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1.
Fam Pract ; 38(5): 549-555, 2021 09 25.
Article in English | MEDLINE | ID: covidwho-1575306

ABSTRACT

BACKGROUND: Virtual consults have replaced in-person visits for many home-isolated patients with COVID-19 disease. OBJECTIVES: To describe the natural history, clinical management and outcomes of community-dwelling patients with COVID-19, who received support from a family medicine-led, virtual CovidCare@Home program in Toronto, Ontario, Canada. METHODS: Observational, descriptive study conducted by retrospective chart review of 98 patients enrolled during the first 5 weeks of program implementation (8 April-11 May 2020); 73 patients with laboratory-confirmed COVID-19, with symptom onset ≤ 14 days before initial consult were included for analysis. Patients were classified as mild, moderate or severe based on WHO Criteria. RESULTS: All patients in the program experienced mild (88%) or moderate (12.3%) disease. No patients were hospitalized or died. Patients were mainly female (70%); with mean age of 43.3 years. Most patients (82.2%) worked in higher risk, healthcare settings. Almost 40% had no medical co-morbidities. Common symptoms were cough (65.8%), fatigue (60.3%), headache (42.5%) and myalgia (39.7%), followed by fever (32.9%), sore throat (21.9%), nasal congestion (21.9%) and rhinorrhea (20.5%). Headache (51%) and anosmia (45.1%) were common among females; fever and breathlessness among males (40.9%). Nine patients (12.3%) experienced worsening of symptoms (mainly respiratory) or exacerbation of co-morbidities, which required care outside the virtual service. CONCLUSION: Patients with mild to moderate COVID-19 disease can be managed safely and effectively in a family medicine-led virtual program. Some sex differences in symptoms were observed. Future work should focus on long-term follow up in view of the existence of so-called 'long-haulers'.


Subject(s)
COVID-19/therapy , Home Care Services/organization & administration , Primary Health Care/organization & administration , Symptom Assessment , Telemedicine , Adult , Female , Humans , Male , Retrospective Studies , Risk Factors , SARS-CoV-2
3.
Medicine (Baltimore) ; 100(41): e27399, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1501200

ABSTRACT

ABSTRACT: The novel coronavirus disease 2019 (COVID-19) pandemic has intensified globally since its origin in Wuhan, China in December 2019. Many medical groups across the United States have experienced extraordinary clinical and financial pressures due to COVID-19 as a result of a decline in elective inpatient and outpatient surgical procedures and most nonurgent elective physician visits. The current study reports how our medical group in a metropolitan community in Kentucky rebooted our ambulatory and inpatient services following the guidance of our state's phased reopening. Particular attention focused on the transition between the initial COVID-19 surge and post-COVID-19 surge and how our medical group responded to meet community needs. Ten strategies were incorporated in our medical group, including heightened communication; ambulatory telehealth; safe and clean outpatient environment; marketing; physician, other medical provider, and staff compensation; high quality patient experience; schedule optimization; rescheduling tactics; data management; and primary care versus specialty approaches. These methods are applicable to both the current rebooting stage as well as to a potential resurgence of COVID-19 in the future.


Subject(s)
Ambulatory Care/organization & administration , Office Visits/statistics & numerical data , Telemedicine/organization & administration , Ambulatory Care/statistics & numerical data , COVID-19/epidemiology , Delivery of Health Care, Integrated/organization & administration , Humans , Kentucky/epidemiology , Pandemics , Primary Health Care/organization & administration , Quality Improvement , SARS-CoV-2
5.
Pediatrics ; 146(1)2020 07.
Article in English | MEDLINE | ID: covidwho-1456130

