Ten pressure points in primary care during COVID-19: findings from an international narrative review.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Sally Hall Dykgraaf, Anne Parkinson, Michael Wright, William C W Wong, Jane Desborough, Lauren Ball, Elizabeth Sturgiss, Garang M Dut, Katelyn Barnes, Danielle Butler, Steph Davis, Kirsty Douglas, Candan Kendir, Danielle Martin, Robert Marten, Katherine Rouleau, Shannon Barkley, Lucas de Toca, Michael Kidd
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引用次数: 0

Abstract

Background: Strong primary care (PC) services are the foundation of high-performing health care systems and can support effective responses to public health emergencies. Primary care practitioners (PCPs) and PC services played crucial roles in supporting global health system responses to the COVID-19 pandemic. However, these contributions have come at a cost, impacting on PC services and affecting patient care. This secondary analysis of data from an integrative systematic review across international PC settings aimed to identify and describe burdens and challenges experienced by PCPs and PC services in the context of their contributions to COVID-19 pandemic responses.

Methods: We conducted an integrative systematic review and narrative analysis, searching PubMed/Medline, Scopus, Proquest Central and Cochrane Database of Systematic Reviews, plus reference lists of key publications. Included studies were published in peer-reviewed English or Chinese language journals, and described collective responses to COVID-19 undertaken in PC settings or by PCPs. Narrative data regarding impacts on PC services and challenges experienced by PCPs were extracted and analysed using inductive coding and thematic analysis.

Results: From 1745 screened papers 108, representing 90 countries, were included. Seventy-eight contained data on negative impacts, challenges or issues encountered in PC. Ten 'pressure points' affecting PC during COVID-19 were identified, clustered in four themes: demand to adopt new ways of working; pressure to respond to fluctuating community needs; strain on PC resources and systems; and ambiguity in interactions with the broader health and social care system.

Conclusions: PCPs and PC services made critical functional contributions to health system responsiveness during the COVID-19 pandemic. However, both practitioners and PC settings were individually and collectively impacted during this period as a result of changing demands in the PC environment and the operational burden of additional requirements imposed on the sector, offering lessons for future pandemics. This study articulates ten empirically derived 'pressure points' that provide an initial understanding of burdens and demands imposed on the international primary care sector during the COVID-19 pandemic. The impact of these contributions should inform future pandemic planning, guided by involvement of PCPs in public health preparedness and policy design.

2019冠状病毒病期间初级保健的十大压力点:一项国际综述的结果。
背景:强大的初级保健服务是高绩效卫生保健系统的基础,可以支持有效应对突发公共卫生事件。初级保健从业人员和初级保健服务在支持全球卫生系统应对COVID-19大流行方面发挥了关键作用。然而,这些贡献是有代价的,影响了PC服务并影响了患者护理。本文对来自国际PC设置的综合系统评价数据进行了二次分析,旨在确定和描述pcp和PC服务在其对COVID-19大流行应对做出贡献的背景下所面临的负担和挑战。方法:检索PubMed/Medline、Scopus、Proquest Central和Cochrane系统综述数据库,结合重点文献的参考文献列表,进行综合系统综述和叙述性分析。纳入的研究发表在同行评议的英文或中文期刊上,并描述了PC环境或pcp对COVID-19的集体反应。通过归纳编码和专题分析,提取和分析了关于PC服务影响和pcp面临挑战的叙述性数据。结果:从1745篇筛选论文中纳入了108篇,代表90个国家。其中78个包含了PC遇到的负面影响、挑战或问题的数据。确定了COVID-19期间影响PC的十大“压力点”,分为四个主题:采用新工作方式的需求;应对不断变化的社区需求的压力;对个人电脑资源和系统的压力;以及与更广泛的卫生和社会保健系统互动的模糊性。结论:pcp和PC服务在COVID-19大流行期间对卫生系统的响应做出了重要的功能贡献。然而,在此期间,由于PC环境的需求变化以及对该部门施加的额外要求带来的运营负担,从业人员和PC设置都受到了单独和集体的影响,为未来的流行病提供了经验教训。本研究阐明了十个经验得出的“压力点”,初步了解了COVID-19大流行期间国际初级保健部门面临的负担和需求。这些贡献的影响应为今后的大流行病规划提供参考,并由公共卫生服务提供者参与公共卫生准备和政策设计。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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