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Maclaren AS, Locock L, Skea Z, Skåtun D, Wilson P. Rurality, healthcare and crises: Investigating experiences, differences, and changes to medical care for people living in rural areas. Health Place 2024; 87:103217. [PMID: 38493657 DOI: 10.1016/j.healthplace.2024.103217] [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: 11/21/2023] [Revised: 01/12/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024]
Abstract
Healthcare provision in rural areas is a global challenge, characterised by a dispersed patient population, difficulties in the recruitment and retention of healthcare professionals and a physical distance from hospital care. This research brings together both public and doctor perspectives to explore the experience of healthcare across rural Scotland, against the backdrop of contemporary crises, including a global pandemic and extreme weather events. We draw on two studies on rural healthcare provision to understand how healthcare services have been experienced, changed and might move on after periods of short- and longer-term change caused by such crises. We highlight the importance of communicating service changes to aid in setting healthcare expectations and advocate a mixed approach to the introduction of digital solutions to best balance access to services in rural areas with the challenges of digital connectivity and literacy.
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Affiliation(s)
- Andrew S Maclaren
- Institute of Applied Health Sciences, University of Aberdeen, UK; Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB24 3UF, UK.
| | - Louise Locock
- University of Aberdeen, Institute of Applied Health Sciences, Health Services Research Unit, Aberdeen, UK.
| | - Zoë Skea
- University of Aberdeen, Institute of Applied Health Sciences, Health Services Research Unit, Aberdeen, UK.
| | - Diane Skåtun
- University of Aberdeen, Institute of Applied Health Sciences, Health Economics Research Unit, Aberdeen, UK
| | - Philip Wilson
- University of Aberdeen, Institute of Applied Health Sciences, Centre for Rural Health, Inverness, UK.
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Mathews M, Hedden L, Lukewich J, Marshall EG, Meredith L, Moritz L, Ryan D, Spencer S, Brown JB, Gill PS, Wong EKW. Adapting care provision in family practice during the COVID-19 pandemic: a qualitative study exploring the impact of primary care reforms in four Canadian regions. BMC PRIMARY CARE 2024; 25:109. [PMID: 38582824 PMCID: PMC10998349 DOI: 10.1186/s12875-024-02356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Over the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians' (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care. METHODS As part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data. RESULTS Sixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs' ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care. CONCLUSIONS Recent primary care system reforms implemented in Canada enhanced FPs' ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Judith B Brown
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Eric K W Wong
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
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Spencer S, Lukewich J, Marshall EG, Mathews M, Asghari S, Brown JB, Freeman TR, Gill P, Idrees S, McCracken RK, Ranade S, Slade S, Terry AL, Wickett J, Wong E, Buote R, Meredith L, Moritz L, Ryan D, Hedden L. "Family doctors are also people": a qualitative analysis of how family physicians managed competing personal and professional responsibilities during the COVID-19 pandemic. HUMAN RESOURCES FOR HEALTH 2024; 22:18. [PMID: 38439084 PMCID: PMC10913223 DOI: 10.1186/s12960-024-00901-4] [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: 06/09/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Family physicians (FPs) fill an essential role in public health emergencies yet have frequently been neglected in pandemic response plans. This exclusion harms FPs in their clinical roles and has unintended consequences in the management of concurrent personal responsibilities, many of which were amplified by the pandemic. The objective of our study was to explore the experiences of FPs during the first year of the COVID-19 pandemic to better understand how they managed their competing professional and personal priorities. METHODS We conducted semi-structured interviews with FPs from four Canadian regions between October 2020 and June 2021. Employing a maximum variation sampling approach, we recruited participants until we achieved saturation. Interviews explored FPs' personal and professional roles and responsibilities during the pandemic, the facilitators and barriers that they encountered, and any gender-related experiences. Transcribed interviews were thematically analysed. RESULTS We interviewed 68 FPs during the pandemic and identified four overarching themes in participants' discussion of their personal experiences: personal caregiving responsibilities, COVID-19 risk navigation to protect family members, personal health concerns, and available and desired personal supports for FPs to manage their competing responsibilities. While FPs expressed a variety of ways in which their personal experiences made their professional responsibilities more complicated, rarely did that affect the extent to which they participated in the pandemic response. CONCLUSIONS For FPs to contribute fully to a pandemic response, they must be factored into pandemic plans. Failure to appreciate their unique role and circumstances often leaves FPs feeling unsupported in both their professional and personal lives. Comprehensive planning in anticipation of future pandemics must consider FPs' varied responsibilities, health concerns, and necessary precautions. Having adequate personal and practice supports in place will facilitate the essential role of FPs in responding to a pandemic crisis while continuing to support their patients' primary care needs.
