ABSTRACT
Background: Primary health care (PHC) system is designated to be responsible for epidemic control and prevention during the outbreak of COVID-19 in China, while COVID-19 suspected cases in PHC are required to be transferred to specialist fever clinics at higher level hospitals. This study aims to understand to impact of COVID-19 on PHC delivery and antibiotic prescribing at community level in the rural areas of central China.Methods: Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and thematically analysed.Results: Practitioners’ and patients’ views and perspectives on COVID-19 impacts on PHC services and antibiotic prescribing are organised into four broad themes. PHC practitioners took on a key public health role of tracing, screening and educating in rural areas, while their original role in seeing and treating patients was reduced since government required patients to be diverted. The additional work, risk, and financial pressure that PHC practitioners faced placed considerable strain on them, particularly those working in the village clinics. PHC largely diminished that related to the difficulty of PHC workforce with limited medical training and the high number of elderly patients in rural areas, and as a result of epidemic, rural patients found it more difficult to access health care. Antibiotic prescribing practices for non-COVID-19 respiratory tract infections remained unchanged and were not seen as relevant to practitioners’ knowledge of COVID-19, although overall antibiotic treatments were reduced because fewer patients were attending rural PHC clinics. Conclusions: Our study identified the considerable impact of COVID-19 epidemic on PHC in rural China. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and prevention and public health roles and, in the case of the village clinics, remain financially viable.
Subject(s)
COVID-19ABSTRACT
Introduction Primary health care (PHC) system is designated to be responsible for epidemic control and prevention during the outbreak of COVID-19 in China, while COVID-19 suspected cases in PHC are required to be transferred to specialist fever clinics at higher level hospitals. This study aims to understand to impact of COVID-19 on PHC delivery and antibiotic prescribing at community level in the rural areas of central China. Methods Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres (THCs) and nine village clinics (VCs) in two rural residential areas of Anhui province. Interviews were transcribed verbatim and thematically analysed. Results Practitioners' and patients' views and perspectives on COVID-19 impacts on PHC services and antibiotic prescribing are organised into four broad themes: switch from PHC to epidemic prevention and control, concerns and challenges faced by those delivering PHC, diminished PHC, and COVID-19 as a different class of illness. Conclusion The COVID-19 epidemic has had a considerable impact on the roles of rural PHC clinics in China that shifted to public health from principal medical, and highlighted the difficulties in rural PHC including inadequately trained practitioners, additional work and financial pressure, particularly in VCs. Antibiotic prescribing practices for non-COVID-19 respiratory tract infections remained unchanged since the knowledge of COVID-19 was not seen as relevant to practitioners' antibiotic treatment practices, although overall rates were reduced because fewer patients were attending rural PHC clinics. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and public health roles and, in the case of the VCs, remain financially viable. Keywords COVID-19, antibiotic treatment, township health centre, village clinic, epidemic prevention and control