ABSTRACT

CONTEXT: More than 4 decades of research indicate that parenting interventions are effective at preventing and treating mental, emotional, and behavioral disorders in children and adolescents. Pediatric primary care is a viable setting for delivery of these interventions. OBJECTIVE: Previous meta-analyses have shown that behavioral interventions in primary care can improve clinical outcomes, but few reviews have been focused specifically on the implementation of parenting interventions in primary care. We aimed to fill this gap. DATA SOURCES: We reviewed 6532 unique peer-reviewed articles published in PubMed, the Cumulative Index to Nursing and Allied Health Literature, and PsycInfo. STUDY SELECTION: Articles were included if at least part of the intervention was delivered in or through primary care; parenting was targeted; and child-specific mental, emotional, and behavioral health outcomes were reported. DATA EXTRACTION: Articles were reviewed in Covidence by 2 trained coders, with a third coder arbitrating discrepancies. RESULTS: In our review of 40 studies, most studies were coded as a primary. Few researchers collected implementation outcomes, particularly those at the service delivery system level. LIMITATIONS: Including only published articles could have resulted in underrepresentation of implementation-related data. CONCLUSIONS: Parenting interventions delivered and implemented with fidelity in pediatric primary care could result in positive and equitable impacts on mental, emotional, and behavioral health outcomes for both parents and their children. Future research on the implementation strategies that can support adoption and sustained delivery of parenting interventions in primary care is needed if the field is to achieve population-level impact.


Subject(s)
Neurodevelopmental Disorders/therapy , Parenting , Parents/psychology , Primary Health Care/organization & administration , Child , Humans , Neurodevelopmental Disorders/psychology
6.
BMC Fam Pract ; 21(1): 141, 2020 07 13.
Article in English | MEDLINE | ID: covidwho-1455918

ABSTRACT

BACKGROUND: The potential value of expanding the Practice Nurse role to include the recognition and management of dementia has been acknowledged. Practice Nurses are well-positioned to provide comprehensive dementia information and support so that people living with dementia are better equipped to self-manage their health and live well with dementia. The purpose of this review was to systematically examine published literature to identify existing and potential roles of Practice Nurse's in the delivery of care to people affected by dementia and to describe the characteristics and effectiveness of nurse interventions in dementia models of care. METHODS: The PRISMA statement guided the systematic review of the quantitative and qualitative evidence for roles and characteristics of the Practice Nurse in the delivery of dementia care. A comprehensive literature search of seven electronic databases and Google scholar identified relevant original research published in English between January 2000 and January 2019. Thirteen articles met the inclusion criteria and were extracted into the Covidence software for analysis. RESULTS: The heterogeneity of the included studies purpose, design and outcomes measures and the diversity in health systems and primary care nurses scope of practice made it difficult to synthesise the findings and draw conclusions. The heterogeneity did, however, provide important insights into the characteristics of roles undertaken by nurses working in the general practice setting, which were potentially beneficial to people living with dementia and their support person. These included patient accessibility to the Practice Nurse, early recognition and management of cognitive changes, care management and collaboration with the General Practitioner. Limitations of the provision of dementia care by Practice Nurses included a lack of definition of the role, inadequate dementia specific training, time constraints and poor communication with General Practitioners. CONCLUSIONS: Embedding an evidence-based model that describes the role of the Practice Nurse in dementia care provision has the potential to increase early recognition of cognitive impairment and more appropriate primary care management of dementia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2018 CRD42018088191.


Subject(s)
Dementia , Evidence-Based Nursing/methods , Nurse's Role , Primary Health Care/organization & administration , Cognition , Dementia/diagnosis , Dementia/nursing , Dementia/psychology , Humans
7.
Medicine (Baltimore) ; 100(37): e27294, 2021 Sep 17.
Article in English | MEDLINE | ID: covidwho-1434549

ABSTRACT

ABSTRACT: This study aimed to assess the association between role conflict and ambiguity among nurses in primary healthcare centers (PHCs) in Saudi Arabia and their stress levels during the coronavirus disease 2019 (COVID-19) pandemic.In this online cross-sectional study, sociodemographic and occupational characteristics, role conflict, and ambiguity of 432 nurses were assessed using the Bowling Scale for Role Conflict and Ambiguity and stress was assessed using the 10-item Perceived Stress Scale from September 27 to October 17, 2020. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for above-median stress levels of nurses with average and high (2nd and 3rd tertiles) role conflict and ambiguity compared with nurses with low role conflict and ambiguity (1st tertile).The mean (standard deviation) age of the nurses was 36.5 ±â€Š6.6 years, and 25.9% of them were males. After adjusting for PHC type and working hours, nurses with average and high role conflict had significantly higher stress rates than those with low role conflict, with ORs (95% CIs) of 2.69 (1.62-4.46) and 6.31 (3.78-10.53), respectively. Similarly, nurses with average- and high-role ambiguity had significantly higher stress than those with low role ambiguity, with ORs (95% CIs) of 2.15 (1.30-3.55) and 7.68 (4.54-13.01), respectively. Increasing stress rates were detected across increasing categories of role conflict and ambiguity (P values for trend <.001).We found that role conflict and ambiguity were associated with stress among nurses in PHCs in Saudi Arabia during the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Nurse's Role , Occupational Stress/etiology , Adult , COVID-19/psychology , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Middle Aged , Nurses , Occupational Stress/psychology , Primary Health Care/organization & administration , Primary Health Care/statistics & numerical data , Saudi Arabia , Surveys and Questionnaires
9.
Healthc Policy ; 17(1): 73-90, 2021 08.
Article in English | MEDLINE | ID: covidwho-1431156

