NCT05249868 [ClinicalTrials.gov].
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Affiliation(s)
- Milagros Rico-Blazquez
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid Health Service, Madrid, Spain
| | - Silvia Esteban-Sepúlveda
- Departament d'Infermeria Fonamental i Medicoquirúrgica, Escola d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Sánchez-Ruano
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
| | - Ana María Aritztegui-Echenique
- Subdirección de Cuidados, Atención Domiciliaria, Sociosanitaria y Acciones Comunitarias, Gerencia de Atención Primaria de Navarra, Servicio de Navarro de Salud – Osasunbidea, Navarra, Spain
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra, Navarra, Spain
| | - Eva María Artigues-Barbera
- Balàfia Primary Care Center, Gerència Territorial Lleida, Institut Català de la Salut (ICS), Lleida, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Multidisciplinary Research Group in Therapeutics and Interventions in Primary Care (RETICAP), IDIAPJGol, Barcelona, Spain
| | - Pedro Ruymán Brito-Brito
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), ISCIII, Madrid, Spain
- Department of Nursing, University of la Laguna, Santa Cruz de Tenerife, Spain
- Training and Research in Care, Primary Care Management Board of Tenerife, The Canary Islands Health Service, Santa Cruz de Tenerife, Spain
| | - Elvira Casado-Ramirez
- Nursing and Healthcare Research Unit (Investén-isciii), Instituto de Salud Carlos III, Madrid, Spain
- Frailty and Healthy Ageing-CIBERFES, Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Ángeles Cidoncha-Moreno
- IIS Bioaraba, General Head Office of Osakidetza, Basque Health Service, Subdirection of Nursing, Vitoria-Gasteiz, Spain
| | - María Inmaculada Fabregat-Julve
- Primary Care Nursing Department, Castellón Health Department, Castelló de la Plana, Spain
- Nursing Department, Universitat Jaume I, Castelló de la Plana, Spain
| | - Isabel Feria-Raposo
- Benito Menni CASM, Barcelona, Spain
- FIDMAG Research Foundation, Barcelona, Spain
- Networked Biomedical Research Center, Mental Health (CIBERSAM), Barcelona, Spain
| | - Montserrat Hernandez-Pascual
- Technology and Humanization Projects Service Manager, General Directorate of Humanization and Patient Care, Ministry of Health of the Madrid Regional Government, Madrid, Spain
| | - Cristina Lozano-Hernández
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), ISCIII, Madrid, Spain
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
| | - María Teresa Moreno-Casbas
- Nursing and Healthcare Research Unit (Investén-isciii), Instituto de Salud Carlos III, Madrid, Spain
- Frailty and Healthy Ageing-CIBERFES, Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Otones-Reyes
- San Andrés Healthcare Center, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Ana María Palmar-Santos
- Nursing Department, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid Health Service, Madrid, Spain
| | - Azucena Pedraz-Marcos
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), ISCIII, Madrid, Spain
- Nursing and Healthcare Research Unit (Investén-isciii), Instituto de Salud Carlos III, Madrid, Spain
| | - Esperanza María Romero-Rodriguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | | | - Joana María Taltavull-Aparicio
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), ISCIII, Madrid, Spain
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, Palma, Spain
- Research Group in Primary Care and Promotion-Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - María Clara Vidal-Thomas
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), ISCIII, Madrid, Spain
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, Palma, Spain
- Research Group in Primary Care and Promotion-Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Víctor Manuel Gonzalez-Chorda
- Nursing and Healthcare Research Unit (Investén-isciii), Instituto de Salud Carlos III, Madrid, Spain
- Frailty and Healthy Ageing-CIBERFES, Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Nursing Research Group (Code 241), Universitat, Jaume I.Castellón, Castelló de la Plana, Spain
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Tureck F, Chioro A, Tofani LFN, Lima CL, Vieira ADCS, Andreazza R. Innovations produced in Primary Health Care during the COVID-19 pandemic: an integrative literature review. CIENCIA & SAUDE COLETIVA 2024; 29:e07022023. [PMID: 38896673 DOI: 10.1590/1413-81232024296.07022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 06/21/2024] Open
Abstract
Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to keep up its provision of regular services as well. This article identifies the main arrangements made to provide PHC care in the context of the COVID-19 pandemic. An integrative literature review of articles found in PubMed, SciELO and LILACS databases was performed using the descriptors "Primary Health Care" and "COVID-19". Findings were analyzed considering three questions: Information and Communication Technologies (ICT), Organizations of Work Processes and Non-COVID Chronic Diseases. The use of different forms of ICT to provide PHC is highlighted regarding patients with respiratory symptoms and chronic patients. Changes in team composition, service flows, physical spaces and working hours were also introduced. Although strategies aimed at monitoring chronic patients and at remote care may have helped minimize deterioration of their health, the decrease in the number of visits performed during this period could have resulted in an increased demand for PHC in post-pandemic years.
