Department of Family Medicine, University of Alberta, Edmonton, Canada.
MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.
BMC Prim Care. 2023 Jan 23;24(1):27. doi: 10.1186/s12875-022-01954-x.
The COVID-19 pandemic challenged healthcare systems worldwide and disrupted primary care, particularly prevention, screening, and lifestyle counselling. BETTER WISE is a comprehensive and structured approach that proactively addresses cancer and chronic disease prevention and screening (CCDPS), including cancer survivorship and screening for poverty and lifestyle risks for patients aged 40 to 65. Patients from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada were invited for a 1-hour visit with a prevention practitioner (PP), a member of the primary care team with specialized training in CCDPS to provide patients an overview of eligible screening and assist with lifestyle counselling. This qualitative sub-study describes how the COVID-19 pandemic impacted BETTER WISE in a constantly changing medical landscape.
We conducted 17 focus groups and 48 key informant interviews with a total of 132 primary care providers (PPs, physicians, allied health professionals, and clinic staff) over three different time points to better understand their perspectives on the BETTER WISE project. We also received 585 patient feedback forms of the 1005 patients who agreed to participate in the study. We also collected field notes and memos and employed thematic analysis using a constant comparative method focused on the impact of the pandemic on BETTER WISE.
We identified four themes related to how the COVID-19 pandemic impacted the BETTER WISE study: 1) Switch of in-person visits to visits over the phone; 2) Lack of access to preventive care and delays of screening tests; 3) Changes in primary care providers' availability and priorities; 4) Mental health impacts of the pandemic on patients and primary care providers.
The COVID-19 pandemic had and, at the time of writing, continues to have an impact on primary care, particularly on prevention, screening, and lifestyle counselling. Despite structural, procedural, and personal challenges throughout different waves of the pandemic, the primary care clinics participating in BETTER WISE were able to complete the study. Our results underscore the importance of the role of primary care providers in adapting to changing circumstances and support of patients in these challenging times.
This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).
COVID-19 大流行挑战了全球的医疗体系，并扰乱了初级保健，特别是预防、筛查和生活方式咨询。BETTER WISE 是一种全面和结构化的方法，积极应对癌症和慢性病的预防和筛查（CCDPS），包括癌症生存和筛查贫困以及 40 至 65 岁患者的生活方式风险。来自加拿大艾伯塔省、安大略省和纽芬兰与拉布拉多的 13 个初级保健诊所（城市、农村和偏远地区）的患者受邀与预防从业者（PP）进行 1 小时的访问，预防从业者是初级保健团队的一员，专门接受过 CCDPS 培训，为患者提供合格筛查的概述并协助进行生活方式咨询。这项定性子研究描述了 COVID-19 大流行如何在不断变化的医疗环境中影响 BETTER WISE。
我们在三个不同时间点共对 132 名初级保健提供者（PP，医生，辅助卫生专业人员和诊所工作人员）进行了 17 次焦点小组和 48 次关键知情人访谈，以更好地了解他们对 BETTER WISE 项目的看法。我们还收到了 1005 名同意参与研究的患者中的 585 份患者反馈表。我们还收集了现场笔记和备忘录，并使用以关注大流行对 BETTER WISE 影响的恒定比较方法进行了主题分析。
我们确定了四个与 COVID-19 大流行如何影响 BETTER WISE 研究相关的主题：1）将面对面访问改为电话访问；2）无法获得预防保健和筛查测试的延迟；3）初级保健提供者的可用性和优先级发生变化；4）大流行对患者和初级保健提供者的心理健康产生影响。
COVID-19 大流行已经并在撰写本文时继续对初级保健产生影响，特别是对预防、筛查和生活方式咨询产生影响。尽管在不同的大流行浪潮中存在结构、程序和个人挑战，但参与 BETTER WISE 的初级保健诊所仍能够完成研究。我们的结果强调了初级保健提供者在适应不断变化的环境和支持患者在这些困难时期的重要性。
这项定性研究是 BETTER WISE 实用、cRCT 的子组成部分，试验注册 ISRCTN21333761（注册日期为 2016 年 12 月 19 日）。
