The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
BMC Fam Pract. 2021 Jun 2;22(1):108. doi: 10.1186/s12875-021-01468-y.
Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs' choices between telephone, video and face-to-face consultations.
This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed.
The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue CONCLUSION: This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.
应对 COVID-19 大流行的尝试导致全球医疗保健系统进行了彻底的重组。全科医生（GP）为绝大多数患者提供医疗服务，而他们在大流行期间为常规健康问题提供医疗服务的经验却鲜为人知。因此，在丹麦背景下，我们探讨了全科医生如何重组工作，以努力维持足够的患者护理，同时有助于最大限度地减少 COVID-19 的传播。此外，我们还研究了是什么指导了全科医生在电话、视频和面对面咨询之间进行选择。
本研究包括对 13 名全科医生的定性访谈。他们在大流行初期大约三个月进行了两次访谈，并在 20 天内每天记录。所有访谈都进行了录音、转录，并进行了归纳分析。
全科医生彻底重组了他们的临床工作。大多数咨询都转为视频或电话，推迟或取消。最初使用视频咨询的次数增加，但很快就下降了，再次被面对面咨询的增加所取代。在选择咨询形式时，全科医生考虑到了降低 COVID-19 风险的必要性、主要指南以及他们自己对面对面咨询的偏好。随着时间的推移和全科医生之间的变化，哪些健康问题通过使用视频和/或电话来处理也有所不同。对于某些健康问题，全科医生通常认为在大流行期间，使用视频或电话、短期推迟或取消预约是可以接受的，并且在危机情况下也是如此。他们在视频咨询方面经历了关系和技术方面的限制，而诊断上的不确定性则不被认为是一个突出的问题。
本研究表明，在必须严格限制面对面咨询的大流行情况下，全科医生如何认为电话和视频咨询是有用的。然而，全科医生确实发现了一些类似于非大流行时期的局限性。权衡利弊的意愿以及使用这些替代方法的意愿在再次认为面对面咨询可行时发生了变化，并且总体上减弱了。在未来的大流行中，这些替代方法似乎很有价值，至少在短期内是如此。
