Multinational primary health care experiences from the initial wave of the COVID-19 pandemic: A qualitative analysis

Understanding the experiences of PHC nurses in caring for older patients in the post-fifth wave of the COVID-19 pandemic: an exploratory qualitative study

Objective

To ensure the best possible care, the perspective of PHC nurse work experience during the COVID-19 pandemic should be considered when developing nursing care protocols for older patients who receive PHC services.

Method

This exploratory qualitative study was conducted with 18 nurses working continuously in PHC between the first and fifth waves of the pandemic. Semi-structured thematic interviews were undertaken. Qualitative thematic content analysis was conducted to identify and group the themes that emerged from the discourse. Interviews were transcribed and analyzed using thematic analysis.

Results

The first topic describes the nurses' experiences of physical and mental suffering in caring for older patients in response to the pandemic. The second topic covers the experience of reorganizing PHC work. The third topic focuses on the difficulties of caring for older patients. The final topic includes issues of support needs for nurses in PHC work.

Conclusion

The experience and understanding of PHC nurses in caring for older people during the COVID pandemic should lead to significant changes in the system of nursing care for geriatric patients and in the cooperative role within geriatric care specialist teams. Drawing on the experience of COVID-19, it is necessary to work on the weak points of PHC exposed by the pandemic in order to improve the quality of care and life for geriatric patients.

"What We're Doing Now…Is More Than Water Cooler": Perspectives of Primary Care Leaders on Leading Through (and Beyond) COVID-19

BACKGROUND

COVID-19 presented numerous challenges to primary care, but little formal research has explored the experience of practice leaders and their strategies for managing teams as the crisis unfolded.

OBJECTIVE

Describe the experience of leaders in US primary care delivery organizations, and their strategies for leading teams during COVID-19 and beyond.

DESIGN

Qualitative study using semi-structured interviews performed between 9/15/2020 and 8/31/2021.

PARTICIPANTS

Purposive sample of 17 clinical leaders in a range of US primary care organizations.

APPROACH

An iterative grounded review of interview transcripts was performed, followed by immersion/crystallization analysis.

KEY RESULTS

Early in the pandemic, practice leaders reported facing rapid change and the need for constant decision-making, amidst an environment of stress, fear, and uncertainty, but this was buffered by a strong sense of purpose. Later, leaders noted the emergence of layered crises, and evolving challenges including fatigue, burnout, and strained relationships within their organizations and with the communities they serve. Leaders described four interrelated strategies for supporting their teams: (1) Being intentionally present, physically and emotionally; (2) Frequent and transparent communication; (3) Deepening and broadening relationships; (4) Increasing adaptive decision-making, alternating between formal hierarchical and flexible participatory processes. These strategies were influenced by individual leaders' perceived autonomy, which was impacted by the leader's specific role, and organizational size, complexity, and funding model.

CONCLUSIONS

As the burnout and workforce crises have accelerated, the identified strategies can be useful to leaders to support teams and build organizational resilience in primary care moving forward.

Task shifting healthcare services in the post-COVID world: A scoping review

Task shifting (TS) is the redistribution of healthcare services from specialised to less-qualified providers. Need for TS was intensified during COVID-19. We explore what impact TS had on service delivery during the pandemic and examine how the pandemic affected TS strategies globally. We searched five databases in October 2022, namely Medline, CINAHL Plus, Elsevier, Global Health and Google Scholar. 35 citations were selected following the PRISMA-ScR guidelines. We analysed data thematically and utilised the WHO health systems framework and emergent themes to frame findings. We uncovered instances of TS in countries across all income levels. 63% (n = 22) of the articles discussed the impact of TS on healthcare services. These encompassed services related to mental healthcare, HIV, sexual and reproductive health, nutrition and rheumatoid diseases. The remaining 37% (n = 13) focused on how the pandemic altered strategies for TS, particularly in services related to mental healthcare, HIV, hypertension, diabetes and emergency care. We also found that studies differed in how they reported TS, with majority using terms "task shifting", followed by "task sharing", "task shifting and sharing" and "task delegation". Our analysis demonstrates that TS had a substantial impact across healthcare systems. Modifying roles through training and collaboration strengthened workforce and enhanced diagnostic services. Strategic leadership played a crucial role in the process. More research on the financial aspects of TS during pandemics is required. Stakeholders generally accepted TS, but transferring staff between healthcare programs caused unintended disruptions. The pandemic reshaped TS, moving training, patient care and consultations to digital platforms. Virtual interventions showed promise, but digital access remained a challenge. Healthcare organisations adapted by modifying procedures, pathways and staff precautions. We recommend refining strategies for TS, and expanding on it to address workforce shortages, improve access, and enhance services, not only during crises but also beyond.

