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2.
Front Public Health ; 9: 810014, 2021.
Article in English | MEDLINE | ID: covidwho-1607214

ABSTRACT

Background: Workplace violence is a social problem of special interest in both intervention and research. Among the sectors that most perceive this type of violence, health care professionals stand out. The most common type of violence for this professional group is the one perpetrated by the users or patients themselves. It has been reported that one out of every four acts of violence in the workplace occurs in the healthcare setting. Within the health sector, the Mental Health, Emergency and Primary Care services have been widely reported as being among the most vulnerable, with Primary Care being the least addressed of the three. Although the available literature is extensive, there are hardly any studies that explore from a qualitative perspective what are the sources of conflict in this sector from the perspective of the users, the most common being to work with professionals. Objective: The aim of this study is to examine those aspects derived from the organization, the professionals or the users of Primary Care that, from the users' point of view, cause violent situations and how they think these could be avoided. Method: The sample consisted of 80 users of the Primary Care services of the Health Service of Murcia. For data collection, a qualitative study was conducted through 10 focus groups and a subsequent thematic analysis of the data. Results: The results have allowed us to identify that, from an organizational point of view, the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, or the management of emergencies in Primary Care are the aspects that cause most conflicts between users and professionals. In this sense, suggested improvements are aimed at providing information in the mobile application updated on the opening hours or maintaining the telephone appointment for those who need or request it, among many others. As for the professionals, users point out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users. Another professional group widely addressed in the focus groups was the administrative staff, being described as lacking in communication skills, assertiveness, or empathy. Users recognize the existence of a demanding/aggressive profile among users, who makes instrumental use of violence to achieve privileges over users in general. We have also identified the profile of the user who makes use of Primary Care as a way of socializing or managing conflicts of a socioemotional nature. As proposals for this thematic block, users suggest group therapies, the use of audiovisual material complementary to the information provided by professionals or community interventions in psychoeducation. Conclusion: This study allows to explore conflicts between users and professionals from the Primary Care patients' perspective. Our results are complementary to the available evidence that has used the professional's approach to study the phenomenon of workplace violence. The identification of sources of conflict and the assessment and contribution of users on possible ways of improvement can serve as a basis for the design of prevention and intervention plans to improve the work environment in Primary Care centers.


Subject(s)
COVID-19 , Humans , Perception , Primary Health Care , SARS-CoV-2 , Violence
3.
BMJ ; 375: n3080, 2021 12 29.
Article in English | MEDLINE | ID: covidwho-1594915
4.
Med Pr ; 72(5): 591-604, 2021 Nov 19.
Article in Polish | MEDLINE | ID: covidwho-1599922

ABSTRACT

Following the outbreak of the COVID-19 pandemic, the objectives of the health care system had to be adapted to the changing circumstances, in order to meet the health needs of patients, but also the expectations of medical workers related to ensuring safe working conditions in the crisis situation. The activities of medical staff are greatly affected by organizational and financial changes in health care systems, which affect both the health care systems all over the world and the functioning of all forms of health care. The article examines the organizational and financial changes resulting from the introduction of regulations affecting the conditions of primary health care (PHC) workers in Poland from the beginning of the COVID-19 pandemic to May 8, 2021. The findings regarding measures taken to ensure the stability of PHC functioning during the pandemic highlight that the public health emergency exposed a significant need to introduce organizational and financial changes in PHC. The changes arising from legislation and good practices of medical, organizational and financial character resulted in health care system modernizations in Poland. It is worth stressing, however, that there is a great need to maintain coherence when implementing organizational and financial changes affecting the fluidity and effectiveness of the actions taken by PHC personnel, and thus their working conditions, when implementing future responses to public health emergencies. Such changes should be based on an analysis of the solutions introduced since the beginning of the pandemic in Poland: these include organizational changes such as housing conditions, organization of work and workplaces, flow of information and way of supplying the patient, and financial changes involving mobilization of additional financial resources. The article presents a list of future research questions that merit consideration when setting problems and priorities: these can be used to guide the introduction of permanent modifications to the functioning of PHC in Poland and to facilitate possible future adaptation in times of emergency. Med Pr. 2021;72(5):591-604.


