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      Prevention and control of COVID-19 by primary health care facilities in China: a field-survey-based qualitative study in three typical cities

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          Abstract

          Background

          During the coronavirus disease 2019 (COVID-19) containment, primary health care (PHC) facilities inChina played an important role in providing both healthcare and public care services to community populations. The tasks of COVID-19 containment facilitated by PHC facilities were different among different regions and during different periods of COVID-19 pandemic. We sought to investigate the gaps on task participation, explore existing problems and provide corresponding solutions.

          Methods

          Semi-structured face-to-face interviews with COVID-19 prevention and control management teams of PHC facilities were conducted. Purposive stratified sampling was used and 32 team members of 22 PHC facilities were selected from Wuhan (as high-risk city), Shanghai (as medium-risk city) and Zunyi (as low-risk city). Framework analysis was employed to analyze the transcribed recordings.

          Results

          The main tasks of PHC facilities during the early period of the pandemic included assisting in contact tracing and epidemiological investigation, screening of populations at high-risk at travel centers/internals, house-by-house, or pre-examination/triage within PHC facilities; at-home/ centralized quarantine management; the work of fever sentinel clinics.

          Further analyses revealed the existing problems and suggestions for improvement or resolutions. Regular medical supply reserves were recommended because of the medical supply shortage during the pre-outbreak period. Temporarily converted quarantine wards and centralized quarantine centers could be used to deal with pressures on patients’ treatment and management of the febrile patients. Only after strict evaluation of nucleic acid testing (NAT) results and housing conditions, decision on quarantine at-home or centralized quarantine centers could be made. Settings of fever sentinel clinics at PHC facilities allowed fever patients with no COVID-19 infection risks for treatment without being transferred to fever clinics of the designed secondary hospitals. Psychological intervention was sometimes in need and really helped in addressing individuals’ mental pressures.

          Conclusions

          During the COVID-19 containment, PHC facilities in China were responsible for different tasks and several problems were encountered in the working process. Accordingly, specific and feasible suggestions were put forward for different problems. Our findings are highly beneficial for healthcare teams and governments in handling similar situations.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12913-022-07770-4.

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          The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts

          Kuan-Yu Pan, Almar Kok, Merijn Eikelenboom … (2020)
          Background The impact of the COVID-19 pandemic on mental health in people with pre-existing mental health disorders is unclear. In three psychiatry case-control cohorts, we compared the perceived mental health impact and coping and changes in depressive symptoms, anxiety, worry, and loneliness before and during the COVID-19 pandemic between people with and without lifetime depressive, anxiety, or obsessive-compulsive disorders. Methods Between April 1 and May 13, 2020, online questionnaires were distributed among the Netherlands Study of Depression and Anxiety, Netherlands Study of Depression in Older Persons, and Netherlands Obsessive Compulsive Disorder Association cohorts, including people with (n=1181) and without (n=336) depressive, anxiety, or obsessive-compulsive disorders. The questionnaire contained questions on perceived mental health impact, fear of COVID-19, coping, and four validated scales assessing depressive symptoms, anxiety, worry, and loneliness used in previous waves during 2006–16. Number and chronicity of disorders were based on diagnoses in previous waves. Linear regression and mixed models were done. Findings The number and chronicity of disorders showed a positive graded dose–response relation, with greater perceived impact on mental health, fear, and poorer coping. Although people with depressive, anxiety, or obsessive-compulsive disorders scored higher on all four symptom scales than did individuals without these mental health disorders, both before and during the COVID-19 pandemic, they did not report a greater increase in symptoms during the pandemic. In fact, people without depressive, anxiety, or obsessive-compulsive disorders showed a greater increase in symptoms during the COVID-19 pandemic, whereas individuals with the greatest burden on their mental health tended to show a slight symptom decrease. Interpretation People with depressive, anxiety, or obsessive-compulsive disorders are experiencing a detrimental impact on their mental health from the COVID-19 pandemic, which requires close monitoring in clinical practice. Yet, the COVID-19 pandemic does not seem to have further increased symptom severity compared with their prepandemic levels. Funding Dutch Research Council.
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            Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

