Access to General Practitioners during the COVID-19 pandemic in Portugal-A survey study of patient experiences in an urban setting.

BACKGROUND: In 2020, Portugal had high levels of unmet health care needs. Primary Care was reported as the main source of unmet needs. OBJECTIVES: To describe face-to-face and remote access to GPs in Portugal during the COVID-19 pandemic. To discover patient experiences and attitudes to access to care. To identify determinants of access to care. METHODS: A survey of a random sample of 4,286 adults registered in a group of Family Practices was conducted in 2021. Paper questionnaires were sent by post to patients who had no e-mail address registered with the practice. Patients with an e-mail address were sent a link to an online questionnaire. Outcomes were reported waiting times for face-to-face and remote contacts with GPs, dichotomized to ascertain compliance with standards. Associations between participant characteristics and outcome variables were tested using logistic regression. RESULTS: Waiting times for face-to-face consultations with GPs during the pandemic often exceeded the maximum waiting times (MWT) set by the National Health Service. Remote contacts were mostly conducted within acceptable standards. Waiting times for speaking with the GP over the phone were rated as 'poor' by 40% and 27% reported requests for these calls as unmet. The odds of getting care over MWT increased for participants who reported poorer digital skills. Participants were less likely to get non-urgent consultations over MWT if they found it easy to use the online patient portal to book appointments (odds ratio 0.24; 99% confidence intervals 0.09-0.61), request prescriptions (0.18; 0.04-0.74) or insert personal data (0.18; 0.04-0.95). CONCLUSION: Patient reported access to GPs during the pandemic was uneven in Portugal. Obtaining non-urgent consultations and remote contacts over MWT affected mainly those patients with poor digital skills. Telephone access to GPs received the worse ratings. Access through traditional pathways must remain available, to prevent the widening of inequities.

Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors.

BACKGROUND: The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS: All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS: A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS: Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.

[The Impact of the COVID-19 Pandemic on the Healthcare System and on the Mental Health of Primary Health Care Providers]. / Repercussão da Pandemia de COVID-19 nos Serviços de Saúde e na Saúde Mental dos Profissionais dos Cuidados de Saúde Primários.

INTRODUCTION: The COVID-19 pandemic forced the reorganization of primary health care services. The aim of this study was to describe how the health services responded to organizational requests; how the health services involved and supported their employees; how professionals perceived their involvement in the procedures and what support was provided to them. Additions aims included assessing the levels of anxiety and depression of professionals and their association with the perceived support, availability of personal protective equipment and involvement in pandemic-related tasks. MATERIAL AND METHODS: Cross-sectional, analytical study directed at professionals from three health center groups using an online questionnaire. We collected information from sociodemographic data, access to personal protective equipment, perceived support, workload and levels of anxiety and depression. Between each variable and the levels of anxiety and depression, multivariate logistic regression was applied. RESULTS: There were responses from 237 professionals (83.8% women; mean age 43.7 years; 43.2% physicians). Almost 60% worked with COVID-19 patients. The availability of personal protective equipment in March versus June 2020 increased (17.7% vs 55.3%). There was a risk management plan in 86% of the workplaces. A high workload (90%) and time pressure (74.6%) were identified. Physicians and nurses had a higher prevalence of depression associated with workload and fatigue (p < 0.001). Protective anxiety factors were having space to talk about problems, support in face of these problems and having a place to relax in the health unit. A lower risk of depression was found in the administrative staff group, in those who felt supported, and in those who actively participated in the contingency plans. CONCLUSION: The COVID-19 pandemic led to considerable changes in the dynamics of primary health care. The time pressure to carry out tasks and the level of concentration required were associated with a higher risk of mental disease. The support felt by healthcare professionals regarding their problems and concerns and the existence of places to relax in the health units were identified as protective factors. Health promotion, the maintenance of the social contacts of healthcare professionals and their involvement in the processes should be taken into account in the organizational dynamics of the institutions.