Subject(s)
COVID-19 , Pandemics , Health Personnel , Humans , Pandemics/prevention & control , Primary Health Care , SARS-CoV-2
5.
J Prim Care Community Health ; 12: 21501327211014093, 2021.
Article in English | MEDLINE | ID: covidwho-1593984

ABSTRACT

The COVID-19 pandemic is unprecedented in recent history as radically and forcefully changing healthcare delivery. Practice facilitators, who often use tools of improvement science, have long played a critical role in supporting routine primary care practice transformation when healthcare system and policy changes occur. However, current events have taken many healthcare systems to the brink of collapse. Our practice facilitation team, which has a long history of sustained primary care partnerships in rural under-resourced settings, is finding creative solutions to carry forward work in research and quality improvement, and the tools of improvement science are well-suited to address rapidly changing demands of primary care during such a crisis. We reflect here on practice facilitation through the pandemic-the value of applied improvement science, and the critical necessity of strong relationships, flexibility, and creativity to support ongoing primary care partnerships.


Subject(s)
COVID-19 , Pandemics , Delivery of Health Care , Humans , Pandemics/prevention & control , Primary Health Care , SARS-CoV-2
8.
Int J Environ Res Public Health ; 18(24)2021 12 09.
Article in English | MEDLINE | ID: covidwho-1598579

ABSTRACT

Common mental health disorders (CMDs) represent a major public health concern and are particularly prevalent in people experiencing disadvantage or marginalisation. Primary care is the first point of contact for people with CMDs. Pharmaceutical interventions, such as antidepressants, are commonly used in the treatment of CMDs; however, there is concern that these treatments are over-prescribed and ineffective for treating mental distress related to social conditions. Non-pharmaceutical primary care interventions, such as psychological therapies and "social prescribing", provide alternatives for CMDs. Little is known, however, about which such interventions reduce social inequalities in CMD-related outcomes, and which may, unintentionally, increase them. The aim of this protocol (PROSPERO registration number CRD42021281166) is to describe how we will undertake a systematic review to assess the effects of non-pharmaceutical primary care interventions on CMD-related outcomes and social inequalities. A systematic review of quantitative, qualitative and mixed-methods primary studies will be undertaken and reported according to the PRISMA-Equity guidance. The following databases will be searched: Assia, CINAHL, Embase, Medline, PsycInfo and Scopus. Retrieved records will be screened according to pre-defined eligibility criteria and synthesised using a narrative approach, with meta-analysis if feasible. The findings of this review will guide efforts to commission more equitable mental health services.


Subject(s)
Mental Disorders , Mental Health , Humans , Mental Disorders/epidemiology , Mental Disorders/therapy , Meta-Analysis as Topic , Primary Health Care , Qualitative Research , Socioeconomic Factors , Systematic Reviews as Topic
9.
JMIR Mhealth Uhealth ; 9(12): e28285, 2021 12 21.
Article in English | MEDLINE | ID: covidwho-1596951

ABSTRACT

BACKGROUND: The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health remote monitoring systems (HRMS) present various advantages such as the reduction in patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, older adults, and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection. OBJECTIVE: This paper aimed to perform a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the digitalization of health processes, remote data acquisition, and interactions between health care personnel and patients. METHODS: A systematic literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify articles that explored interventions with HRMS in patients with chronic diseases in the PHC setting. RESULTS: The literature review yielded 123 publications, 18 of which met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (9/26, 35%) and cardiovascular diseases (7/26, 27%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of information into already existing systems in the PHC infrastructure and in changing working processes of PHC professionals (83%). CONCLUSIONS: The PHC context integrates multidisciplinary teams and patients with often complex, chronic pathologies. Despite the theoretical framework, objective identification of problems, and involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale up. Despite the inherent limitations of conducting a systematic literature review, the small number of studies in the PHC context is a relevant limitation. This study aimed to demonstrate the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way.


Subject(s)
COVID-19 , Pandemics , Aged , Chronic Disease , Humans , Primary Health Care , SARS-CoV-2
12.
J Am Board Fam Med ; 34(6): 1189-1202, 2021.
Article in English | MEDLINE | ID: covidwho-1581435

ABSTRACT

BACKGROUND: Primary care is crucial to the health of individuals and communities, but it faces numerous structural and systemic challenges. Our study assessed the state of primary care in Virginia to prepare for Medicaid expansion. It also provides insight into the frontline of health care prior to an unprecedented global COVID-19 pandemic. METHODS: We surveyed 1622 primary care practices to understand organizational characteristics, scope of care, capacity, and organizational stress. RESULTS: Practices (484) varied in type, ownership, location, and care for medically underserved and diverse patient populations. Most practices accepted uninsured and Medicaid patients. Practices reported a broad scope of care, including offering behavioral health and medication-assisted therapy for opioid addiction. Over half addressed social needs like transportation and unstable housing. One in three practices experienced a significant stress in 2019, prepandemic, and only 18.8% of practices anticipated a stress in 2020. CONCLUSIONS: Primary care serves as the foundation of our health care system and is an essential service, but it is severely stressed, under-resourced, and overburdened in the best of times. Primary care needs strategic workforce planning, adequate access to resources, and financial investment to sustain its value and innovation.