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Affiliation(s)
- Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, B3J 3T4, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Judith B Brown
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Paul Gill
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Samina Idrees
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Rita K McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Sudit Ranade
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Steve Slade
- The College of Family Physicians of Canada, 2630 Skymark Avenue, Mississauga, ON, L4W 5A4, Canada
| | - Amanda L Terry
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Jamie Wickett
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, B3J 3T4, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, B3J 3T4, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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Hedden L, Spencer S, Mathews M, Gard Marshall E, Lukewich J, Asghari S, Gill P, McCracken RK, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, Schacter G. "Technology has allowed us to do a lot more but it's not necessarily the panacea for everybody": Family physician perspectives on virtual care during the COVID-19 pandemic and beyond. PLoS One 2024; 19:e0296768. [PMID: 38422067 PMCID: PMC10903916 DOI: 10.1371/journal.pone.0296768] [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] [Received: 07/05/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Early in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments. Our objective was to explore Canadian family physicians' perspectives on the strengths and limitations of virtual care implementation for their patient populations during the COVID-19 pandemic and implications for the integration of virtual care into broader primary care practice. METHODS We conducted semi-structured qualitative interviews with family physicians working in four Canadian jurisdictions (Vancouver Coastal health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region, Newfoundland and Labrador). We analyzed interview data using a structured applied thematic approach. RESULTS We interviewed 68 family physicians and identified four distinct themes during our analysis related to experiences with and perspectives on virtual care: (1) changes in access to primary care; (2) quality and efficacy of care provided virtually; (3) patient and provider comfort with virtual modalities; and (4) necessary supports for virtual care moving forward. CONCLUSIONS The move to virtual care enhanced access to care for select patients and was helpful for family physicians to better manage their panels. However, virtual care also created access challenges for some patients (e.g., people who are underhoused or living in areas without good phone or internet access) and for some types of care (e.g., care that required access to medical devices). Family physicians are optimistic about the ongoing integration of virtual care into broader primary care delivery, but guidance, regulations, and infrastructure investments are needed to ensure equitable access and to maximize quality of care.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Paul Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rita K. McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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McKay M, Brown R, Mallam K, MacDonald Green A, Bernard A. Engaging the collective voice of physicians: Optimizing participation in research and policy development in the context of COVID-19 and physician burnout. Healthc Manage Forum 2023; 36:378-381. [PMID: 37671740 DOI: 10.1177/08404704231199083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Physicians and governments work collaboratively to determine optimal healthcare policy options. Physicians are also engaged by health researchers to participate in studies. Physician engagement can be impeded by limits on physician time and remuneration for engagement, and the impact of physician burnout (exacerbated by COVID-19). Doctors Nova Scotia engaged physicians on various research and policy items throughout the pandemic. Strategies included integrating physicians into research teams, remunerating engagement activities, and leveraging existing tools and networks. Health researchers and policy-makers can improve physician engagement through physician champions, reduction of research duplication, valuing of physician contributions, and integrating networks.
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Affiliation(s)
| | - Ryan Brown
- Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katie Mallam
- Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada
| | | | - André Bernard
- Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
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Mathews M, Liu T, Ryan D, Hedden L, Lukewich J, Marshall EG, Buote R, Meredith L, Moritz LR, Spencer S, Asghari S, Brown JB, Freeman TR, Gill PS, Sibbald S. Practice- and System-Based Interventions to Reduce COVID-19 Transmission in Primary Care Settings: A Qualitative Study. Healthc Policy 2023; 19:63-78. [PMID: 38105668 PMCID: PMC10751755 DOI: 10.12927/hcpol.2023.27232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Using qualitative interviews with 68 family physicians (FPs) in Canada, we describe practice- and system-based approaches that were used to mitigate COVID-19 exposure in primary care settings across Canada to ensure the continuation of primary care delivery. Participants described how they applied infection prevention and control procedures (risk assessment, hand hygiene, control of environment, administrative control, personal protective equipment) and relied on centralized services that directed patients with COVID-19 to settings outside of primary care, such as testing centres. The multi-layered approach mitigated the risk of COVID-19 exposure while also conserving resources, preserving capacity and supporting supply chains.