            Veronique Verhoeven, Giannoula Tsakitzidis, Hilde Philips … (2020)
            Objectives The current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline. Design, setting, participants We performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis. Results Changes in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak—as well as the measures taken to control it—will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves. Conclusions The current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.
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              Mental health implications of COVID-19 pandemic and its response in India

              Adrija Roy, Arvind Singh, Shree Mishra … (2020)
              Introduction: Mental health concerns and treatment usually take a backseat when the limited resources are geared for pandemic containment. In this global humanitarian crisis of the COVID-19 pandemic, mental health issues have been reported from all over the world. Objectives: In this study, we attempt to review the prevailing mental health issues during the COVID-19 pandemic through global experiences, and reactive strategies established in mental health care with special reference to the Indian context. By performing a rapid synthesis of available evidence, we aim to propose a conceptual and recommendation framework for mental health issues during the COVID-19 pandemic. Methods: A search of the PubMed electronic database and google scholar were undertaken using the search terms ‘novel coronavirus’, ‘COVID-19’, ‘nCoV’, SARS-CoV-2, ‘mental health’, ‘psychiatry’, ‘psychology’, ‘anxiety’, ‘depression’ and ‘stress’ in various permutations and combinations. Published journals, magazines and newspaper articles, official webpages and independent websites of various institutions and non-government organizations, verified social media portals were compiled. Results: The major mental health issues reported were stress, anxiety, depression, insomnia, denial, anger and fear. Children and older people, frontline workers, people with existing mental health illnesses were among the vulnerable in this context. COVID-19 related suicides have also been increasingly common. Globally, measures have been taken to address mental health issues through the use of guidelines and intervention strategies. The role of social media has also been immense in this context. State-specific intervention strategies, telepsychiatry consultations, toll free number specific for psychological and behavioral issues have been issued by the Government of India. Conclusion: Keeping a positive approach, developing vulnerable-group-specific need-based interventions with proper risk communication strategies and keeping at par with the evolving epidemiology of COVID-19 would be instrumental in guiding the planning and prioritization of mental health care resources to serve the most vulnerable.
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                Author and article information

                Contributors
                Xue Xiao: xxellen@163.com
                Zhao-hui Du: dzh820@126.com
                Xiao-ming Sun: xm_sun2003@163.com
                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6963
                Publication date (Electronic): 26 March 2022
                Publication date PMC-release: 26 March 2022
                Publication date Collection: 2022
                Volume: 22
                Electronic Location Identifier: 399
                Affiliations
                [1 ]GRID grid.11841.3d, ISNI 0000 0004 0619 8943, Zhongshan Hospital, , Shanghai Medical College of Fudan University, ; 180 Fenglin Road, Xuhui District, 200030 Shanghai, China
                [2 ]GRID grid.413390.c, ISNI 0000 0004 1757 6938, Affiliated Hospital of Zunyi Medical University, ; 149 Dalian Road, Huichuan District, Guizhou Province 563000 Zunyi, China
                [3 ]Wuchang District Shouyilu Street Community Healthcare Center, Wuhan, China
                [4 ]Wuchang District Huanghelou Street Community Healthcare Center, Wuhan, China
                [5 ]Yachuan Township Health Center, Fenggang County, Zunyi, Guizhou Province 564200 China
                [6 ]Pudong New District Shanggang Community Healthcare Center, 360 Changli Road, Pudong New District, 200120 Shanghai, China
                Article
                Publisher ID: 7770
                DOI: 10.1186/s12913-022-07770-4
                PMC ID: 8960212
                PubMed ID: 35346179
                SO-VID: 1308a9fb-4310-4e02-ac59-c091eb40d927
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 20 May 2021
                Date accepted : 11 March 2022
                Funding
                Funded by: Pudong New District Health System Preponderant Discipline of General Practice
                Award ID: PWYq2020-01
                Funded by: Pudong New District Health System New Pilot Model of General Practice Service in Traditional Chinese Medicine
                Award ID: PDZY-2020-0703
                Funded by: Medical Discipline Construction Project of Pudong Health Committee of Shanghai
                Award ID: PWYsf2021-03
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Health & Social care
                Keywords: covid-19,community-based,prevention and control,phc facilities
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: covid-19, community-based, prevention and control, phc facilities

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