Subject(s)
COVID-19 , Pandemics , Health Services Accessibility , Humans , Medicaid , Primary Health Care , SARS-CoV-2 , United States , Virginia
13.
Aten Primaria ; 53 Suppl 1: 102199, 2021 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1588293

ABSTRACT

This narrative review manuscript aims to raise the difficulties and opportunities for patient safety in specialised healthcare training considering undergraduate, postgraduate, specialist and continuing education, even during the COVID-19 pandemic. It also suggests some proposals for carrying it out. It very briefly discusses this specific training and its current situation in primary care. Highlighting that patient safety is a need, an area of competence and a training opportunity for residents. It establishes the general framework of patient safety in primary care in the document "7 steps for Patient Safety in Primary Care", stating the need for a systemic approach. It highlights the elaboration and presentation of cases on clinical errors as the most frequent training strategy. The real-life clinical scenarios relate to difficult patients, critical incidents and bioethics issues in professional practice. These scenarios have as common characteristics, the fact to produce difficulties and suffering for all the actors involved. Several instruments for training in patient safety are also included. The medium-term goal is to consolidate clinical safety in specialised healthcare training. Finally, an analysis is made of the impact of the pandemic on patient safety training, particularly on specialised healthcare training and some proposals are recommended on how to carry out safe teaching in the times of the COVID-19 pandemic.


Subject(s)
COVID-19 , Patient Safety , Humans , Pandemics , Primary Health Care , SARS-CoV-2
14.
Aten Primaria ; 53 Suppl 1: 102216, 2021 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1588292

ABSTRACT

The greatest asset of any health system is its professionals, and they must be cared for in order to take care. It is necessary to emphasize that they are key for the resilience of our health systems. This is particularly important in crisis times and especially important for primary health care.During the COVID-19 pandemic, working conditions have been the main common latent factor for patient safety incidents. Primary Care professionals have worked in unsafe working conditions, with lack of means of protection, great uncertainty, lack of scientific knowledge and rapidly changing work protocols for dealing with cases and contacts of COVID-19 infection, with a high care pressure, long working hours, suspension of vacations, and even changes in their jobs. All of this has contributed to their becoming, not only the first victims of the pandemic, but also the second victims of the adverse events that occurred during it.Therefore, in this article we analyze the main risks and damages suffered by professionals in Primary Care and provide keys to contribute to their protection in future similar situations.


Subject(s)
COVID-19 , Patient Safety , Humans , Pandemics , Primary Health Care , SARS-CoV-2
15.
Aten Primaria ; 53 Suppl 1: 102217, 2021 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1588291

ABSTRACT

OBJECTIVE: To analyse and compare the epidemiology of patient safety incidents reported in Primary Health Care, before and after the start of the COVID-19 pandemic. DESIGN AND SETTING: Analytical descriptive study comparing reported incidents from March 1st 2019 to February 28th 2020, and from March 1st 2020 to February 28th 2021, notified through the TPSC Cloud™ platform accessible from the Intranet corporative in 25 Primary Health Care centres from Tarragona district, in Catalonia (Spain). MEASUREMENTS: Data obtained from voluntary notifications, through electronic, standardized and anonymized forms. VARIABLES: Centre, professional, incident type, risk matrix, causal factors and contributing factors, and avoidability. STATISTICAL ANALYSIS: Every notification was included in descriptive analysis, and another one specifically for adverse events, comparing both periods. RESULTS: 2231 incidents were reported. Comparing both periods, during the pandemic a reduction in the number of reported incidents was observed (only represented 20% of the total). However, the percentage of reported notifications from health care professionals and adverse events that required observation were increased. Causal factors related to attendance and diagnosis were incremented whereas the causal factors related to medication were decreased. In addition, an increase in contributing factors related to the professional was observed. Avoidability was high (>95%) in both periods. CONCLUSIONS: During the pandemic, fewer patient safety incidents have been reported, but proportionally more adverse events, most of which are preventable. The professional himself becomes the main contributing factor.


