Rural Physicians' Duties and Responsibilities in COVID-19 Pandemic Containment: an Empirical Study from the Perspective of Governance in Primary Care

ABSTRACT

Background: COVID-19 pandemic containment in rural areas is the frontline for containing COVID-19 and a key part of response system for public health emergencies in China, during which rural physicians play an important role as the "gatekeeper" of rural residents' health and rural pandemic prevention and control. However, rural physicians have demonstrated some work-related problems during the COVID-19 pandemic containment, which have affected the implementation effectiveness of their duties and responsibilities. Objective: To investigate the duties and responsibilities of rural physicians during COVID-19 pandemic containment in rural areas, and to identify the problems, then put forward relevant suggestions. Methods: An on-site semi-structured interview using non-participant observation approach was carried out in Beijing's Huairou District from April to July, 2021. Eighteen rural physicians were selected to attend the interview as stakeholders. The interview was guided by an outline developed based on a literature review and an expert consultation, including three parts (1)demographic characteristics(practice location, sex, age), (2)practicing qualifications(education level, starting time of practicing, professional qualifications), (3)involvement in COVID-19 pandemic prevention and control(awareness of the 10 instructions for COVID-19 pandemic containment in village clinics, participation in COVID-19 pandemic containment, and personal protective equipment materials for COVID-19). The interview was continued until data saturation. Results: Among the 18 rural physicians, 14(77.8%) were certified as rural physicians, 3(16.7%) were certified as rural assistant general practitioners, 2(11.1%) had a certificate of licensed physician and 1(5.6%) had a certificate of licensed assistant physician. Except for one(5.6%), the rural physicians〔17(94.4%)〕 indicated that they knew the 10 instructions for COVID-19 pandemic containment in the village clinic. The top three services about COVID-19 pandemic containment most frequently provided by the rural physicians were health education (94.4%), information reporting(72.2%) and diagnosis and treatment(64.7%), and the least provided was throat swab sampling〔only one case (5.6%)〕. In addition, three rural physicians participated in providing other services, which included screening suspected COVID-19 cases in the village, guiding COVID-19 pandemic containment in the village, and purchasing food for villagers. Ten physicians(55.6%)indicated that personal protective equipment materials for COVID-19 were adequate, but other 8(44.4%) expressed that such materials were inadequate during the first response phase. During the regular COVID-19 pandemic containment phase, 16 physicians(88.9%) indicated that personal protective equipment materials for COVID-19 were adequate, but other 2(11.1%) still indicated that such materials were inadequate. The top four personal protective equipment materials for COVID-19 owned by the physicians in regular COVID-19 pandemic containment phase were 84 Disinfectant(72.2%), ordinary disposable medical masks(66.7%), disposable gloves(66.7%) and medical surgical masks(61.1%), and the least owned were medical protective clothing(38.9%) and goggles(11.1%). Conclusion: Rural physicians play a necessary role in COVID-19 pandemic containment in rural areas, but the effectiveness of their services has been affected by limited personal capabilities in delivering COVID-19 pandemic containment services(including pharyngeal swab sampling), lack of a legal right to provide home-based isolation and monitoring services, and inadequate personal protective equipment materials. Therefore, it is recommended that relevant laws and regulations should be improved to provide a legal right for rural physicians to perform their duties and responsibilities in COVID-19 pandemic containment, recruit them to the public health team of the village committee, and ensure the provision of emergency materials for village physicians to help them to realize their potential in pandemic ontainment. Copyright © 2022 by the Chinese General Practice.