Homeniuk Robyn, Collins Claire
Research Centre, Irish College of General Practitioners, Dublin, Ireland.
BMJ Open. 2021 Apr 8;11(4):e044685. doi: 10.1136/bmjopen-2020-044685. eCollection 2021.
How general practice is delivered in many countries has drastically changed due to the COVID-19 pandemic. This study aimed to answer the question of how general practice has changed in Ireland in response to COVID-19.
The Irish College of General Practitioners surveyed its membership before and after the global pandemic hit Ireland using a cross-sectional online survey instrument.
This study focuses on primary care, specifically general practice, in Ireland.
In February 2020 before the global pandemic, 526 general practices across Ireland submitted responses to the survey; 538 general practices responded to the second survey during the pandemic in June 2020. This covers 32% and 33% of practices in Ireland, respectively.
The type of consultations by general practitioners (GPs) and practice nurses in both surveys is the main outcome measure reported in this paper. Other changes such as the perceived change in attendance by certain patient groups and practice income are also reported.
Face-to-face consultations significantly (p<0.001) decreased from a median of 26 (IQR 21.3-30) to a median of 8 (IQR 6-13). GP telemedicine consultations increased (p<0.001) from a median of 2.4 (IQR 0-5.3) to a median of 11.3 (IQR 6-19). The majority of practices (80.0%) reported reduced practice profit. Respondents reported a decline in non-COVID-19-related consultations among certain patient cohorts-92.0% for children under 6 years old; 79.5% for patients over 70 years.
It is likely that the way general practice is delivered will not return to as it was before the COVID-19 pandemic and increased telemedicine can be expected. However, it is necessary to assess the impact of this shift on patient health and to assess healthcare provider and patient experience to ensure continued high-quality care and patient safety.
由于新冠疫情，许多国家提供全科医疗服务的方式发生了巨大变化。本研究旨在回答爱尔兰的全科医疗服务因新冠疫情发生了怎样变化的问题。
爱尔兰全科医生学院在全球疫情袭击爱尔兰之前和之后，使用横断面在线调查工具对其成员进行了调查。
本研究聚焦于爱尔兰的初级医疗，特别是全科医疗服务。
2020年2月全球疫情爆发前，爱尔兰各地526家全科医疗服务机构提交了调查问卷回复；2020年6月疫情期间，538家全科医疗服务机构回复了第二次调查。这分别覆盖了爱尔兰32%和33%的医疗服务机构。
本文报告的主要观察指标是两次调查中全科医生（GP）和执业护士的会诊类型。还报告了其他变化，如某些患者群体就诊率的感知变化以及医疗服务机构收入情况。
面对面会诊显著减少（p<0.001），中位数从26次（四分位间距21.3 - 30）降至8次（四分位间距6 - 13）。全科医生的远程医疗会诊增加（p<0.001），中位数从2.4次（四分位间距0 - 5.3）增至11.3次（四分位间距6 - 19）。大多数医疗服务机构（80.0%）报告利润下降。受访者称某些患者群体中与新冠疫情无关的会诊减少——6岁以下儿童减少92.0%；70岁以上患者减少79.5%。
全科医疗服务的提供方式很可能不会恢复到新冠疫情之前的状态，预计远程医疗将会增加。然而，有必要评估这一转变对患者健康的影响，并评估医疗服务提供者和患者的体验，以确保持续提供高质量医疗服务和患者安全。
