Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany.
BMC Prim Care. 2022 Aug 11;23(1):203. doi: 10.1186/s12875-022-01786-9.
Primary care is a relevant pillar in managing not only individual, but also societal medical crises. The COVID-19 pandemic has demanded a rapid response from primary care with interventions in the health care system. The aim of this paper was to explore the responses of primary care practitioners (PCP) during the early COVID-19 pandemic and to analyze these with a view on the resilience of the primary health care system from the PCPs perspective.
Shortly after the first COVID-19 wave (July-October 2020) n = 39, semi-structured telephone interviews were conducted with PCP in practices and at Corona contact points (CCP) in Baden-Wuerttemberg (Germany). Qualitative content analysis was applied, and the evolved categories were related to in a framework for resilience.
Primary care had an overall strong ability to adapt and show resilience, albeit with wide variance in speed and scope of the responses. When coping with uncertainty, the reasons given by PCPs in favor of opening a CCP mainly involved intrinsic motivation and self-initiative; the reasons against doing so were i.e. the lack of personal protective equipment, problems with space, and worries about organizational burden. A strong association existed between the establishment of a CCP and the use of resources (i.e. existing networks, personal protective equipment, exercising an office of professional political function). Our study predominantly found adaptive aspects for measures taken at medical practices and transformative aspects for setting up outpatient infection centers. PCPs played an important role in the coordination process (i.e. actively transferring knowledge, integration in crisis management teams, inclusion in regional strategic efforts) reaching a high level in the dimensions knowledge and legitimacy. The dimension interdependence repeatedly came into focus (i.e. working with stakeholders to open CCP, interacting among different types of primary care facilities, intersectoral interfaces). A need for regional capacity planning was visible at the time of the interviews.
The results can be used for practical and research-based institutional and capacity planning, for developing resilience in primary care and for augmentation by perspectives from other stakeholders in the primary health care system.
初级保健不仅是管理个人医疗危机的重要支柱，也是管理社会医疗危机的重要支柱。COVID-19 大流行要求初级保健迅速做出反应，在医疗保健系统中进行干预。本文的目的是探讨初级保健从业者（PCP）在 COVID-19 早期大流行期间的反应，并从 PCP 的角度分析这些反应，以了解初级卫生保健系统的弹性。
在 COVID-19 第一波（2020 年 7 月至 10 月）之后不久，对巴登-符腾堡州（德国）的实践和 Corona 联络点（CCP）的 PCP 进行了 39 次半结构化电话访谈。应用定性内容分析，演变的类别与弹性框架相关。
初级保健具有较强的整体适应能力和弹性，尽管在反应的速度和范围上存在很大差异。在应对不确定性时，PCP 赞成开设 CCP 的主要原因涉及内在动机和主动；反对这样做的原因是缺乏个人防护设备、空间问题以及对组织负担的担忧。设立 CCP 与资源的使用（即现有网络、个人防护设备、行使专业政治职能的办公室）之间存在很强的关联。我们的研究主要发现了医疗实践中采取的措施的适应性方面，以及为建立门诊感染中心而采取的变革性方面。PCP 在协调过程中发挥了重要作用（即积极传递知识、融入危机管理团队、纳入区域战略努力），在知识和合法性维度上达到了较高水平。相互依存维度反复成为焦点（即与利益相关者合作开设 CCP、不同类型的初级保健机构之间相互作用、部门间接口）。在接受采访时，人们对区域能力规划的需求显而易见。
研究结果可用于初级保健的实践和基于研究的机构和能力规划，用于增强初级保健的弹性，并增加初级卫生保健系统中其他利益相关者的观点。