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Affiliation(s)
- Fernando Tureck
- Escola de Medicina, Universidade do Contestado. Av. Nereu Ramos 1071, Jardim do Moinho. 89300-000 Mafra SC Brasil.
| | - Arthur Chioro
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Luís Fernando Nogueira Tofani
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Carolina Loyelo Lima
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Amanda da Cruz Santos Vieira
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Rosemarie Andreazza
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
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Olesen AE, Juhl MH, Deilkås ET, Kristensen S. Review: application of the Safety Attitudes Questionnaire (SAQ) in primary care - a systematic synthesis on validity, descriptive and comparative results, and variance across organisational units. BMC PRIMARY CARE 2024; 25:37. [PMID: 38273241 PMCID: PMC10809511 DOI: 10.1186/s12875-024-02273-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
Patient safety research has focused mostly on the hospital and acute care setting whereas assessments of patient safety climate in primary health care settings are warranted. Valid questionnaires as e.g., the Safety Attitudes Questionnaire (SAQ) may capture staff perceptions of patient safety climate but until now, an overview of the use of SAQ in primary care has not been systematically presented. Thus, the aim of this systematic review is to present an overview of SAQ used in primary care.Methods The electronic databases: PubMed, Embase, Cinahl, PsycInfo and Web of Science were used to find studies that used any version of SAQ in primary care. Studies were excluded if only abstract or poster was available, as the information in abstract and posters was deemed insufficient. Commentaries and nonempirical studies (e.g., study protocols) were excluded. Only English manuscripts were included.Results A total of 43 studies were included and 40 of them fell into four categories: 1) validation analysis, 2) descriptive analysis, 3) variance assessment and 4) intervention evaluation and were included in further analyses. Some studies fell into more than one of the four categories. Seventeen studies aimed to validate different versions of SAQ in a variety of settings and providers. Twenty-five studies from fourteen different countries reported descriptive findings of different versions of SAQ in a variety of settings. Most studies were conducted in primary health care centres, out-of-hours clinics, nursing homes and general practice focusing on greatly varying populations. One study was conducted in home care. Three studies investigated variance of SAQ scores. Only five studies used SAQ to assess the effects of interventions/events. These studies evaluated the effect of electronic medical record implementation, a comprehensive Unit-based Safety Program or COVID-19.Conclusion The synthesis demonstrated that SAQ is valid for use in primary care, but it is important to adapt and validate the questionnaire to the specific setting and participants under investigation. Moreover, differences in SAQ factor scores were related to a variety of descriptive factors, that should be considered in future studies More studies, especially variance and intervention studies, are warranted in primary care.Trial registration This systematic review was not registered in any register.
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Affiliation(s)
- Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8a, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark.
