Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection.

Problem: The two waves of COVID-19 severely affected the healthcare system in India. The government responded to the first wave with a strict nationwide lockdown which disrupted primary care, including the management of non-communicable diseases (NCDs). The second wave overwhelmed healthcare facilities leading to inadequate access to hospital services. Collectively, these issues required urgent responses, including the adaptation of primary care. Approach: The Low-Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore (CMC) has a network of community volunteers, community health workers, an outreach nurse, social workers and doctors who operate clinics in six poorer areas of Vellore. The network adapted quickly, responding to the lockdown during the first wave and ensuring ongoing primary care for patients with non-communicable diseases. During the second wave, the team developed a system in collaboration with other CMC departments to provide home-based care for patients with COVID-19. Local setting: The LCECU is a 48-bed unit of the Department of Family Medicine, part of the 3,000-bed CMC. It originated in 1982, aiming to care for the poor populations of Vellore town. It has been actively working among urban communities since 2002, with a focus on delivering Community Oriented Primary Care (COPC), for six poor urban communities since 2016. Relevant changes: During the first wave of COVID the LCECU team ensured patients with NCDs had uninterrupted primary care and medications by visiting them in their homes. The team also addressed food insecurity by organizing a daily lunch service for 600 people for over 2 months. In the second wave, the team responded to community needs by organizing and delivering home-based care to monitor patients affected by COVID-19. Lessons learned: The COVID-19 pandemic raises many questions about the preparedness of health systems for disasters that disproportionately affect marginalized populations globally. COVID-19 is only one of the many potential disasters, including non-communicable diseases, mental health problems, pollution, climate change, and lifestyle illness. There is an urgent need to study models of care that support vulnerable communities in an accessible, cost-effective, and patient-oriented way, particularly in low- and middle-income countries. This paper outlines lessons on how the LCECU team addressed disaster management:1. The COVID-19 pandemic has highlighted the importance of primary care-based rapid response interventions in disaster management.2. The LCECU model demonstrated the effectiveness of a primary care intervention based on pre-existing networks and familiarity between primary care teams and the community.3. Establishing community-based health care via interdisciplinary teams, including community health workers, community volunteers, outreach nurses, and doctors, is key.4. Addressing other social determinants of health, such as food insecurity, is an important component of care delivery.

Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection

Problem The two waves of COVID-19 severely affected the healthcare system in India. The government responded to the first wave with a strict nationwide lockdown which disrupted primary care, including the management of non-communicable diseases (NCDs). The second wave overwhelmed healthcare facilities leading to inadequate access to hospital services. Collectively, these issues required urgent responses, including the adaptation of primary care. Approach The Low-Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore (CMC) has a network of community volunteers, community health workers, an outreach nurse, social workers and doctors who operate clinics in six poorer areas of Vellore. The network adapted quickly, responding to the lockdown during the first wave and ensuring ongoing primary care for patients with non-communicable diseases. During the second wave, the team developed a system in collaboration with other CMC departments to provide home-based care for patients with COVID-19. Local setting The LCECU is a 48-bed unit of the Department of Family Medicine, part of the 3,000-bed CMC. It originated in 1982, aiming to care for the poor populations of Vellore town. It has been actively working among urban communities since 2002, with a focus on delivering Community Oriented Primary Care (COPC), for six poor urban communities since 2016. Relevant changes During the first wave of COVID the LCECU team ensured patients with NCDs had uninterrupted primary care and medications by visiting them in their homes. The team also addressed food insecurity by organizing a daily lunch service for 600 people for over 2 months. In the second wave, the team responded to community needs by organizing and delivering home-based care to monitor patients affected by COVID-19. Lessons learned The COVID-19 pandemic raises many questions about the preparedness of health systems for disasters that disproportionately affect marginalized populations globally. COVID-19 is only one of the many potential disasters, including non-communicable diseases, mental health problems, pollution, climate change, and lifestyle illness. There is an urgent need to study models of care that support vulnerable communities in an accessible, cost-effective, and patient-oriented way, particularly in low- and middle-income countries. This paper outlines lessons on how the LCECU team addressed disaster management: 1. The COVID-19 pandemic has highlighted the importance of primary care-based rapid response interventions in disaster management. 2. The LCECU model demonstrated the effectiveness of a primary care intervention based on pre-existing networks and familiarity between primary care teams and the community. 3. Establishing community-based health care via interdisciplinary teams, including community health workers, community volunteers, outreach nurses, and doctors, is key. 4. Addressing other social determinants of health, such as food insecurity, is an important component of care delivery.

