Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia.
Institute for Culture and Society, Western Sydney University, Parramatta, NSW, Australia.
BMC Prim Care. 2024 Jul 5;25(1):240. doi: 10.1186/s12875-024-02485-3.
The COVID-19 pandemic period (2020 to 2022) challenged and overstretched the capacity of primary health care services to deliver health care globally. The sector faced a highly uncertain and dynamic period that encompassed anticipation of a new, unknown, lethal and highly transmissible infection, the introduction of various travel restrictions, health workforce shortages, new government funding announcements and various policies to restrict the spread of the COVID-19 virus, then vaccination and treatments. This qualitative study aims to document and explore how the pandemic affected primary health care utilisation and delivery in remote and regional Aboriginal and Torres Strait Islander communities.
Semi-structured interviews were conducted with staff working in 11 Aboriginal Community-Controlled Health Services (ACCHSs) in outer regional, remote and very remote Australia. Interviews were transcribed, inductively coded and thematically analysed.
248 staff working in outer regional, remote and very remote primary health care clinics were interviewed between February 2020 and June 2021. Participants reported a decline in numbers of primary health care presentations in most communities during the initial COVID-19 lock down period. The reasons for the decline were attributed to community members apprehension to go to the clinics, change in work priorities of primary health care staff (e.g. more emphasis on preventing the virus entering the communities and stopping the spread) and limited outreach programs. Staff forecasted a future spike in acute presentations of various chronic diseases leading to increased medical retrieval requirements from remote communities to hospital. Information dissemination during the pre-vaccine roll-out stage was perceived to be well received by community members, while vaccine roll-out stage information was challenged by misinformation circulated through social media.
The ability of ACCHSs to be able to adapt service delivery in response to the changing COVID-19 strategies and policies are highlighted in this study. The study signifies the need to adequately fund ACCHSs with staff, resources, space and appropriate information to enable them to connect with their communities and continue their work especially in an era where the additional challenges created by pandemics are likely to become more frequent. While the PHC seeking behaviour of community members during the COVID-19 period were aligned to the trends observed across the world, some of the reasons underlying the trends were unique to outer regional, remote and very remote populations. Policy makers will need to give due consideration to the potential effects of newly developed policies on ACCHSs operating in remote and regional contexts that already battle under resourcing issues and high numbers of chronically ill populations.
2020 年至 2022 年的 COVID-19 大流行时期，对全球初级卫生保健服务提供医疗保健的能力提出了挑战并使其不堪重负。该部门面临着一个高度不确定和动态的时期，包括对一种新的、未知的、致命的和高度传染性的感染的预期，各种旅行限制的引入，卫生劳动力短缺，新的政府资金公告以及各种政策的出台，以限制 COVID-19 病毒的传播，然后是疫苗接种和治疗。本定性研究旨在记录和探讨大流行如何影响偏远和地区的原住民和托雷斯海峡岛民社区的初级卫生保健的利用和提供。
对澳大利亚远郊、偏远和极偏远地区 11 个原住民社区控制的卫生服务机构（ACCHSs）的工作人员进行了半结构式访谈。访谈记录被转录、归纳编码并进行主题分析。
2020 年 2 月至 2021 年 6 月期间，对在远郊、偏远和极偏远初级保健诊所工作的 248 名工作人员进行了访谈。参与者报告说，在 COVID-19 封锁初期，大多数社区的初级保健就诊人数下降。下降的原因归因于社区成员对去诊所的担忧、初级保健工作人员工作重点的变化（例如，更加重视防止病毒进入社区和阻止传播）以及外联计划有限。工作人员预测，各种慢性疾病的急性发作数量将会增加，这将导致从偏远社区到医院的医疗检索需求增加。在疫苗推出前阶段，信息传播被认为受到了社区成员的欢迎，而在疫苗推出阶段，信息传播受到了通过社交媒体传播的错误信息的挑战。
本研究强调了原住民社区控制的卫生服务机构能够适应不断变化的 COVID-19 战略和政策，调整服务提供的能力。这项研究表明，需要为原住民社区控制的卫生服务机构提供充足的工作人员、资源、空间和适当的信息，以使他们能够与社区保持联系并继续开展工作，特别是在大流行带来的额外挑战可能变得更加频繁的时代。虽然 COVID-19 期间社区成员的初级卫生保健寻求行为与世界范围内观察到的趋势一致，但其中一些趋势背后的原因是远郊、偏远和极偏远地区特有的。政策制定者需要充分考虑新制定的政策对在资源匮乏和慢性病人口众多的偏远和地区环境中运作的原住民社区控制的卫生服务机构的潜在影响。