| | - Marie Haase Juhl
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8a, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
| | - Ellen Tveter Deilkås
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Oslo, Norway
| | - Solvejg Kristensen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark
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Glette MK, Bates DW, Dykes PC, Wiig S, Kringeland T. A resilience perspective on healthcare personnels' experiences of managing the COVID-19 pandemic: a qualitative study in Norwegian nursing homes and come care services. BMC Health Serv Res 2023; 23:1177. [PMID: 37898762 PMCID: PMC10613357 DOI: 10.1186/s12913-023-10187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to new and unfamiliar changes in healthcare services globally. Most COVID-19 patients were cared for in primary healthcare services, demanding major adjustments and adaptations in care delivery. Research addressing how rural primary healthcare services coped during the COVID-19 pandemic, and the possible learning potential originating from the pandemic is limited. The aim of this study was to assess how primary healthcare personnel (PHCP) working in rural areas experienced the work situation during the COVID-19 outbreak, and how adaptations to changes induced by the pandemic were handled in nursing homes and home care services. METHOD This study was conducted as an explorative qualitative study. Four municipalities with affiliated nursing homes and homecare services were included in the study. We conducted focus group interviews with primary healthcare personnel working in rural nursing homes and homecare services in western Norway. The included PHCP were 16 nurses, 7 assistant nurses and 2 assistants. Interviews were audio recorded, transcribed and analyzed using thematic analysis. RESULTS The analysis resulted in three main themes and 16 subthemes describing PHCP experience of the work situation during the COVID-19 pandemic, and how they adapted to the changes and challenges induced by the pandemic. The main themes were: "PHCP demonstrated high adaptive capacity while being put to the test", "Adapting to organizational measures, with varying degree of success" and "Safeguarding the patient's safety and quality of care, but at certain costs". CONCLUSION This study demonstrated PHCPs major adaptive capacity in response to the challenges and changes induced by the covid-19 pandemic, while working under varying organizational conditions. Many adaptations where long-term solutions improving healthcare delivery, others where short-term solutions forced by inadequate management, governance, or a lack of leadership. Overall, the findings demonstrated the need for all parts of the system to engage in building resilient healthcare services. More research investigating this learning potential, particularly in primary healthcare services, is needed.
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Affiliation(s)
- Malin Knutsen Glette
- SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway.
| | - David W Bates
- SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patricia C Dykes
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Siri Wiig
- SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Tone Kringeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
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Kraus M, Stegner C, Reiss M, Riedel M, Børsch AS, Vrangbaek K, Michel M, Turmaine K, Cseh B, Dózsa CL, Dandi R, Mori AR, Czypionka T. The role of primary care during the pandemic: shared experiences from providers in five European countries. BMC Health Serv Res 2023; 23:1054. [PMID: 37784101 PMCID: PMC10546726 DOI: 10.1186/s12913-023-09998-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience. METHODS The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care. RESULTS Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues. CONCLUSION Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.
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Affiliation(s)
- Markus Kraus
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria.
| | - Christoph Stegner
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Miriam Reiss
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Monika Riedel
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Anne Sofie Børsch
- University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1353, Denmark
| | - Karsten Vrangbaek
- University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1353, Denmark
| | - Morgane Michel
- Université Paris Cité, ECEVE, UMR 1123, 10 avenue de Verdun, Inserm, Paris, 75010, France
- Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 48 boulevard Sérurier, Paris, 75019, France
| | - Kathleen Turmaine
- Université Paris Cité, ECEVE, UMR 1123, 10 avenue de Verdun, Inserm, Paris, 75010, France
| | - Borbála Cseh
- University of Miskolc, Egyetem út 1, Miskolc-Egyetemváros, 3515, Hungary
| | - Csaba László Dózsa
- University of Miskolc, Egyetem út 1, Miskolc-Egyetemváros, 3515, Hungary
| | - Roberto Dandi
- Luiss Business School, Via Nomentana 216, Roma, 00162, RM, Italy
| | - Angelo Rossi Mori
- Institute for Research on Population and Social Policies, Via Palestro 32, Roma, 00185, Italy
| | - Thomas Czypionka
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Knutsen Glette M, Ludlow K, Wiig S, Bates DW, Austin EE. Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis. BMJ Open 2023; 13:e071828. [PMID: 37730402 PMCID: PMC10514639 DOI: 10.1136/bmjopen-2023-071828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify, review and synthesise qualitative literature on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic. DESIGN Systematic review with meta-synthesis. DATA SOURCES Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus. ELIGIBILITY CRITERIA Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis. RESULTS Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services. CONCLUSION Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals' experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.