ABSTRACT

OBJECTIVE: This study documents the adoption of telehealth by various types of primary healthcare (PHC) providers working in teaching PHC clinics in Quebec during the COVID-19 pandemic. It also identifies the perceived advantages and disadvantages of telehealth. METHOD: A cross-sectional study was conducted between May and August 2020. The e-survey was completed by 48/50 teaching primary care clinics representing 603/1,357 (44%) PHC providers. RESULTS: Telephone use increased the most, becoming the principal virtual modality of consultation, during the pandemic. Video consultations increased, with variations by type of PHC provider: between 2% and 16% reported using it "sometimes." The main perceived advantages of telehealth were minimizing the patient's need to travel, improved efficiency and reduction in infection transmission risk. The main disadvantages were the lack of physical exam and difficulties connecting with some patients. CONCLUSION: The variation in telehealth adoption by type of PHC provider may inform strategies to maximize the potential of telehealth and help create guidelines for its use in more normal times.


Subject(s)
COVID-19/diagnosis , COVID-19/therapy , Health Personnel/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Primary Health Care/organization & administration , Primary Health Care/statistics & numerical data , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pandemics , Quebec , SARS-CoV-2
10.
Child Adolesc Psychiatr Clin N Am ; 30(4): 809-826, 2021 10.
Article in English | MEDLINE | ID: covidwho-1415269

ABSTRACT

Psychiatry and psychology have a long history of competition that too often interferes with the collaboration that can characterize complementary contributions to our common missions. We hope this article will inspire our disciplines to expand on this collaboration, for the sake of our children and families, our communities, our colleagues, and honestly, ourselves. We are better together than apart. This text is a blueprint for the assumptions, attitudes, skills, and advocacy that can make this partnership healthy and successful.


Subject(s)
Child Psychiatry/methods , Delivery of Health Care, Integrated/organization & administration , Primary Health Care , Psychology, Child/methods , Adolescent , Child , Humans , Interprofessional Relations , Intersectoral Collaboration , Mental Health , Models, Organizational , Primary Health Care/ethics , Primary Health Care/organization & administration
11.
World J Emerg Surg ; 16(1): 46, 2021 09 10.
Article in English | MEDLINE | ID: covidwho-1403246

ABSTRACT

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.


Subject(s)
COVID-19/epidemiology , Global Health , Pandemics , Biomedical Research , COVID-19/diagnosis , COVID-19/therapy , COVID-19 Vaccines , Delivery of Health Care/organization & administration , Health Policy , Health Services Accessibility , Health Status Disparities , Healthcare Disparities , Humans , International Cooperation , Mass Vaccination/organization & administration , Pandemics/prevention & control , Politics , Primary Health Care/organization & administration , Telemedicine/organization & administration
12.
J Obstet Gynecol Neonatal Nurs ; 50(6): 742-752, 2021 11.
Article in English | MEDLINE | ID: covidwho-1392426