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Affiliation(s)
- Maria Mathews
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Tiffany Liu
- Research Assistant, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Dana Ryan
- Research Assistant, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Lindsay Hedden
- Assistant Professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Julia Lukewich
- Associate Professor, Faculty of Nursing, Memorial University, St. John's, NL
| | - Emily Gard Marshall
- Professor, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Richard Buote
- Research Assistant, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Leslie Meredith
- Research Manager, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Lauren R. Moritz
- Research Associate, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Sarah Spencer
- Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Shabnam Asghari
- Professor, Discipline of Family Medicine, Memorial University, St. John's, NL
| | - Judith B. Brown
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Thomas R. Freeman
- Professor Emeritus, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Paul S. Gill
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Lecturer, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Shannon Sibbald
- Associate Professor, School of Health Studies, Faculty of Health Sciences, Western University, Associate Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
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Elliott J, Tong C, Gregg S, Mallinson S, Giguere A, Brierley M, Giosa J, MacNeil M, Juzwishin D, Sims-Gould J, Rockwood K, Stolee P. Policy and practices in primary care that supported the provision and receipt of care for older persons during the COVID-19 pandemic: a qualitative case study in three Canadian provinces. BMC PRIMARY CARE 2023; 24:199. [PMID: 37770822 PMCID: PMC10536733 DOI: 10.1186/s12875-023-02135-0] [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: 01/24/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The effects of the COVID-19 pandemic on older adults were felt throughout the health care system, from intensive care units through to long-term care homes. Although much attention has been paid to hospitals and long-term care homes throughout the pandemic, less attention has been paid to the impact on primary care clinics, which had to rapidly change their approach to deliver timely and effective care to older adult patients. This study examines how primary care clinics, in three Canadian provinces, cared for their older adult patients during the pandemic, while also navigating the rapidly changing health policy landscape. METHODS A qualitative case study approach was used to gather information from nine primary care clinics, across three Canadian provinces. Interviews were conducted with primary care providers (n = 17) and older adult patients (n = 47) from October 2020 to September 2021. Analyses of the interviews were completed in the language of data collection (English or French), and then summarized in English using a coding framework. All responses that related to COVID-19 policies at any level were also examined. RESULTS Two main themes emerged from the data: (1) navigating the noise: understanding and responding to public health orders and policies affecting health and health care, and (2) receiving and delivering care to older persons during the pandemic: policy-driven challenges & responses. Providers discussed their experiences wading through the health policy directives, while trying to provide good quality care. Older adults found the public health information overwhelming, but appreciated the approaches adapted by primary care clinics to continue providing care, even if it looked different. CONCLUSIONS COVID-19 policy and guideline complexities obliged primary care providers to take an important role in understanding, implementing and adapting to them, and in explaining them, especially to older adults and their care partners.
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Affiliation(s)
- Jacobi Elliott
- Lawson Health Research Institute, London, ON, Canada.
- St. Joseph's Health Care London, London, ON, Canada.
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Catherine Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Susie Gregg
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sara Mallinson
- Alberta Health Services, Calgary, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Laval, QC, Canada
| | | | - Justine Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- SE Research Centre, SE Health, Markham, ON, Canada
| | - Maggie MacNeil
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Don Juzwishin
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Mathews M, Meredith L, Ryan D, Hedden L, Lukewich J, Marshall EG, Moritz L, Spencer S, Xiao J, Brown JB, McKay M, Wong E, Gill P. An analysis of policies supporting the roles of family physicians in four regions in Canada during the COVID-19 pandemic. Healthc Manage Forum 2023; 36:333-339. [PMID: 37326140 PMCID: PMC10290925 DOI: 10.1177/08404704231183174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Policy supports are needed to ensure that Family Physicians (FPs) can carry out pandemic-related roles. We conducted a document analysis in four regions in Canada to identify regulation, expenditure, and public ownership policies during the COVID-19 pandemic to support FP pandemic roles. Policies supported FP roles in five areas: FP leadership, Infection Prevention and Control (IPAC), provision of primary care services, COVID-19 vaccination, and redeployment. Public ownership polices were used to operate assessment, testing and vaccination, and influenza-like illness clinics and facilitate access to personal protective equipment. Expenditure policies were used to remunerate FPs for virtual care and carrying out COVID-19-related tasks. Regulatory policies were region-specific and used to enact and facilitate virtual care, build surge capacity, and enforce IPAC requirements. By matching FP roles to policy supports, the findings highlight different policy approaches for FPs in carrying out pandemic roles and will help to inform future pandemic preparedness.