COVID-19 Vaccine Attitudes and Barriers among Unvaccinated Residents in Rural Northern/Central Illinois.

Background: Rural communities have lower COVID-19 vaccine uptake and poorer health outcomes compared to non-rural communities, including in rural, northern/central Illinois. Understanding community perceptions about vaccination is critical for developing targeted responses to improve vaccine uptake in rural communities and meet global vaccination targets. Purpose: This study examines COVID-19 vaccine attitudes and barriers as well as the impact of COVID-19 on specific health behaviors of residents in rural northern/central Illinois to inform efforts to increase vaccine uptake. Methods: In collaboration with community partners and local health departments, we conducted a 54-item, English-language, online questionnaire from Feb 11 to March 22, 2021; the questionnaire included the COVID behavioral questionnaire scale (CoBQ), as well as questions on intention to vaccinate, vaccination attitudes, and barriers to vaccine access. Descriptive and bivariate analyses assessed participant differences based on intention to vaccinate. Results: Most unvaccinated survey respondents (n = 121) were White (89.3%) and female (78.5%), with an average age of 52.3±14.1 years. Lack of intention to vaccinate was negatively associated with trust in the science behind vaccine development (P = .040), belief in the safety of the vaccine (P = .005) and belief that the vaccine was needed (P=.050). CoBQ scores of respondents who intended to get vaccinated differed significantly from those who did not (P<.001), showing a greater negative impact of COVID-19 on engaging in health behaviors for vaccine-hesitant participants. Conclusion: Study findings show mistrust of science and lack of confidence in vaccine safety are barriers to vaccination in rural northern Illinois residents. Similar results have been reported in low- and middle-income countries.

COVID-19 behavioral questionnaire (CoBQ): Comparing the pandemic's impact on health behavior in three US states.

Background: The COVID-19 pandemic impacted daily routines for a majority of the population, with implications for their health behaviors. Racial and ethnic minorities have been disproportionately impacted by COVID-19. The novel COVID-19 Behavioral Questionnaire (CoBQ) was developed in Fall 2020 to provide a means to measure the impact of the COVID-19 pandemic on the United States population. The study utilized behavioral domains to determine which demographic groups reported that they were made the most vulnerable during Fall-Winter 2020-2021 of the pandemic. Objectives: The study aimed to further validate and test the CoBQ in varied US regions and compare the scores obtained from three states, California, Ohio, and Illinois. Methods: A prospective, multi-site survey-based study was designed to further validate and test the 17-item CoBQ in varied populations. Respondents included patients on routine visits at each pharmacy or clinical site who agreed to complete the survey online via Qualtrics. Data analyses included descriptive statistics, psychometric testing, and comparison of groups using Analysis of Variance. Results: Completed surveys (n = 507) between October 2021 and March 2021 were analyzed. Respondents were mostly female, white, and had some college education. The CoBQ showed improved reliability compared with previous testing and strong construct validity through factor analysis. Overall scores were similar between three states. The most impacted groups included those who reported within the 18-49 age group, a yearly household income <$50 000, or education up to high school. Conclusions: The CoBQ is the first validated tool to measure the negative impact of the COVID-19 pandemic on health behaviors. Results could serve as a baseline to address the most vulnerable patient groups and support identified behavioral needs during a similar pandemic situation.