ABSTRACT

OBJECTIVE: To examine the roles and experiences of labor and delivery (LD) nurses during the COVID-19 pandemic. DESIGN: Cross-sectional survey. SETTING: Online distribution between the beginning of July and end of August 2020. PARTICIPANTS: LD nurses (N = 757) responded to an open-ended question about changes to their roles during the COVID-19 pandemic as part of a larger national survey. METHODS: We calculated descriptive statistics on respondents' characteristics and their hospitals' characteristics. We applied conventional content analysis to free-text comments. RESULTS: We derived four major categories from the responses: Changes in Roles and Responsibilities, Adaptations to Changes, Psychological Changes, and Perceived Effects on LaborSupport. Nearly half (n = 328) of respondents reported changes in their roles and responsibilities during the COVID-19 pandemic. They described adaptations and responses to these changes and perceived effects on patient care. Infection control policies and practices as well as the stress of a rapidly changing work environment affected the provision of labor support and personal well-being. CONCLUSION: The experiences described by respondents conveyed considerable changes in their roles and subsequent direct and indirect effects on quality of patient care and personal well-being. Policies and practices that can facilitate the ability of LD nurses to safely and securely remain at the bedside and provide high-touch, hands-on labor support are needed. The findings of our study can help facilitate the provision of labor support during times of disruption and foster the resiliency of the nursing workforce.


Subject(s)
COVID-19/nursing , Delivery, Obstetric/nursing , Nurses/psychology , Pregnant Women/psychology , Prenatal Care/psychology , Primary Health Care/organization & administration , Adult , COVID-19/epidemiology , COVID-19/psychology , Cross-Sectional Studies , Delivery, Obstetric/psychology , Female , Humans , Middle Aged , Pandemics/prevention & control , Pregnancy , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology
14.
Aust N Z J Public Health ; 45(4): 318-324, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1343798

ABSTRACT

OBJECTIVES: To examine the perceptions of health professionals regarding the gaps in mental health service provision in Australia and their need for assistance in managing patients with mental illness. METHOD: A total of 570 health professionals participated in an anonymous online survey in January 2018 that assessed: i) health professionals' current levels of need for assistance in the management of patients with mental health conditions; and ii) perceived gaps in the mental health care system, and how these can be addressed. Data were analysed using a mixed-methods approach. RESULTS: Of those surveyed, 71.2% of health professionals and 77.3% of general practitioners reported that they required assistance in managing their patients with at least one stage of care for at least one type of mental disorder. Qualitative analyses revealed eight major themes in health professionals' perceptions of gaps in mental health service provision, including affordability and accessibility, the problems with crisis-driven care and the 'missing middle'. CONCLUSION: Overall, the results of this study provide a concerning insight into the substantial gaps in mental health care within the Australian system. Implications for public health: The results of this study add weight to ongoing calls for reform of and increased investment in the Australian mental health care system.


Subject(s)
Clinical Competence , Community Mental Health Services/organization & administration , Health Personnel/psychology , Mental Health/statistics & numerical data , Primary Health Care/organization & administration , Adult , Aged , Australia , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Humans , Male , Mental Disorders , Mental Health Services , Middle Aged , Surveys and Questionnaires
15.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 576-581, 2021 Jun.
Article in Russian | MEDLINE | ID: covidwho-1335560

ABSTRACT

The article analyzes the impact of the pandemic COVID-19 in 2020 on the state of competition in the medical services market and the competitiveness of primary care organizations, and identifies prospects for the development of the medical services market. The SWOT-analysis and analysis of complaints and statements of citizens on the quality of medical services made it possible to comprehensively assess the strengths and weaknesses of organizations, external opportunities and threats, specify the positions of medical organizations in the medical services market and determine strategic directions for the development and ensuring the competitiveness of primary medical organizations. The results of the study allowed the authors to propose strategic directions for ensuring the competitiveness of the primary medical organization, namely, the creation of mechanisms for material and intangible incentives for medical personnel; improving the quality of health services; modernization of the medical diagnostic base of the primary medical organization.


Subject(s)
COVID-19 , Delivery of Health Care/organization & administration , Primary Health Care/organization & administration , Humans , Organizations
16.
JAAPA ; 34(8): 1-3, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1328937

ABSTRACT

ABSTRACT: The COVID-19 pandemic has been exceptionally disruptive to healthcare delivery, exposing the strengths and weaknesses of our healthcare system. Though systems will continue to improvise in the short term to provide essential patient care, thoughtful consideration should be given to a long-term approach to improve healthcare delivery. Policy makers, legislators, and healthcare system leaders have the opportunity to reflect on lessons learned during this time and update outdated and detrimental restrictions affecting healthcare providers who have been vital to the pandemic response. This article focuses on lessons learned about the use of physician assistants and NPs, who have been readily deployed during this time.