Preparedness, impacts, and responses of public health emergencies towards health security: qualitative synthesis of evidence

BACKGROUND

Natural and human-made public health emergencies (PHEs), such as armed conflicts, floods, and disease outbreaks, influence health systems including interruption of delivery and utilization of health services, and increased health service needs. However, the intensity and types of impacts of these PHEs vary across countries due to several associated factors. This scoping review aimed to synthesise available evidence on PHEs, their preparedness, impacts, and responses.

METHODS

We conducted a scoping review of published evidence. Studies were identified using search terms related to two concepts: health security and primary health care. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines to select studies. We adapted the review framework of Arksey and O'Malley. Data were analyzed using a thematic analysis approach and explained under three stages of PHEs: preparedness, impacts, and responses.

RESULTS

A total of 64 studies were included in this review. Health systems of many low- and middle-income countries had inadequate preparedness to absorb the shocks of PHEs, limited surveillance, and monitoring of risks. Health systems have been overburdened with interrupted health services, increased need for health services, poor health resilience, and health inequities. Strategies of response to the impact of PHEs included integrated services such as public health and primary care, communication and partnership across sectors, use of digital tools, multisectoral coordination and actions, system approach to responses, multidisciplinary providers, and planning for resilient health systems.

CONCLUSIONS

Public health emergencies have high impacts in countries with weak health systems, inadequate preparedness, and inadequate surveillance mechanisms. Better health system preparedness is required to absorb the impact, respond to the consequences, and adapt for future PHEs. Some potential response strategies could be ensuring need-based health services, monitoring and surveillance of post-emergency outbreaks, and multisectoral actions to engage sectors to address the collateral impacts of PHEs. Mitigation strategies for future PHEs could include risk assessment, disaster preparedness, and setting digital alarm systems for monitoring and surveillance.

Working conditions in primary health care in the COVID-19 pandemic: an overview of Brazil and Portugal

The COVID-19 pandemic has put pressure on public health systems worldwide since 2020. This article aims to discuss working conditions in Primary Health Care (PHC) in Brazil, while dialoguing with primary health care (CSP, Cuidados de Saúde Primários) in Portugal in the pandemic scenario. For that purpose, data from the study "Working conditions of health professionals in the context of COVID-19 in Brazil" are presented, for further discussion with the report produced by "Family Health Units - National Association (USF-AN, Unidades de Saúde Familiar - Associação Nacional)" on the CSP in Portugal. In Brazil, regarding the sample of 3,895 PHC health professionals, it was observed: multiple employment relationships, lack of institutional support and specific training, living with fake news and the lack of political cohesion between health authorities, with significant changes in these workers' mental health. In Portugal, the increase in the workload and the presence of Burnout Syndrome among FHU professionals was emphasized. The pandemic had a significant impact on the health and daily work of health professionals in PHC and CSP. However, the Brazilian context was more adverse due to fake news and divergences regarding conducts related to the fight against the pandemic, due to the actions and denialism by the federal government.

Healthcare practitioners' construction of occupational risk during the COVID-19 pandemic

RATIONALE AND OBJECTIVE

In the pandemic's first year, frontline healthcare practitioners (HCPs) experienced a disproportionate burden of COVID-19's negative effects, including infection, death, trauma and burnout. Qualitative research is needed to understand practitioners' experiences to address the unique challenges they face. To this end, this article investigates occupational factors identified by practitioners as relevant to their risk perceptions. By positioning HCPs as a distinctive risk group in the hierarchical space of risk group prioritization, this analysis extends thinking about such classifications within medicine.

