加拿大家庭医生在COVID-19期间的激增能力和实践管理挑战:一项定性研究

IF 3.9 2区 医学 Q1 HEALTH POLICY & SERVICES
Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Paul Gill, Stephen J Wetmore, Leslie Meredith, Sarah Spencer, Judith Belle Brown, Thomas R Freeman
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引用次数: 0

摘要

背景:应急能力规划是公共卫生应急准备的一个重要组成部分,即卫生服务超出正常能力并满足日益增加的临床护理需求的能力。在2019冠状病毒病大流行期间,家庭医生被要求在医院病房和急诊科等环境中提供应急能力,同时保持其初级保健责任。大多数研究报告都是关于投射模型、医院环境或虚拟护理的使用,而对FPs在这一角色中的第一手经验的关注有限。为了弥补这一差距,本研究考察了FPs的经验及其在支持COVID-19大流行期间的应急能力方面的作用。方法:作为混合方法、多案例研究的一部分,我们在2020年10月至2021年6月期间对加拿大四个省(不列颠哥伦比亚省、安大略省、新斯科舍省、纽芬兰和拉布拉多)的FPs进行了半结构化访谈。在访谈中,工作人员被问及他们在大流行的不同阶段所扮演的角色,以及影响他们履行这些角色能力的因素。采访被逐字记录下来,并采用专题分析方法来确定反复出现的主题。结果:我们采访了四个省的68个FPs,并确定了两个总体主题:(1)FPs用于创建应急能力的机制;(2)有组织的应急能力计划的关键考虑因素。在大流行期间,通过延长计划生育工作时间、扩大计划生育工作队伍以及将计划生育人员重新部署到新的角色和环境中,实现了激增能力。计划生育人员激增能力的有效实施需要有组织的沟通和协调机制,明确重新部署期间的实践范围的政策,与新的重新部署角色相关的培训和指导,计划生育人员拥有医院特权,以及有助于保持初级保健能力的政策。结论:FPs对增兵能力做出了重要贡献,但需要有组织的支持,以平衡其重新部署角色与正在进行的初级保健责任。在突发公共卫生事件期间,确保他们的做法得到充分覆盖,并采用强有力的沟通和协调机制,对于维持高质量的护理和管理FPs和卫生系统的压力至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surge capacity and practice management challenges of Canadian family physicians during COVID-19: a qualitative study.

Background: Planning for surge capacity, that is, the ability of a health service to expand beyond normal capacity and meet an increased demand for clinical care, is an essential component of public health emergency preparedness. During the COVID-19 pandemic, family physicians (FPs) were called upon to provide surge capacity in settings such as hospital units and emergency departments while also maintaining their primary care responsibilities. Most research reports on projection models, hospital settings, or the use of virtual care, with limited focus on the firsthand experiences of FPs in this role. To address this gap, this study examines the experiences of FPs and their roles in supporting surge capacity during the COVID-19 pandemic.

Methods: As part of a mixed methods, multiple case study, we conducted semi-structured interviews with FPs between October 2020 and June 2021 across four Canadian provinces (British Columbia, Ontario, Nova Scotia, Newfoundland and Labrador). During the interviews, FPs were asked about the roles they assumed during the different stages of the pandemic and the factors that impacted their ability to fulfil these roles. Interviews were transcribed verbatim and a thematic analysis approach was employed to identify recurring themes.

Results: We interviewed a total of 68 FPs across the four provinces and identified two overarching themes: (1) mechanisms used to create surge capacity by FPs, and (2) key considerations for an organized surge capacity program. During the pandemic, surge capacity was achieved by extending FP working hours, expanding the FP workforce, and redeploying FPs to new roles and settings. The effective implementation of FP surge capacity requires organized communication and coordination mechanisms, policies to clarify scope of practice during redeployment, training and mentorship related to new redeployment roles, FPs holding hospital privileges, and policies that help to preserve primary care capacity.

Conclusions: FPs make critical contributions to surge capacity but require structured support to balance their redeployment roles with their ongoing primary care responsibilities. Ensuring adequate coverage for their practices and employing strong communication and coordination mechanisms are essential for maintaining high-quality care and managing the strain on FPs and the health system during public health emergencies.

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来源期刊
Human Resources for Health
Human Resources for Health Social Sciences-Public Administration
CiteScore
8.10
自引率
4.40%
发文量
102
审稿时长
34 weeks
期刊介绍: Human Resources for Health is an open access, peer-reviewed, online journal covering all aspects of planning, producing and managing the health workforce - all those who provide health services worldwide. Human Resources for Health aims to disseminate research on health workforce policy, the health labour market, health workforce practice, development of knowledge tools and implementation mechanisms nationally and internationally; as well as specific features of the health workforce, such as the impact of management of health workers" performance and its link with health outcomes. The journal encourages debate on health sector reforms and their link with human resources issues, a hitherto-neglected area.
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