Introdução: A pandemia de COVID-19 forçou a reorganização dos serviços dos cuidados de saúde primários. Com este estudo pretendemos descrever como responderam os serviços de saúde às solicitações organizacionais, como envolveram e apoiaram os seus colaboradores; como os profissionais percecionaram o seu envolvimento nos procedimentos e que apoio lhes foi fornecido. Pretendemos também avaliar os níveis de ansiedade e depressão dos profissionais e a sua associação não só com o apoio sentido pelos profissionais, mas também com a disponibilidade de equipamentos de proteção individual e com o seu envolvimento nas tarefas relacionadas com a pandemia.Material e Métodos: Estudo transversal analítico dirigido aos profissionais de três agrupamentos de centros de saúde usando um questionário online. Colhemos dados sociodemográficos, informação sobre o acesso a equipamento de proteção individual, apoio percecionado, carga de trabalho e níveis de ansiedade e depressão. Entre cada variável e os níveis de ansiedade e depressão aplicou-se regressão logística multivariada.Resultados: Responderam 237 profissionais (83,8% mulheres; idade média 43,7 anos; 43,2% de médicos). Quase 60% trabalhou com doentes COVID-19. A disponibilidade de equipamento de proteção individual em março versus junho de 2020 aumentou (17,7% vs 55,3%). Existia plano de gestão do risco em 86% dos locais. Identificou-se uma alta carga de trabalho (90%) e pressão do tempo (74,6%). Médicos e enfermeiros apresentavam maior prevalência de depressão associada à carga de trabalho e fadiga (p < 0,001). Ter espaço para falar dos problemas, apoio sentido perante esses problemas e dispor na unidade de saúde de um espaço para relaxar foram alguns fatores protetores de ansiedade. Foi encontrado menor riso de depressão no grupo do secretariado clínico, nos profissionais que se sentiram apoiados, e nos que tiveram participação ativa nos planos de contingência.Conclusão: A pandemia de COVID-19 levou a grandes alterações na dinâmica dos CSP. A pressão do tempo para realização de tarefas e a concentração exigida associaram-se a maior risco de desenvolvimento de patologia mental. O apoio sentido pelos profissionais perante os seus problemas e preocupações, e a existência de espaços para relaxar nas USF foram identificados como fatores protetores. A promoção da saúde, a manutenção dos contactos sociais dos profissionais e o seu envolvimento nos processos deverão ser tidos em conta na dinâmica organizacional das instituições.

Reinfection with SARS-CoV-2: An inconvenient truth?

Data show that antibody-related immunity against SARS-CoV-2 may not be long-lasting. We report two cases regarded as cured from COVID-19, which presented again with symptoms and a positive SARS-CoV-2 RT-PCR test. Case one, a 60-year-old male, had a biphasic presentation of symptoms compatible with COVID-19 infection, associated with a positive RT-PCR test. Case two, a 25-year-old female, had a first positive RT-PCR test during hospital screening, and months later a symptomatic presentation of COVID-19, associated with a positive RT-PCR test. All cases were immunocompetent. Anti-IgG-SARS-CoV-2 blood samples were negative in both. Elevation of analytical inflammatory markers suggested new infection in both cases. COVID-19 reinfection may be a differential diagnosis and primary care physicians should acknowledge it. Previously cured patients should be encouraged to comply with health public preventive measures.

Bacterial Nosocomial Infections: Multidrug Resistance as a Trigger for the Development of Novel Antimicrobials.

Nosocomial bacterial infections are associated with high morbidity and mortality, posing a huge burden to healthcare systems worldwide. The ongoing COVID-19 pandemic, with the raised hospitalization of patients and the increased use of antimicrobial agents, boosted the emergence of difficult-to-treat multidrug-resistant (MDR) bacteria in hospital settings. Therefore, current available antibiotic treatments often have limited or no efficacy against nosocomial bacterial infections, and novel therapeutic approaches need to be considered. In this review, we analyze current antibacterial alternatives under investigation, focusing on metal-based complexes, antimicrobial peptides, and antisense antimicrobial therapeutics. The association of new compounds with older, commercially available antibiotics and the repurposing of existing drugs are also revised in this work.