METHODS

Remote interviews were conducted between 2020 and 2022 with 45 U.S. practitioners, including physicians, nurse practitioners, physician associates, registered nurses and technicians. Interviews were audio recorded, transcribed, and coded using NVivo to analyze how practitioners understood their occupational risk.

RESULTS

Participants' risk perceptions focused on three concerns. First, working within spatial concentrations of COVID-19 required adapting procedures and reimagining their bodies as potentially hazardous. Second, the limitations of protective measures elevated concerns about healthcare work, and were perceived as pitting practitioners' health against patient care and administrative needs. Third, managing the many uncertainties about COVID-19 meant HCPs risked both its known and unknown effects.

CONCLUSION

This study examines frontline practitioners' perceptions of occupational risk during the pandemic. It argues two tensions underlie practitioners' risk perceptions. First, like other essential workers, HCPs constituted a unique risk group that distinguished them from other vulnerable populations - due to risks arising from occupational rather than biomedical factors. Second, unlike other essential workers, practitioners were directly exposed to infectious patients that posed risks to their health. These elements each highlight a perceived gap between practitioners' and administrators' risk perceptions that facilitated HCP cynicism about guidelines. Future research may fruitfully investigate if these themes persist outside the U.S. and across healthcare systems.

Towards applying the essential public health functions for building health systems resilience: A renewed list and key enablers for operationalization

The COVID-19 pandemic, climate change-related events, protracted conflicts, economic stressors and other health challenges, call for strong public health orientation and leadership in health system strengthening and policies. Applying the essential public health functions (EPHFs) represents a holistic operational approach to public health, which is considered to be an integrated, sustainable, and cost-effective means for supporting universal health coverage, health security and improved population health and wellbeing. As a core component of the Primary Health Care (PHC) Operational Framework, EPHFs also support the continuum of health services from health promotion and protection, disease prevention to treatment, rehabilitation, and palliative services. Comprehensive delivery of EPHFs through PHC-oriented health systems with multisectoral participation is therefore vital to meet population health needs, tackle public health threats and build resilience. In this perspective, we present a renewed EPHF list consisting of twelve functions as a reference to foster country-level operationalisation, based on available authoritative lists and global practices. EPHFs are presented as a conceptual bridge between prevailing siloed efforts in health systems and allied sectors. We also highlight key enablers to support effective implementation of EPHFs, including high-level political commitment, clear national structures for institutional stewardship on EPHFs, multisectoral accountability and systematic assessment. As countries seek to transform health systems in the context of recovery from COVID-19 and other public health emergencies, the renewed EPHF list and enablers can inform public health reform, PHC strengthening, and more integrated recovery efforts to build resilient health systems capable of managing complex health challenges for all people.

Primary healthcare providers challenged during the COVID-19 pandemic: a qualitative study

BACKGROUND

Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and long-lasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers' experiences with coronavirus pandemic preparedness and response in Armenia.

METHODS

We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the "SPSS22.0.0.0" software.

RESULTS

Five main themes of primary healthcare providers' experiences were drawn out based on the study findings: 1) the gap in providers' risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers' experiences during the pandemic. The study highlighted the health systems' unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers' behalf.

CONCLUSION

The study discovered that PHC providers have a very important role in healthcare system's preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment.

Postscript: A pandemic read on African health and environmental histories

This postscript reflects on this special issue's contributions for readers preoccupied with the COVID-19 pandemic. First, these articles on African environment and health underscore that past process of and interventions into land use and human health have cumulative effects on disease emergence and re-emergence. Relatedly, although multiple epidemics have affected the African continent and other parts of the world over the past century, global health institutions and actors have sidelined or forgotten these epidemics. These analyses draw our attention to the historical production and mobilization of specific concepts which frame what questions are asked, how they are answered, and the material solutions provided or withheld. And finally, these pieces highlight the ethical stakes of agricultural, conservation, and health interventions, reminding us that the African continent's histories are fraught with inequities from colonial and postcolonial extractive relations and racist assumptions that have undermined livelihoods, food security and health. As African states, institutions, and global health critics politick for vaccine equity and deplore the inequitable access to COVID-19 vaccines in African countries compared to the rest of the world, these articles remind us that these long-standing inequities should catalyze fundamental change.