Life After COVID-19: Rethinking the Healthcare System and Valuing the Role of Citizens' Engagement in Health Prevention

The Contribution of Cultural Heritage Owned by Local Health Authorities in the Humanization of Care: The Point of View of Top Management

After the COVID-19 pandemic, reforms in healthcare systems have the purpose to fully recover the relationship of healthcare organizations with their patients. For centuries, art was used throughout Europe in the healthcare context for its power to engage and support patients in their illnesses. This approach can be rediscovered by utilizing the cultural heritage owned by Local Health Authorities. In this context, tradition, art, innovation, and care coexist. This study aims to investigate the interest in developing projects for the humanization of care by the top management of Italian Local Health Authorities, in particular exploiting their cultural heritage. The evaluation of the proposal was conducted using semi-structured interviews with the top management of two Local Health Authorities, in which the Santa Maria Nuova hospital in Florence and the Santo Spirito in Sassia Hospital in Rome are located, as the two selected cases for this study. The interviewees welcomed the proposal to develop humanization of care projects involving the use of their cultural heritage. Moreover, they expressed their desire to invest human, economic, and structural resources in the development of these initiatives. The implementation of humanization of care projects using cultural heritage owned by Local Health Authorities is useful to apply specific policies to enhance the governance of the cultural heritage according to the health mission. On the other hand, it permits the search for additional or ad hoc resources. Finally, it is possible to humanize and improve patients' experience while increasing awareness among the health workforce and trainees.

How community medical facilities can promote resilient community constructions under the background of pandemics

Nowadays, urban and community resilience have become the core issues of urban theoretical research and construction practices. While there are many studies on climate change, natural hazards and environmental pollution, relatively less attention has been paid to public and human health. However, the current COVID-19 pandemic, which is a major global public health crisis, is posing severe challenges to the resilience of cities and communities in the context of high-mobility, high-density and high-intensity, as well as expands the connotation of community resilience to public health. To compensate for the lack of current research, this study examined the characteristics of community medical facilities in response to pandemics at urban, community and individual multi-spatial scales based on a thorough review of current research and relevant practice. It also emphasized the significant role played by community medical facilities in improving resilient community constructions in the face of large-scale public health emergencies. These characteristics were fully utilized to explore ways to build and govern the 'resilience' of communities in the future, help people to survive better as well as develop in complex and changeable external environments.

Proposals for person-centred care in the COVID-19 era. Delphi study

BACKGROUND

In this COVID-19 era, we need to rethink the criteria used to measure the results of person-centred care strategies.

OBJECTIVE

To identify priorities, and criteria that health services can use to pursue actually the goal of achieving person-centred care.

DESIGN

Three-phase online qualitative study performed during May-July of 2020 using the Delphi technique.

SETTING AND PARTICIPANTS

An online platform was used for a consensus meeting of 114 participants, including health planning experts, health-care institution managers, clinicians and patients.

MAIN OUTCOME MEASURES

Criteria and indicators for the achievement of person-centred care.

MAIN RESULTS

The first round began with 125 proposals and 11 dimensions. After the second round, 28 ideas reached a high level of consensus among the participants. Ultimately, the workgroup agreed on 20 criteria for goals in the implementation of person-centred care during the COVID-19 era and 21 related indicators to measure goal achievement.

DISCUSSION

Nine dimensions and 28 priorities were identified. These priorities are also in accordance with the quadruple aim approach, which emphasizes the need for care for health-care professionals, without whom it is impossible to achieve a better quality of care.

CONCLUSIONS

Person-centred care continues to be a key objective. However, new metrics are needed to ensure its continued development during the restoration of public health services beyond the control of COVID-19.

PATIENT OR PUBLIC CONTRIBUTION

Twelve professionals and patient representatives participated voluntarily in the construction of the baseline questionnaire and in the selection of the criteria and indicators using an online platform for consensus meetings.

Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare

COVID-19 pandemic mitigation strategies are mainly based on social distancing measures and healthcare system reinforcement. However, many countries in Europe and elsewhere implemented strict, horizontal lockdowns because of extensive viral spread in the community which challenges the capacity of the healthcare systems. However, strict lockdowns have various untintended adverse social, economic and health effects, which have yet to be fully elucidated, and have not been considered in models examining the effects of various mitigation measures. Unlike commonly suggested, the dilemma is not about health vs wealth because the economic devastation of long-lasting lockdowns will definitely have adverse health effects in the population. Furthermore, they cannot provide a lasting solution in pandemic containment, potentially resulting in a vicious cycle of consecutive lockdowns with in-between breaks. Hospital preparedness has been the main strategy used by governments. However, a major characteristic of the COVID-19 pandemic is the rapid viral transmission in populations with no immunity. Thus, even the best hospital system could not cope with the demand. Primary, community and home care are the only viable strategies that could achieve the goal of pandemic mitigation. We present the case example of Greece, a country which followed a strategy focused on hospital preparedness but failed to reinforce primary and community care. This, along with strategic mistakes in epidemiological surveillance, resulted in Greece implementing a second strict, horizontal lockdown and having one of the highest COVID-19 death rates in Europe during the second wave. We provide recommendations for measures that will reinstate primary and community care at the forefront in managing the current public health crisis by protecting hospitals from unnecessary admissions, providing primary and secondary prevention services in relation to COVID-19 and maintaining population health through treatment of non-COVID-19 conditions. This, together with more selective social distancing measures (instead of horizontal lockdowns), represents the only viable and realistic long-term strategy for COVID-19 pandemic mitigation.