Experiences of family and community care physicians and nurse residents in Madrid regarding their training during the COVID-19 pandemic: A Photovoice study (preprint)

Background: The COVID-19 pandemic brought about sudden changes in healthcare demands, necessitating additional healthcare professionals and altering the educational landscape for medical and nursing residents. This study aimed to explore the experiences and impact of the pandemic on the training of family and community medicine as well as family and community nursing residents. Method: A participatory qualitative study was conducted using the Photovoice methodology. Seven residents in family and community medicine and nursing in the Madrid region were purposively sampled. Participants took photographs and engaged in weekly sessions over five weeks to discuss and analyse their photos, which were grouped into themes and further categorized. Recommendations for institutions and program leaders were developed using an adapted logical framework approach. Results: The average age was 27 years, with 86% being female. Participants captured 96 photographs categorized into five themes (physical and emotional impact;  impact on primary care system;  hospital care ; social and environmental impact ; and impact on training). Through critical discussions on impact on training-related photos, seven emergent themes were identified: 1) COVID-19 monograph, buried knowledge;  2) Changing roles ; 3) Transition from face-to-face to online delivery format ; 4) Supervision; 5) Tutor as educator and caregiver ; 6) Advocacy ;  7) Family and nursing residents as agents of change. Subsequently, participants formulated seven recommendations that should be considered in similar situations. Conclusion: The COVID-19 pandemic has posed significant challenges in implementing medical education programs. It has had both formative and professional impacts on medical and nursing residents. These findings can aid in designing coping and educational strategies to navigate exceptional situations such as the one experienced during the pandemic.

Evolution of physical function, cognition, depressive mood, and quality of life during the Covid-19 pandemic in prefrail elderly people: A longitudinal cohort study (Covid-Mefap).

Confinement due to the COVID-19 pandemic has had a major impact on the living habits and health of the population, notably in the pre-frail elderly. This study aimed to study the effect of the COVID-19 pandemic on the physical function, mental function (cognition and mood), and quality of life of pre-frail elderly individuals over 70 years of age following confinement as well as to analyze the variables associated with the observed changes. METHODS: Observational study of a cohort of pre-frail community-dwelling older adults over 70 years of age during the COVID-19 pandemic conducted in primary care. VARIABLES: The main outcome variables were recorded during face-to-face interviews between December 14 of 2020 and August 12 of 2021 using scales for the evaluation of physical function (Short Physical Performance Battery), cognition (Lobo's Mini-Examen Cognoscitivo), depressive mood (Geriatric Depression Scale), and quality of life (EuroQol-5D-3L). Covariates: sociodemographic data and variables related to the pandemic and general health (social support network, COVID-19 infection, exercising, and leisure activities) were also collected. ANALYSIS: The Student's t-test for paired samples and multivariate linear regression models were employed for the statistical analyses. RESULTS: Ninety-two subjects were included in the study. Physical function, cognition, and depressive mood improved during the pandemic, whereas no changes were observed in quality of life. Suffering from COVID-19 was associated with deterioration of the cognitive function (-1.460; CI95%: -2.710 to -0.211). CONCLUSION: Confinement due to the COVID-19 pandemic was not associated with a decline in physical function, cognition, depressive mood, or quality of life in pre-frail individuals over 70 years of age.

Psychological impact of the COVID-19 pandemic on primary care workers: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has had a major impact on the mental health of healthcare workers, yet studies in primary care workers are scarce. AIM: To investigate the prevalence of and associated factors for psychological distress in primary care workers during the first COVID-19 outbreak. DESIGN AND SETTING: This was a multicentre, cross-sectional, web-based survey conducted in primary healthcare workers in Spain, between May and September 2020. METHOD: Healthcare workers were invited to complete a survey to evaluate sociodemographic and work-related characteristics, COVID-19 infection status, exposure to patients with COVID-19, and resilience (using the Connor-Davidson Resilience Scale), in addition to being screened for common mental disorders (depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder). Positive screening for any of these disorders was analysed globally using the term 'any current mental disorder'. RESULTS: A total of 2928 primary care professionals participated in the survey. Of them, 43.7% (95% confidence interval [CI] = 41.9 to 45.4) tested positive for a current mental disorder. Female sex (odds ratio [OR] 1.61, 95% CI = 1.25 to 2.06), having previous mental disorders (OR 2.58, 95% CI = 2.15 to 3.10), greater occupational exposure to patients with COVID-19 (OR 2.63, 95% CI = 1.98 to 3.51), having children or dependents (OR 1.35, 95% CI = 1.04 to 1.76 and OR 1.59, 95% CI = 1.20 to 2.11, respectively), or having an administrative job (OR 2.24, 95% CI = 1.66 to 3.03) were associated with a higher risk of any current mental disorder. Personal resilience was shown to be a protective factor. CONCLUSION: Almost half of primary care workers showed significant psychological distress. Strategies to support the mental health of primary care workers are necessary, including designing psychological support and resilience-building interventions based on risk factors identified.

[What have we missed because of COVID-19? Missed diagnoses and delayed follow-ups. SESPAS Report 2022]. / ¿Qué hemos dejado de atender por la COVID-19? Diagnósticos perdidos y seguimientos demorados. Informe SESPAS 2022.

The COVID-19 pandemic and the associated public health emergency have affected patients and health services in non-COVID-19 pathologies. Several studies have shown its dissociation from health services, with a decrease in emergency department visits, in hospital admissions for non-COVID-19 pathologies, as well as in the reported weekly incidence of acute illnesses and new diagnoses in primary care. In parallel, the pandemic has had direct and indirect effects on people with chronic diseases; the difficulties in accessing health services, the interruption of care, the saturation of the system itself and its reorientation towards non-face-to-face formats has reduced the capacity to prevent or control chronic diseases. All this has also had an impact on the different areas of people's lives, creating new social and economic difficulties, or aggravating those that existed before the pandemic. All these circumstances have changed with each epidemic wave. We present a review of the most relevant studies that have been analyzing this problem and incorporate as a case study the results of a retrospective observational study carried out in Primary Care in the Madrid Health Service, which provides health coverage to a population of more than 6 million people, and whose objective was to analyze the loss of new diagnoses in the most prevalent pathologies such as common mental health problems, cardiovascular and cerebrovascular diseases, type 2 diabetes, chronic obstructive pulmonary disease, and breast and colon tumors, in the first and second waves. Annual incidence rates with their confidence interval were calculated for each pathology and the monthly frequency of new codes recorded between 1/01/2020 and 12/31/2020 was compared with the monthly mean of observed counts for the same months between 2016 and 2019. The annual incidence rate for all processes studied decreased in 2020 except for anxiety disorders. Regarding the recovery of lost diagnoses, heart failure is the only diagnosis showing an above-average recovery after the first wave. To return to pre-pandemic levels of diagnosis and follow-up of non-COVID-19 pathology, the healthcare system must reorganize and contemplate specific actions for the groups at highest risk.