COVID-19 pandemic impact on Primary Health Care Accessibility in Portugal

 

The COVID-19 pandemic disrupted health systems worldwide, mobilizing most of its resources to COVID-19 care. In Portugal, since mid-March 2020, the scheduled assistance activity of the primary health care services has been altered or interrupted, to respond to the needs of users with suspected or diagnosed SARS-CoV-2 infection. This study intends aims to assess the impact of the COVID-19 pandemic in terms of access to primary health care during 2020 in Portugal. Primary Health Care accessibility data were extracted from the national data transparency portal. Data were aggregated by the 5 health regions and compared to homologous periods for years 2019 and 2020. In Portugal, in 2020 the number of primary health care consultations decreased in the regions of Alentejo (-5%), Algarve (-1%) and Centre (-1%) but increased in both North (+6%) and Lisbon and the Tagus Valley regions (+7%). The number of scheduled appointments decreased in the 5 regions (-16%), increasing the unscheduled appointments (+24%). Those differences were higher during the first lockdown (-42% schedule appointments vs + 13% unscheduled appointments). Presential consultations decreased by 38%, non-presential increased by 101%, and domiciliary consultations were reduced by 37%. Changes to regular activity of primary health care units compromised the access to presential health care by the non-COVID-19 population. After the first pandemic wave, the resumption of scheduled activity changed from face-to-face to non-presential consultation. The adoption of new technologies and telemedicine increased the total of registered consultations, compared to previous year. However, not all non-presential consultation is in fact patient-facing teleconsultation, with some of them being just for prescription renewal or to prescribe complementary exams. Predominantly urban regions were less affected by the suspension of presential activity, maintaining their assistance by non-presential provision of care and telework.

Key messages

Amidst the COVID-19 pandemic, the Portuguese primary health care services ensured the assistance to their population by non-presential provision of care. Predominantly rural regions were most affected by the suspension of presential consultation.

Co-production of health: are communities being heard in local health planning in Portugal?

Background

Health planning is an essential tool to address communities' health needs. Although recommended by portuguese national guidelines, Local Health Plans (LHP) lack adequate community participation, which could improve their implementation and contribute to achieve the SDG agenda and universal health coverage. The aim of this study is to assess the degree of community participation in LHP in Portugal.

Methods

Data was collected from 52 (out of 54) publicly available LHP in April 2021. Each document was reviewed by two independent researchers and analysed considering time frame, participatory approach, stage of the health planning cycle in which the community was involved and methods used to promote community participation. A descriptive analysis was performed.

Results

Although 52 LHP were available, only 37 were valid for 2020. Although community participation was mentioned in all PLH, most did not include a comprehensive community participation approach (88%). Community representatives were particularly involved in the prioritizing health problems stage of the health planning cycle (81%); no LHP mentioned the involvement of the community in the monitoring and evaluation stage. Methods used to promote community participation were clearly stated in 48% of LHP.

Conclusions

Community participation is a key strategy for successful implementation of LHP in Portugal. Most LHP show a clear concern to include community representatives when it comes to prioritizing health problems and highlight the importance of co-production of health between health services and the community, but fail to integrate community participation throughout the health planning cycle. Specific community fora could improve community participation and therefore better implementation of LHP.

Key messages

Most Local Health Plans in Portugal lack a comprehensive community participation approach. A community-centred approach should be prioritized in order to improve LHP implementation.

Implementing Health Literacy Intelligence during COVI-19 outbreak

Background

During events that involve health risks, people may feel the need personal and social resources to cope with the demands posed by event. Depending on their individual characteristics, people may perceive their resources as sufficient or as insufficient to face the situation. Risk perception analysis was conducted in Portugal during the COVID-19 outbreak, to develop communication strategies, customized to the changing needs, helping people make informed decisions.

Methods

Citizens messages on social networks of 3 official information sources, and 8 media sources were analyzed between 26th January and 5th March 2020. A sample of comments to publications related to COVID-19 were analyzed in 4-days periods and categorized. A qualitative theory-driven thematic analysis was carried out based on two global categories: Demands and Resources. From this analysis, the threat level ratio (Demands/Resources) was calculated.

Results

A total of 8,251 comments were analysed in 10 periods of 4 days of data collection, from 26th January to 5th March. The threat level ratio increased during the first 15 days of analysis, having its maximum (6.80) in the period between the 7th and 14th of February, mostly associated with the perceived danger associated with the lack of airports arrivals control from China. After the announcement of the first confirmed case of COVID-19 in a Portuguese citizen outside Portugal, on 23rd February, the risk perception increased 1,4% compared to the previous period of analysis. On the contrary, after announcing the first confirmed case in Portugal, on the 1st March, the risk perception decreased 1,6%, which is inferred to be associated with a shift in the media discourse and to the use of humour.

Conclusions

Awareness of risks is a necessary condition for people to adhere to the necessary recommendations to mitigate the crisis. During an epidemic, an effective communication strategy can become an opportunity to promote health literacy.

Key messages

Risk perception is essential to define effective communication strategies to promote health literacy and best practices among targeted populations.

effective communication strategies customized to people’s needs and priorities help people making informed decisions during a public health emergency.

Preparedness and response in Portuguese emergency plans - Interaction with public health

Background

Articulation between Civil Protection and Public Health authorities is of paramount importance to control, reduce and prevent threats to the health of the population in situations of crisis or catastrophes. National Civil Protection Authority produces Emergency Plans which describe the role of every stakeholder in emergency situations. Role and importance of Public Health and Public Health Authorities is not always present or well described and known amongst stakeholders.

Methods

Data was collected from all Districtal Emergency Plans (n = 18). Each document was analysed considering time frame, refences to Public Health and Health Authorities, definition of roles, communication channels, coordination and inclusion of intersectoral communication flow. Quantitative analysis included absolute and relative frequencies and qualitative analysis to all parts related to the terms “Public Health” and “Health Authority”. Each document was reviewed by 2 independent researchers.

Results

From 18 Districtal Emergency Plans (DEP) analysed, 94,4% (n = 17) had references to Public Health, but none referred the role of Public Health Officers. Only 16,7% referred to Health Authorities, although 94,4% mentioned the law 135/2013, defining the role and attributes of Health Authority. In 72,2%, coordination of Public Health Measures was attributed to the National Medical Emergency Institute. Epidemiological surveillance and Public Health Emergencies were referred in 55,6%, and attributed to the Regional Administration of Health.

Conclusions

Public Health Authorities and Public Health Medical Officers role in articulation with National Civil Protection Authority in emergency situations lacks severely, with this role being replaced by other entities. This is of great concern regarding management and control of diseases, particularly communicable diseases.

Key messages

Public Health Authorities lack the necessary involvement in Emergency Plans and emergency situations. Public health measures are coordinated by other entities rather than Public Health Authorities.