Primary care during the COVID-19 pandemic - observations and challenges identified through a survey and interviews with community paediatricians: the calm before the storm

ABSTRACT

BackgroundGlobally, the COVID-19 pandemic has a major impact on healthcare provision. The effects in primary care are understudied. AimTo document changes in consultation numbers and patient management during the COVID-19 pandemic, and to identify challenges for patient care. MethodsSurvey of 44 paediatric primary care practices on consultation numbers and patient management changes (response rate 50%), and semi-structured interviews to identify challenges for patient care. ResultsNumbers of consultations for scheduled developmental examinations remained unchanged compared to the previous year while emergency visits were strongly reduced (mean 87.3 less/week in March-May 2020 compared to 2019, median reduction 55.0%). Children dependent on developmental therapy and with chronic health conditions were identified as patient groups receiving deteriorated care. High patient numbers, including of mildly symptomatic children presenting for health certificates, in combination with increased organisational demands and expected staff outages are priority concerns for the winter. ConclusionPrimary care paediatricians offered stable service through the early pandemic but expect strained resources for the upcoming winter. Unambiguous guidance on which children should present to primary care and who should be tested would help to allocate resources appropriately, and this guidance needs to consider age group specific issues including high prevalence of respiratory symptoms, dependency on carers and high contact rates.