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Affiliation(s)
| | | | - 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
| | | | | | | | - Eric Wong
- Western University, London, Ontario, Canada
- Thames Valley Family Health Team, London, Ontario, Canada
- St. Joseph's Health Care London, London, Ontario, Canada
| | - Paul Gill
- Western University, London, Ontario, Canada
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Hedden L, Spencer S, Mathews M, Marshall EG, Lukewich J, Asghari S, Brown JB, Gill PS, Freeman TR, McCracken RK, Ryan BL, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, McKay M, Schacter G. "There's nothing like a good crisis for innovation": a qualitative study of family physicians' experiences with virtual care during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:338. [PMID: 37016330 PMCID: PMC10072815 DOI: 10.1186/s12913-023-09256-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/07/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians' perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic. METHODS We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes. RESULTS We identified three prominent themes throughout participants' reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers. CONCLUSION Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rita K McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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10
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Mathews M, Ryan D, Hedden L, Lukewich J, Marshall EG, Asghari S, Terry AL, Buote R, Meredith L, Moritz L, Spencer S, Brown JB, Christian E, Freeman TR, Gill PS, Sibbald SL, Wong E. Family physicians' responses to personal protective equipment shortages in four regions in Canada: a qualitative study. BMC PRIMARY CARE 2023; 24:56. [PMID: 36849904 PMCID: PMC9969942 DOI: 10.1186/s12875-022-01958-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/23/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. METHODS As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. RESULTS A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. CONCLUSIONS During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Amanda Lee Terry
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Judith B Brown
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Erin Christian
- Nova Scotia Health, 78 Lovett Lake Ct, Halifax, NS, B3S 1B8, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Thames Valley Family Health Team, 1385 North Routledge Park, Unit 6, London, ON, N6H 5N5, Canada.,St. Joseph's Health Care London, Family Medical Centre, PO Box 5777, Stn B, London, ON, N6A 4V2, Canada
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11
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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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12
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Spencer S, Hedden L, Vaughan C, Marshall EG, Lukewich J, Asghari S, Gill P, Buote R, Meredith L, Moritz L, Ryan D, Mathews M. "It was horrible for that community, but not for the way we had imagined": A qualitative study of family physicians' experiences of caring for communities experiencing marginalisation during COVID-19. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100176. [PMID: 36248310 PMCID: PMC9536327 DOI: 10.1016/j.ssmqr.2022.100176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/16/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 response required family physicians (FPs) to adapt their practice to minimise transmission risks. Policy guidance to facilitate enacting public health measures has been generic and difficult to apply, particularly for FPs working with communities that experience marginalisation. Our objective was to explore the experiences of FPs serving communities experiencing marginalisation during COVID-19, and the impact the pandemic and pandemic response have had on physicians' ability to provide care. We conducted semi-structured qualitative interviews with FPs from four Canadian regions, October 2020 through June 2021. We employed maximum variation sampling and continued recruitment until we reached saturation. Interviews explored participants' roles/experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support communities experiencing marginalisation throughout. We used a thematic approach to analyse the data. FPs working with communities experiencing marginalisation expressed the need to continue providing in-person care throughout the pandemic, often requiring them to devise innovative adaptations to their clinical settings and practice. Physicians noted the health implications for their patients, particularly where services were limited or deferred, and that pandemic response policies frequently ignored the unique needs of their patient populations. Pandemic-related precautionary measures that sought to minimise viral transmission and prevent overwhelming acute care settings may have undermined pre-existing services and superseded the ongoing harms that are disproportionately experienced by communities experiencing marginalisation. FPs are well placed to support the development of pandemic response plans that appreciate competing risks amongst their communities and must be included in pandemic planning in the future.
