Prevention and screening during the COVID-19 pandemic: qualitative findings from the BETTER WISE project.

BACKGROUND: The COVID-19 pandemic challenged healthcare systems worldwide and disrupted primary care, particularly prevention, screening, and lifestyle counselling. BETTER WISE is a comprehensive and structured approach that proactively addresses cancer and chronic disease prevention and screening (CCDPS), including cancer survivorship and screening for poverty and lifestyle risks for patients aged 40 to 65. Patients from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada were invited for a 1-hour visit with a prevention practitioner (PP), a member of the primary care team with specialized training in CCDPS to provide patients an overview of eligible screening and assist with lifestyle counselling. This qualitative sub-study describes how the COVID-19 pandemic impacted BETTER WISE in a constantly changing medical landscape. METHODS: We conducted 17 focus groups and 48 key informant interviews with a total of 132 primary care providers (PPs, physicians, allied health professionals, and clinic staff) over three different time points to better understand their perspectives on the BETTER WISE project. We also received 585 patient feedback forms of the 1005 patients who agreed to participate in the study. We also collected field notes and memos and employed thematic analysis using a constant comparative method focused on the impact of the pandemic on BETTER WISE. RESULTS: We identified four themes related to how the COVID-19 pandemic impacted the BETTER WISE study: 1) Switch of in-person visits to visits over the phone; 2) Lack of access to preventive care and delays of screening tests; 3) Changes in primary care providers' availability and priorities; 4) Mental health impacts of the pandemic on patients and primary care providers. CONCLUSIONS: The COVID-19 pandemic had and, at the time of writing, continues to have an impact on primary care, particularly on prevention, screening, and lifestyle counselling. Despite structural, procedural, and personal challenges throughout different waves of the pandemic, the primary care clinics participating in BETTER WISE were able to complete the study. Our results underscore the importance of the role of primary care providers in adapting to changing circumstances and support of patients in these challenging times. TRIAL REGISTRATION: This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).

The impact of Covid-19 pandemic on the health and lifestyle hemophilia patients in a low resourced country and its effect on their activated partial thromboplastin time (aPTT) results

Background: Haemophilia is a genetic bleeding disorder caused by the deficiency of clotting factor-VIII or factor-IX. The challenge to have access to factor VIII and IX concentrate could have been compounded by the COVID-19 pandemic and affected the health and lifestyle of haemophilia patients in an already low resourced lower-middle- income country like Ghana. Aim(s): This study was aimed at determining the effect of COVID-19 on prolonged Activated Partial Thromboplastin Time (aPTT) among haemophilia 'A' patients in the middle belt of Ghana. Method(s): We retrospectively evaluated, for 12 months before the COVID -19 pandemic and followed up on 45 haemophilia patients during the pandemic for this study. Questionnaires were administered to the study participants. Blood samples were collected before the COVID-19 pandemic. Further samples were collected in the pandemic period into citrate tubes and tested for aPTT. SPSS v21 was used for the analysis of the data and P-value < 0.05 was considered statistically significant. Result(s): We found that aPTT test result of study participants increased significantly from the pre-pandemic to the pandemic period (68.04 +/- 15.97 s to 160.80 +/- 87.90 s, p < 0.001) Also, there was a statistically significant increase between aPTT results of participants that could not visit the clinic during the pandemic to participants who visited (194.6 +/- 86.5 s to 128.4 +/- 77.9 s, p = 0.009). Finally, the comparison of aPTT of participants who were impacted by COVID-19 restrictions to that of those who did not suffer restrictions was statistically different (168.3 +/- 87.6 s to 124.3 +/- 81.2 s, p = 0.042), with those who suffered restrictions having prolonged aPTT results. Conclusion(s): We observed a very high increase in the aPTT of in the pandemic period compared to the pre-pandemic period. Patients who suffered government restrictions and could not travel to assess health centres and patients who could not visit the hospital during the pandemic had a prolonged aPTT making them susceptible to prolonged bleeding episodes. (Figure Presented).