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Affiliation(s)
- Malin Knutsen Glette
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Kristiana Ludlow
- Centre for Health Services Research, The University of Queensland School of Psychology, Saint Lucia, Queensland, Australia
| | - Siri Wiig
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - David Westfall Bates
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, New South Wales, Australia
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Palmar-Santos AM, Pedraz Marcos A, Rubio-Casado LA, Pulido-Fuentes M, García-Perea ME, Navarta-Sanchez MV. Resilience among primary care professionals in a time of pandemic: a qualitative study in the Spanish context. BMJ Open 2023; 13:e069606. [PMID: 37399436 DOI: 10.1136/bmjopen-2022-069606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES This study explores the impact of the COVID-19 pandemic on the Spanish primary care structure and services and the mechanisms implemented by the primary care workforce to restore and reinforce their reference care model. DESIGN An exploratory, qualitative study with semistructured interviews and a focus group discussion conducted during the fall semester of 2020. SETTING Primary health centres in Madrid (Spain), chosen based on factors such as infection rates during the earliest stages of the pandemic and demographic and socioeconomic aspects. PARTICIPANTS A total of 19 primary health and social care professionals were purposively selected. Criteria for inclusion were gender (male/female), at least 5 years of experience in their current position, category (health/social/administrative worker), and whether they worked in a rural or urban healthcare setting. RESULTS Two main themes were identified: (1) reflecting on a model in crisis-particularly the reopening of centres to users and the proactive, participative strategies implemented by primary care professionals to reach their community; and (2) regaining a sense of purpose-how healthcare professionals implemented strategies to sustain their vision of their reference model. The COVID-19 pandemic exposed leadership deficiencies that, together with the initial unavailability of resources and difficulties maintaining face-to-face contact with users, triggered a sense of loss of professional identity. On the other hand, the analysis revealed potential strategies to restore and reinforce the traditional model, such as the adoption of digital technologies and reliance on community networks. CONCLUSION This study highlights the importance of a solid reference framework and enhances the strengths and skills of the workforce to reinforce the community-based service provision model.
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Affiliation(s)
- Ana María Palmar-Santos
- Deparment of Nursing, Autonomous University of Madrid, Madrid, Spain
- Nursing and Health Care Research Group, Puerta de Hierro-Segovia Arana Health Research Institute, Madrid, Spain
| | | | | | | | | | - Maria Victoria Navarta-Sanchez
- Deparment of Nursing, Autonomous University of Madrid, Madrid, Spain
- Nursing and Health Care Research Group, Puerta de Hierro-Segovia Arana Health Research Institute, Madrid, Spain
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Mogwitz S, Albus C, Beschoner P, Erim Y, Geiser F, Jerg-Bretzke L, Morawa E, Steudte-Schmiedgen S, Wintermann GB, Weidner K. Mental distress of physicians in the outpatient care throughout the COVID-19 pandemic: emotional and supportive human relations matter - Cross-sectional results of the VOICE-study. BMC Health Serv Res 2023; 23:481. [PMID: 37173735 PMCID: PMC10180613 DOI: 10.1186/s12913-023-09361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/01/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The aim of this cross-sectional study was to evaluate the course of self-reported mental distress and quality of life (QoL) of physicians, working in the outpatient care (POC). Outcomes were compared with a control group of physicians working in the inpatient care (PIC), throughout the Corona Virus Disease (COVID)-19 pandemic. The impact of risk and protective factors in terms of emotional and supportive human relations on mental distress and perceived QoL of POC were of primary interest. METHODS Within the largest prospective, multi-center survey on mental health of health care workers (HCW), conducted during the first (T1) and second (T2) wave of the COVID-19 pandemic in Europe, we investigated the course of current burden (CB), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2) and QoL, cross-sectionally, in n = 848 POC (T1: n = 536, T2: n = 312). The primary outcomes were compared with an age- and gender-matchted control group of n = 458 PIC (T1: n = 262, T2: n = 196). COVID-19-, work-related, social risk and protective factors were examined. RESULTS At T1, POC showed no significant differences with respect to CB, depression, anxiety, and QoL, after Bonferroni correction. Whereas at T2, POC exhibited higher scores of CB (Cohen´s d/ Cd = .934, p < .001), depression (Cd = 1.648, p < 001), anxiety (Cd = 1.745, p < .001), work-family conflict (Cd = 