在 COVID-19 大流行期间，支持为老年人提供和接受护理的初级保健政策和实践：在加拿大三个省份进行的一项定性案例研究。

Policy and practices in primary care that supported the provision and receipt of care for older persons during the COVID-19 pandemic: a qualitative case study in three Canadian provinces.

机构信息

Lawson Health Research Institute, London, ON, Canada.

St. Joseph's Health Care London, London, ON, Canada.

出版信息

BMC Prim Care. 2023 Sep 28;24(1):199. doi: 10.1186/s12875-023-02135-0.

DOI:10.1186/s12875-023-02135-0

PMID:37770822

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10536733/

Abstract

BACKGROUND

The effects of the COVID-19 pandemic on older adults were felt throughout the health care system, from intensive care units through to long-term care homes. Although much attention has been paid to hospitals and long-term care homes throughout the pandemic, less attention has been paid to the impact on primary care clinics, which had to rapidly change their approach to deliver timely and effective care to older adult patients. This study examines how primary care clinics, in three Canadian provinces, cared for their older adult patients during the pandemic, while also navigating the rapidly changing health policy landscape.

METHODS

A qualitative case study approach was used to gather information from nine primary care clinics, across three Canadian provinces. Interviews were conducted with primary care providers (n = 17) and older adult patients (n = 47) from October 2020 to September 2021. Analyses of the interviews were completed in the language of data collection (English or French), and then summarized in English using a coding framework. All responses that related to COVID-19 policies at any level were also examined.

RESULTS

Two main themes emerged from the data: (1) navigating the noise: understanding and responding to public health orders and policies affecting health and health care, and (2) receiving and delivering care to older persons during the pandemic: policy-driven challenges & responses. Providers discussed their experiences wading through the health policy directives, while trying to provide good quality care. Older adults found the public health information overwhelming, but appreciated the approaches adapted by primary care clinics to continue providing care, even if it looked different.

CONCLUSIONS

COVID-19 policy and guideline complexities obliged primary care providers to take an important role in understanding, implementing and adapting to them, and in explaining them, especially to older adults and their care partners.

摘要

背景

COVID-19 大流行对老年人的影响在整个医疗保健系统中都感受到了，从重症监护病房到长期护理院。尽管整个大流行期间都对医院和长期护理院给予了很多关注，但对初级保健诊所的影响关注较少，这些诊所必须迅速改变其方法，为老年患者提供及时有效的护理。本研究考察了加拿大三个省份的初级保健诊所如何在大流行期间为老年患者提供护理，同时还应对快速变化的卫生政策环境。

方法

采用定性案例研究方法从加拿大三个省份的九个初级保健诊所收集信息。对来自这三个省份的 17 名初级保健提供者和 47 名老年患者进行了访谈。访谈于 2020 年 10 月至 2021 年 9 月进行。对访谈的分析是在数据收集的语言（英语或法语）中完成的，然后使用编码框架用英语进行总结。还检查了与任何级别的 COVID-19 政策相关的所有答复。

结果

数据中出现了两个主要主题：（1）在噪音中导航：了解和响应影响健康和医疗保健的公共卫生命令和政策，（2）在大流行期间为老年人提供和接受护理：政策驱动的挑战和应对。提供者讨论了他们在努力提供高质量护理的同时，通过卫生政策指令的经验。老年人发现公共卫生信息令人不知所措，但赞赏初级保健诊所为继续提供护理而采取的方法，即使看起来有所不同。