Subject(s)
COVID-19/therapy , Health Workforce/statistics & numerical data , Nurse Practitioners/statistics & numerical data , Physician Assistants/statistics & numerical data , COVID-19/epidemiology , Humans , Primary Health Care/organization & administration , Workforce/statistics & numerical data
18.
Healthc Q ; 24(2): 33-37, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1323455

ABSTRACT

Physician engagement is an important factor in improving care quality and patient safety, but engaging physicians is not easy. Winston Churchill's famous assertion about never wasting a crisis has defined the approach taken by many leaders during the COVID-19 pandemic. This paper describes three case studies of successful physician engagement across the continuum of acute care, chronic care and primary care settings during the pandemic. These examples offer insights on physician engagement within unique settings by leveraging intrinsic motivators and Spurgeon's model of medical engagement.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/organization & administration , Physicians/organization & administration , Stakeholder Participation , COVID-19/therapy , Critical Care/organization & administration , Humans , Ontario/epidemiology , Organizational Case Studies , Primary Health Care/organization & administration
19.
Eur J Gen Pract ; 27(1): 166-175, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1317859

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had a substantial impact on primary care throughout Europe and globally. OBJECTIVES: This review aims to ascertain how the pandemic has impacted primary care service provision/patients and to examine strategies to mitigate these impacts. METHODS: The scoping review framework comprised a six-stage process developed by Arksey and O'Malley. The search process was guided by the Joanna Briggs Institute three-step search strategy and involved searching the PubMed, Embase, Scopus, CINAHL Plus, and Cochrane Library databases. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A thematic analysis approach by Braun and Clarke was used to interpret the findings. RESULTS: Thirty-two studies from 18 countries and six continents were included, 13 reported original research, three were reviews, and 16 were case reports reporting healthcare systems' experiences of dealing with the pandemic. Emerging themes concerned the COVID-19 pandemic's impact on primary care service provision and patients, the impact of the rapid transition to telemedicine due to COVID-19 on primary care, and strategies to mitigate the impact of COVID-19 on primary care (i.e. infection prevention and control measures, alternatives/modifications to traditional service delivery or workflow, government policy responses, and education). CONCLUSION: The COVID-19 pandemic has considerably impacted on primary care at both service and patient levels, and various strategies to mitigate these impacts have been described. Future research examining the pandemic's ongoing impacts on primary care, as well as strategies to mitigate these impacts, is a priority.


Subject(s)
COVID-19 , Pandemics , Primary Health Care/organization & administration , Health Services Accessibility , Humans , Patient Participation , Quality of Health Care , Telemedicine
20.
J Am Geriatr Soc ; 69(10): 2963-2972, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1304114

ABSTRACT

BACKGROUND: Although more than seven million older adults struggle or are unable to leave their homes independently, only a small minority access home-based primary care (HBPC). Despite substantial growth of HBPC, fueled by growing evidence supporting positive patient outcomes and cost savings, the population remains dramatically underserved and many evidence gaps still exist around scope of practice and key issues in care delivery and quality. Understanding the current state of the field is critical to the delivery of high-quality home-based care. METHODS: We conducted a systematic search of the peer-reviewed literature on HBPC, published between January 2010 and January 2020, using Medline, CINAHL, Embase, Web of Science, and Scopus online libraries. All studies were evaluated by two members of the research team, and key findings were extracted. RESULTS: The initial search yielded 1730 unique studies for screening. Of these initial results, 1322 were deemed not relevant to this review. Of the 408 studies deemed potentially relevant, 79 were included in the study. Researchers identified five overarching themes: the provision of HBPC, the composition of care teams, HBPC outcomes, the role of telehealth, and emergency preparedness efforts. CONCLUSION: The need and desire for growth of HBPC has been highlighted by the recent COVID-19 pandemic. Current research on HBPC finds a diverse scope of practice, successful use of interdisciplinary teams, positive outcomes, and increasing interest in telehealth with many areas ripe for further research.


Subject(s)
COVID-19 , Civil Defense/standards , Delivery of Health Care/standards , Home Care Services , Primary Health Care , Telemedicine , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Health Services Needs and Demand , Home Care Services/organization & administration , Home Care Services/standards , Home Care Services/trends , Humans , Primary Health Care/methods , Primary Health Care/organization & administration , Professional Practice Gaps , SARS-CoV-2 , Telemedicine/methods , Telemedicine/trends , United States
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