4.170, p < .001) and lower QoL (Cd = .891, p = .002) compared with PIC. Nearly all assessed parameters of burden increased from T1 to T2 within the cohort of POC (e.g. depression: CD = 1.580, p < .001). Risk factors for mental distress of POC throughout the pandemic were: increased work-family conflict (CB: ß = .254, p < .001, 95% CI: .23, .28; PHQ-2: ß = .139, p = .011, 95% CI: .09, .19; GAD-2: ß = .207, p < .001, 95% CI: .16, .26), worrying about the patients´ security (CB: ß = .144, p = .007, 95% CI: .07, .22; PHQ-2: ß = .150, p = .006, 95% CI: .00, .30), fear of triage situations (GAD-2: ß = .132, p = .010, 95% CI: -.04, .31) and burden through restricted social contact in spare time (CB: ß = .146, p = .003, 95% CI: .07, .22; PHQ-2: ß = .187, p < .001, 95% CI: .03, .34; GAD-2: ß = .156, p = .003, 95% CI: -.01, .32). Protective factors for mental distress and QoL were the perceived protection by local authorities (CB: ß = -.302, p < .001, 95% CI: -.39, -.22; PHQ-2: ß = -.190, p < . 001, 95% CI: -.36, -.02; GAD-2: ß = -.211, p < .001, 95% CI: -.40, -.03; QoL: ß = .273, p < .001, 95% CI: .18, .36), trust in colleagues (PHQ-2: ß = -.181, p < .001, 95% CI: -.34, -.02; GAD-2: ß = -.199, p < .001, 95% CI: -.37, -.02; QoL: ß = .124, p = .017, 95% CI: .04, .21) and social support (PHQ-2: ß = -.180, p < .001, 95% CI: -.22, -.14; GAD-2: ß = -.127, p = .014, 95% CI: -.17, -.08; QoL: ß = .211, p < .001, 95% CI: .19, .23). CONCLUSIONS During the pandemic, the protective role of emotional and supportive human relations on the mental distress and quality of life of POC should be taken into account more thoroughly, both in practice and future research.
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Affiliation(s)
- Sabine Mogwitz
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany.
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital of Cologne, Kerpener Str. 62, Cologne, 50937, Germany
| | - Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Maximiliansplatz 2, 91054, Erlangen, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lucia Jerg-Bretzke
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Maximiliansplatz 2, 91054, Erlangen, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
| | - Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany.
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
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Albutt A, Ramsey L, Fylan B, Grindey C, Hague I, O'Hara JK. Patient and public co-creation of healthcare safety and healthcare system resilience: The case of COVID-19. Health Expect 2023. [PMID: 37139679 DOI: 10.1111/hex.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Healthcare system resilience is a conceptual approach that seeks to explore how health services adapt and respond to variability in demand and resources. As has been witnessed since the beginning of the COVID-19 pandemic, healthcare services have undergone many reconfigurations. One understudied aspect of how the 'system' is able to adapt and respond is the contribution of key stakeholders-patients and families, and in the context of the pandemic, the general public as a whole. This study aimed to understand what people were doing during the first wave of the pandemic to protect the safety of their health, and the health of others from COVID-19, and the resilience of the healthcare system. METHODS Social media (Twitter) was used as a method of recruitment due to its ability for social reach. Twenty-one participants took part in 57 semistructured interviews over three time points from June to September 2020. The included an initial interview and invitation to two follow-up interviews after 3 and 6 weeks. Interviews were conducted virtually using Zoom-an encrypted secure video conferencing software. A reflexive thematic analysis approach to analysis was used. RESULTS Three themes, each with its own subthemes were identified in the analysis: (1) A 'new safety normal'; (2) Existing vulnerabilities and heightened safety and (3) Are we all in this together? CONCLUSION This study found that the public had a role in supporting the resilience of healthcare services and systems during the first wave of the pandemic by adapting their behaviour to protect themselves and others, and to avoid overwhelming the National Health Service. People who had existing vulnerabilities were more likely to experience safety gaps in their care, and be required to step in to support their safety, despite it being more difficult for them to do so. It may be that the most vulnerable were previously required to do this extra work to support the safety of their care and that the pandemic has just illuminated this issue. Future research should explore existing vulnerabilities and inequalities, and the heightened safety consequences created by the pandemic. PATIENT AND PUBLIC CONTRIBUTION The National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC), Patient and Public Involvement and Engagement Research Fellow and NIHR Yorkshire and Humber PSTRC Patient Involvement in Patient Safety theme lay leader are involved in the preparation of a lay version of the findings within this manuscript.