Subject(s)
COVID-19 , Patient Safety , Humans , Pandemics , Primary Health Care , Risk Management , SARS-CoV-2
16.
Aten Primaria ; 53 Suppl 1: 102222, 2021 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1588290

ABSTRACT

OBJECTIVE: To evaluate the impact of the changes introduced in response to the pandemic on patient-reported patient safety in Primary Care. DESIGN: Prospective observational panel study (health center) based on two cross-sectional surveys. SETTING: 29 Primary Health Care centers from three Spanish health regions (Mallorca, Catalunya Central and Camp de Tarragona). PARTICIPANTS: Random sample of patients visiting their centers before (n=2199 patients) and during the pandemic (n=1955 patients) MAIN MEASUREMENTS: We used the PREOS-PC questionnaire, a validated instrument which assesses patient-reported patient safety in Primary Care. We compared mean scores of the "experiences of errors" and "harm" scales in both periods, and built multilevel regression analyzes to study the variations in patient and center characteristics associated with worse levels of safety. A qualitative (content) analysis of patients' experiences during the pandemic was also performed. RESULTS: The "experiences of errors" and "harm" scales scores significantly worsened during the COVID-19 period (92.65 to 88.81 (Cohen's d=0.27); and 96.92 to 79.97 (d=0.70), respectively). Patient and center characteristics associated to worsened scores were: women, people with a lower educational level, worse health status, more years assigned to the center, and health region. CONCLUSIONS: During the pandemic, a perceptible worsening in patient safety perceived by patients treated in Primary Care has been observed, which has differentially affected patients according to their sociodemographic characteristics or health center profiles.


Subject(s)
COVID-19 , Pandemics , Cross-Sectional Studies , Female , Humans , Patient Reported Outcome Measures , Patient Safety , Primary Health Care , Retrospective Studies , SARS-CoV-2
17.
Aten Primaria ; 53 Suppl 1: 102223, 2021 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1588289

ABSTRACT

The third Global Patient Safety Challenge, Medication Without Harm, was launched in 2017 by the World Health Organization with the goal of reducing the already well-known severe preventable medication-related harm by 50% over the next 5 years. Nothing suggested that, two years later, the world would suffer a terrible pandemic, which has been a much greater challenge than the aforementioned one and that would put it to test from the first stages of the medication use process. The rapid pace imposed by the pandemic has created new risks in the use of medication in those affected by COVID-19 and in the population due to organizational changes in the provision of health care in health services. Therefore, prudent prescribing is becoming more important than ever in health systems. This article aims to analyze the main risks produced during the pandemic period and offer Primary Care professionals an update and a reminder of the main aspects related to the safety use of medications.


Subject(s)
COVID-19 , Humans , Pandemics , Patient Safety , Primary Health Care , SARS-CoV-2
18.
Aten Primaria ; 53 Suppl 1: 102226, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1588288

ABSTRACT

Primary care is an essential foundation for the global response to COVID-19 pandemic. It plays a significant role in the health care response: identifying and triaging potential COVID-19 cases, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, strengthening compliance with prevention and protection measures, and reducing the demand for hospital services. Primary care teams have continued to address citizens' health problems during the pandemic, adapting to strict social control measures imposed by governments such as closing of borders, lockdowns and self-isolation of cases and contacts. We describe the COVID-19 response from primary care in Hong Kong and China, based on their recent pandemic experiences. We also present that of a European country, United Kingdom, less experienced in pandemic management, but with universal and highly developed primary care with great social recognition. Finally, we point out some crucial learning for future pandemic management, highlighting the crucial need to improve the relationship between primary care and public health to improve pandemics response.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Humans , Pandemics/prevention & control , Primary Health Care , SARS-CoV-2
20.
J Prim Health Care ; 13(4): 340-350, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1585643

ABSTRACT

INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy. AIM The purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy. METHODS Semi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants' perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach. RESULTS Four themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs). DISCUSSION Both general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners.


Subject(s)
COVID-19 , Community Pharmacy Services , Electronic Prescribing , Attitude of Health Personnel , Communicable Disease Control , Humans , Pharmacists , Primary Health Care , Professional Role , Qualitative Research , SARS-CoV-2
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