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Affiliation(s)
- Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada,Corresponding author. Faculty of Health Sciences, Simon Fraser University, 8888 University Drive Burnaby, BC, V5A 1S6 Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Paul Gill
- Temerty Faculty of Medicine Department of Family & Community Medicine, University of Toronto, 500 University Avenue, M5G 1V7, Toronto, Ontario, Canada,Gateway Centre of Excellence in Rural Health, 74 Kingston Street, Goderich, Ontario, N7A 3K4, Canada
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Leslie Meredith
- Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, 1465 Richmond Street, London, Ontario, N6G 2M1, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada,Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, 1465 Richmond Street, London, Ontario, N6G 2M1, Canada
| | - Maria Mathews
- Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, 1465 Richmond Street, London, Ontario, N6G 2M1, Canada
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13
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Vaughan C, Lukewich J, Mathews M, Marshall EG, Hedden L, Spencer S, Ryan D, McCracken RK, Gill P, Wetmore S, Buote R, Meredith L, Moritz L, Brown JB. Family physicians' perspectives on the impact of COVID-19 on preventative care in primary care: findings from a qualitative study. Fam Pract 2022:cmac113. [PMID: 36269200 PMCID: PMC9620325 DOI: 10.1093/fampra/cmac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Health system disruptions, caused by unexpected emergencies such as disease outbreaks, natural disasters, and cybercrimes, impact the delivery of routine preventative care. As comprehensive care providers, family physicians (FPs) devote significant time to prevention. However, without emergency and pandemic plans in place in primary care, FPs face added barriers to prioritizing and sustaining preventative care when health systems are strained, which was evident during the COVID-19 pandemic. This study aims to describe FPs' experiences providing preventative care during the COVID-19 pandemic and their perceptions of the impacts of disrupted preventative care in primary care settings. METHODS Using a qualitative descriptive approach, we conducted semistructured interviews with FPs across 4 provinces in Canada (i.e. Newfoundland and Labrador, Nova Scotia, Ontario, British Columbia) between October 2020 and June 2021 as part of a larger multiple case study. These interviews broadly explored the roles and responsibilities of FPs during the COVID-19 pandemic. Interviews were coded thematically and codes from the larger study were analysed further using an iterative, phased process of thematic analysis. RESULTS Interviews averaged 58 min in length (range 17-97 min) and FPs had a mean of 16.9 years of experience. We identified 4 major themes from interviews with FPs (n = 68): (i) lack of capacity and coordination across health systems, (ii) patient fear, (iii) impacts on patient care, and (iv) negative impacts on FPs. Physicians voiced concerns with managing patients' prevention needs when testing availability and coordination of services was limited. Early in the pandemic, patients were also missing or postponing their own primary care appointments. Change in the provision and coordination of routine preventative care had negative impacts on both patients and physicians, affecting disease incidence/progression, physician workload, and psychological wellbeing. CONCLUSION During the COVID-19 pandemic, upstream care efforts were impacted, and FPs were forced to reduce their provision of preventative care. FPs contribute direct insight to primary care delivery that can support pandemic planning to ensure preventative care is sustained during future emergencies.
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Affiliation(s)
- Crystal Vaughan
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Rita K McCracken
- Department of Family Medicine, Providence Health Care, Vancouver, Canada
- Department of Family Practice, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Paul Gill
- Temerty Faculty of Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Gateway Centre of Excellence in Rural Health, Gateway Rural Health Institute, Goderich, Canada
| | - Stephen Wetmore
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Richard Buote
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lauren Moritz
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
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14
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Tharmaratnam T, D'Urzo A, Cazzola M. Medical knowledge about COVID-19 is travelling at the speed of mistrust: why this is relevant to primary care. Fam Pract 2022; 39:988-991. [PMID: 35079783 PMCID: PMC9383313 DOI: 10.1093/fampra/cmac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Anthony D'Urzo
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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15
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Vaughan C, Lukewich J, Mathews M, Hedden L, Poitras ME, Asghari S, Swab M, Ryan D. Nursing contributions to virtual models of care in primary care: a scoping review protocol. BMJ Open 2022; 12:e065779. [PMID: 36127080 PMCID: PMC9490598 DOI: 10.1136/bmjopen-2022-065779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Since the onset of the COVID-19 pandemic, virtual care has gained increased attention, particularly in primary care for the ongoing delivery of routine services. Nurses have had an increased presence in virtual care and have contributed meaningfully to the delivery of team-based care in primary care; however, their exact contributions in virtual models of primary care remain unclear. The Nursing Role Effectiveness Model, applied in a virtual care and primary care context, outlines the association between structural variables, nursing roles and patient outcomes. The aim of this scoping review is to identify and synthesise the international literature surrounding nurse contributions to virtual models of primary care. METHODS AND ANALYSIS The Joanna Briggs Institute scoping review methodology will guide this review. We performed preliminary searches in April 2022 and will use CINAHL, MEDLINE, Embase and APA PsycInfo for the collection of sources for this review. We will also consider grey literature, such as dissertations/theses and organisational reports, for inclusion. Studies will include nurses across all designations (ie, nurse practitioners, registered nurses, practical nurses). To ensure studies capture roles, nurses should be actively involved in healthcare delivery. Sources require a virtual care and primary care context; studies involving the use of digital technology without patient-provider interaction will be excluded. Following a pilot test, trained reviewers will independently screen titles/abstracts for inclusion and extract relevant data. Data will be organised using the Nursing Role Effectiveness Model, outlining the virtual care and primary care context (structure component) and the nursing role concept (process component). ETHICS AND DISSEMINATION This review will involve the collection and analysis of secondary sources that have been published and/or are publicly available. Therefore, ethics approval is not required. Scoping review findings will be published in a peer-reviewed journal and presented at relevant conferences, targeting international primary care stakeholders.
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Affiliation(s)
- Crystal Vaughan
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Maria Mathews
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Shabnam Asghari
- Center for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Michelle Swab
- Health Sciences Library, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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