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Affiliation(s)
- Abigail Albutt
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK
| | - Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK
| | - Beth Fylan
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Chloe Grindey
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK
| | - Isabel Hague
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK
| | - Jane K O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
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10
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Heumann M, Zabaleta-del-Olmo E, Röhnsch G, Hämel K. "Talking on the Phone Is Very Cold"-Primary Health Care Nurses' Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:2436. [PMID: 36553959 PMCID: PMC9777830 DOI: 10.3390/healthcare10122436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/10/2022] Open
Abstract
Strengthening patient participation is considered a crucial element of primary health care (PHC) nurses' practice when working with chronically ill patients. The COVID-19 pandemic had extraordinary effects on PHC nursing routines and how chronically ill patients' could be involved in their own care. This study investigates the adaptation of Spanish PHC nurses' approaches to supporting the participation of patients living with chronic illness during the COVID-19 pandemic. To reach this goal, we interviewed 13 PHC nurses who practiced in PHC centers in Spain. The interviews were analyzed using thematic coding. Three themes emerged from the descriptions of the nurses: (1) High COVID-19-related workload, decreasing health promotion, and chronic care, (2) Emphasis on patients' and families' self-responsibility, (3) Expanded digital and telephone communication with fewer in-person consultations. Nurses felt especially challenged to uphold the support for vulnerable groups, such as older people or patients without family support. Future research should focus on how the participation of the most vulnerable chronic patients can be supported in the context of the growing relevance of remote care.
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Affiliation(s)
- Marcus Heumann
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Edurne Zabaleta-del-Olmo
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Nursing Department, Faculty of Nursing, University of Girona, 17004 Girona, Spain
- Primary Care Directorate, Barcelona Regional Management, Institut Català de la Salut, 08006 Barcelona, Spain
| | - Gundula Röhnsch
- Division Qualitative Social and Education Research, Department of Education and Psychology, Freie Universität Berlin, 14195 Berlin, Germany
| | - Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
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11
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Groenewegen P, Van Poel E, Spreeuwenberg P, Batenburg R, Mallen C, Murauskiene L, Peris A, Pétré B, Schaubroeck E, Stark S, Sigurdsson EL, Tatsioni A, Vafeidou K, Willems S. Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15329. [PMID: 36430047 PMCID: PMC9690243 DOI: 10.3390/ijerph192215329] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed.
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Affiliation(s)
- Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Utrecht University, 3584 CS Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Radboud University, 6535 XN Nijmegen, The Netherlands
| | | | - Liubove Murauskiene
- Department of Public Health, Faculty of Medicine, University of Vilnius, 03101 Vilnius, Lithuania
| | - Antoni Peris
- Castelldefels Agents de Salut (Casap), 08860 Castelldefels, Spain
| | - Benoit Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, 4000 Liège, Belgium
| | - Emmily Schaubroeck
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Emil L. Sigurdsson
- Department of family medicine, University of Iceland, 102 Reykjavík, Iceland
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Kyriaki Vafeidou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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12
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Pulido-Fuentes M, Palmar-Santos AM, Flores-Martos JA, Cipriano-Crespo C, Rubio LA, González LA, Navarta-Sánchez MV. Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study. BMC PRIMARY CARE 2022; 23:64. [PMID: 35361146 PMCID: PMC8970064 DOI: 10.1186/s12875-022-01674-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance. METHODS Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling. RESULTS A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies. CONCLUSIONS Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.
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Affiliation(s)
- Montserrat Pulido-Fuentes
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Ana María Palmar-Santos
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | | | - Carmen Cipriano-Crespo
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Laura Alicia Rubio
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | - Luisa Abad González
- Faculty of Education Sciences and Humanities, University of Castilla -La Mancha, 16071 Cuenca, Spain
| | - MVictoria Navarta-Sánchez
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
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13
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Dionisi S, Di Simone E, Liquori G, De Leo A, Di Muzio M, Giannetta N. Medication errors' causes analysis in home care setting: A systematic review. Public Health Nurs 2021; 39:876-897. [PMID: 34967458 DOI: 10.1111/phn.13037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
Many studies analyze the medication errors in the hospital setting, but the literature involving the home care setting seems scarce. The aim of this study is to identify the main risk factors that affect the genesis of medication errors and the possible solutions to reduce the phenomenon in the home care setting. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The critical analysis of the literature shows that medication errors in home care occur mainly during transitional care. The main risk factors related to transitional care are poor interprofessional communication, lack of a standardized process for medication reconciliation, the widespread use of computerized tools, and the inadequate integration of the pharmacist into the care team. The strategies to reduce the risk of errors from therapy at home are the implementation of the pharmacist in the health team to ensure accurate medication reconciliation and the use of computerized tools to improve communication between professionals and to reduce the dispersion of information.
