基层医疗应对SARS-CoV-2 / COVID-19大流行的策略:一项在线调查。
Strategies in Primary Care to Face the SARS-CoV-2 / COVID-19 Pandemic: An Online Survey.
作者信息
Eisele Marion, Pohontsch Nadine Janis, Scherer Martin
机构信息
Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Front Med (Lausanne). 2021 Jun 2;8:613537. doi: 10.3389/fmed.2021.613537. eCollection 2021.
Primary care plays a key role in pandemics like the SARS-CoV-2 pandemic in 2020. We aimed to investigate the challenges faced and the solutions implemented in primary care. One hundred and twenty-one general practitioners in Germany completed the online survey. We used open questions to examine challenges experienced and solutions implemented during the early pandemic and chose qualitative content analysis to extract and describe the meaning of the answers. We derived deductive categories from the research questions and formed inductive categories during the material reviews. Main challenges were: insufficient information, lack of protective equipment, need to restructure practice procedures and insufficient individual and structural pandemic preparedness, resulting in secondary challenges: fear of infection, impaired patient care, aggravated steering of patients, difficult cooperation with external entities and a not viable hygiene concept advised by authorities. Strategies to address these challenges included establishing regular team-meetings to develop new solutions, focusing on few reliable sources of information, working in alternating shifts, increasing telemedicine, establishing window and open-air practices and building networks with other health care providers. Respondents criticized the lack of consideration of their experiences in planning pandemic measures within primary care. General practitioners successfully applied pragmatic and creative strategies in their practices during the early phase of the pandemic. Among these, communication within and between practices emerged as a key strategy. These strategies should be provided with pandemic preparedness plans. The lacking consideration of the primary care providers' experiences in planning and implementing pandemic measures needs to be addressed by stakeholders.
初级保健在2020年的SARS-CoV-2大流行等疫情中发挥着关键作用。我们旨在调查初级保健所面临的挑战以及实施的解决方案。德国的121名全科医生完成了在线调查。我们使用开放式问题来考察疫情早期所经历的挑战和实施的解决方案,并选择定性内容分析法来提取和描述答案的含义。我们从研究问题中推导出演绎类别,并在材料审查过程中形成归纳类别。主要挑战包括:信息不足、缺乏防护设备、需要调整诊疗程序以及个人和机构层面的疫情准备不足,进而导致了继发性挑战:感染恐惧、患者护理受损、患者转诊困难、与外部机构合作困难以及当局建议的卫生理念不可行。应对这些挑战的策略包括:召开定期团队会议以制定新的解决方案、关注少数可靠的信息来源、轮班工作、增加远程医疗、设立窗口诊疗和露天诊疗以及与其他医疗服务提供者建立网络。受访者批评在初级保健疫情应对措施规划中没有考虑他们的经验。在疫情早期,全科医生在其实践中成功应用了务实且富有创造性的策略。其中,诊所内部和之间的沟通成为一项关键策略。这些策略应纳入疫情应对准备计划。利益相关者需要解决在规划和实施疫情应对措施时未考虑初级保健提供者经验的问题。
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