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Affiliation(s)
- Sara Dionisi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Departement, IRCCS Istituti Fisioterapici Ospitalieri, IFO, Rome, Italy
| | - Gloria Liquori
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Aurora De Leo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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14
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Gens-Barberà M, Hernández-Vidal N, Castro-Muniain C, Hospital-Guardiola I, Oya-Girona EM, Bejarano-Romero F, Rey-Reñones C, Martín-Luján F. [Patient safety incidents reported before and after the start of the COVID-19 pandemic in Primary Care in Tarragona]. Aten Primaria 2021; 53 Suppl 1:102217. [PMID: 34961580 PMCID: PMC8708815 DOI: 10.1016/j.aprim.2021.102217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objetivo Analizar y comparar la epidemiologia de los incidentes de seguridad del paciente notificados en centros de atención primaria, antes y después del inicio de la pandemia COVID-19. Diseño y emplazamiento Estudio descriptivo analítico comparando los incidentes notificados del 01-marzo-2019 al 28-febrero-2020, y del 01-marzo-2020 al 28-febrero-2021, realizados a través de la plataforma TPSC Cloud™ accesible desde la Intranet corporativa en 25 centros de atención primaria del distrito de Tarragona, Cataluña, España. Mediciones Registros obtenidos a partir de notificaciones voluntarias mediante formulario electrónico, estandarizado y anonimizado. Variables: centro sanitario, profesional, tipo de incidente, matriz de riesgo, factores causales, contribuyentes y evitabilidad. Análisis estadístico: Se realizó análisis descriptivo del total de notificaciones y otro específico de los eventos adversos, comparando ambos períodos. Resultados Se notificaron un total de 2.231 incidentes. Comparando ambos períodos, en el de pandemia se observó una reducción del número de incidentes notificados (solo representaron un 20% del total), pero en proporción se incrementó el porcentaje de notificaciones por parte de profesionales sanitarios y el de eventos adversos que requirieron observación. También aumentaron los factores causales relacionados con los cuidados y el diagnóstico, y disminuyeron los de medicación. Además, se observó un incremento de los factores contribuyentes relacionados con el profesional. La evitabilidad fue elevada (>95%) en ambos períodos. Conclusiones Durante la pandemia, se han notificado un menor número de incidentes de seguridad del paciente, pero en proporción, más eventos adversos, siendo en su mayoría evitables. El propio profesional se convierte en el principal factor contribuyente.
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Affiliation(s)
- Montserrat Gens-Barberà
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España.
| | - Núria Hernández-Vidal
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Carles Castro-Muniain
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Inmaculada Hospital-Guardiola
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Centro de Atención Primaria Dr. Turró, Valls, Direcció d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Eva Maria Oya-Girona
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Centre d'Alta Resolució, Salou, Direcció d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Ferran Bejarano-Romero
- Unidad de Calidad y Seguridad del Paciente, Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Cristina Rey-Reñones
- Unitat de Suport a la Recerca Camp de Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Facultad de Medicina y Ciencias de la Salud, Universitat Rovira i Virgili, Tarragona, España
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca Camp de Tarragona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gerencia Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España; Facultad de Medicina y Ciencias de la Salud, Universitat Rovira i Virgili, Tarragona, España
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15
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Hoerold M, Gottschalk M, Debbeler CM, Heytens H, Ehrentreich S, Braun-Dullaeus RC, Apfelbacher C. Healthcare professionals' perceptions of impacts of the Covid-19-pandemic on outpatient care in rural areas: a qualitative study. BMC Health Serv Res 2021; 21:1298. [PMID: 34856970 PMCID: PMC8638652 DOI: 10.1186/s12913-021-07261-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
Background Measures to manage the COVID-19 pandemic have led to impacts on healthcare systems and providers worldwide. Outpatient healthcare professionals (HCPs) provide the majority of patient care. Insight into their experiences during a pandemic is rare. Therefore, we explored how primary and secondary care HCPs in a rural area in Germany experienced their work during the pandemic and what health-related outcomes they perceived in their patients. In this context, we also examined the impact on access to and utilization of healthcare and working conditions. Methods We conducted a qualitative interview study with outpatient HCPs. We recruited by e-mail, telephone, professional networks and personal contacts. Data were collected between August 2020 and January 2021. All interviews were audio recorded, transcribed, and analysed using qualitative content analysis. Results Our sample consisted of 28 HCPs (15 family physicians, 7 cardiologists, and 6 non-physician assistants, 12 female) from Saxony-Anhalt, Germany. HCPs experienced fewer consultations as well as cancellations by hospitals and secondary care physicians, especially at the beginning of the Covid-19-pandemic, while they continued throughout to provide outpatient care. They quickly adopted changes in practice organisation and healthcare provision. There was a shift towards telephone consultations, home visits as well as unconventional consultations e.g. through the practice window. Family physicians used personal relationships to support utilization of healthcare and to avoid health-related effects. Social tension and burden seemed to interact with a perceived lack of preparedness, the pandemic-related changes in their working condition as well as access to and utilization of healthcare. Chronic disease monitoring was postponed, which could have consequences in the course of disease of patients. HCPs experienced effects on patients’ psychological well-being. Conclusion Our study demonstrates the impacts of Covid-19-pandemic on outpatient care in rural areas and emphasizes its importance. HCPs experienced impacts on access to and utilization of healthcare, working conditions and health-related outcomes. Health policy should create a framework for healthcare to support outpatient care in rural areas with a looming undersupply of primary and secondary care in order to maintain healthcare and reduce pandemic impacts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07261-y.
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Affiliation(s)
- Madlen Hoerold
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Marc Gottschalk
- University Clinic for Cardiology and Angiology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Carla Maria Debbeler
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Heike Heytens
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Saskia Ehrentreich
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Ruediger C Braun-Dullaeus
- University Clinic for Cardiology and Angiology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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16
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Carbone T, Picerno V, Pafundi V, Esposito E, Leccese P, Padula AA, D'Angelo S. Impact of the COVID-19 Pandemic on the Appropriateness of Diagnostic Pathways of Autoimmune Rheumatic Diseases. J Rheumatol 2021; 49:219-224. [PMID: 34654735 DOI: 10.3899/jrheum.210611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Early diagnosis of autoimmune rheumatic diseases (ARDs) is key to achieving effective treatment and improving prognosis. The coronavirus disease 2019 (COVID-19) pandemic has led to major changes in clinical practice on a global scale. We aimed to evaluate the impact of the COVID-19 pandemic on rheumatological clinical practice and autoimmunity testing demands. METHODS Data regarding the first rheumatological visits and new diagnoses, together with the autoimmunity laboratory testing volumes related to the COVID-19 pandemic phase (January-December 2020), were collected from medical records and the laboratory information system of a regional reference hospital (Basilicata, Italy) and compared with those obtained during the corresponding period in 2019. RESULTS A significant decrease in the 2020 autoimmunity laboratory test volume was found when compared with the same period in 2019 (9912 vs 14,100; P < 0.05). A significant decrease in first rheumatological visits and diagnosis (1272 vs 2336; P < 0.05) was also observed. However, an equivalent or higher percentage of positive autoimmunity results from outpatient services was recorded during 2020 when compared to the prepandemic state. Of note, COVID-19-associated decline in new diagnoses affected mainly less severe diseases. In contrast, ARDs with systemic involvement were diagnosed at the same levels as in the prepandemic period. CONCLUSION The COVID-19 pandemic has affected access to health services. However, our study highlighted that during the outbreak, greater appropriateness of the requests for laboratory tests and visits emerged, as shown by a greater percentage of positive test results and new diagnoses of more severe ARDs compared to the prepandemic period.
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Affiliation(s)
- Teresa Carbone
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Valentina Picerno
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Vito Pafundi
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Ernesto Esposito
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Pietro Leccese
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Angela Anna Padula
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Salvatore D'Angelo
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
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