Dykgraaf Sally Hall, Parkinson Anne, Wright Michael, Wong William C W, Desborough Jane, Ball Lauren, Sturgiss Elizabeth, Dut Garang M, Barnes Katelyn, Butler Danielle, Davis Steph, Douglas Kirsty, Kendir Candan, Martin Danielle, Marten Robert, Rouleau Katherine, Barkley Shannon, de Toca Lucas, Kidd Michael
School of Medicine & Psychology, College of Health & Medicine, Australian National University, Canberra, Australia.
National Centre for Epidemiology & Population Health, College of Health & Medicine, Australian National University, Canberra, Australia.
BMC Prim Care. 2025 Jan 24;26(1):19. doi: 10.1186/s12875-024-02640-w.
Strong primary care (PC) services are the foundation of high-performing health care systems and can support effective responses to public health emergencies. Primary care practitioners (PCPs) and PC services played crucial roles in supporting global health system responses to the COVID-19 pandemic. However, these contributions have come at a cost, impacting on PC services and affecting patient care. This secondary analysis of data from an integrative systematic review across international PC settings aimed to identify and describe burdens and challenges experienced by PCPs and PC services in the context of their contributions to COVID-19 pandemic responses.
We conducted an integrative systematic review and narrative analysis, searching PubMed/Medline, Scopus, Proquest Central and Cochrane Database of Systematic Reviews, plus reference lists of key publications. Included studies were published in peer-reviewed English or Chinese language journals, and described collective responses to COVID-19 undertaken in PC settings or by PCPs. Narrative data regarding impacts on PC services and challenges experienced by PCPs were extracted and analysed using inductive coding and thematic analysis.
From 1745 screened papers 108, representing 90 countries, were included. Seventy-eight contained data on negative impacts, challenges or issues encountered in PC. Ten 'pressure points' affecting PC during COVID-19 were identified, clustered in four themes: demand to adopt new ways of working; pressure to respond to fluctuating community needs; strain on PC resources and systems; and ambiguity in interactions with the broader health and social care system.
PCPs and PC services made critical functional contributions to health system responsiveness during the COVID-19 pandemic. However, both practitioners and PC settings were individually and collectively impacted during this period as a result of changing demands in the PC environment and the operational burden of additional requirements imposed on the sector, offering lessons for future pandemics. This study articulates ten empirically derived 'pressure points' that provide an initial understanding of burdens and demands imposed on the international primary care sector during the COVID-19 pandemic. The impact of these contributions should inform future pandemic planning, guided by involvement of PCPs in public health preparedness and policy design.
强大的初级保健（PC）服务是高效医疗体系的基础，能够支持对突发公共卫生事件做出有效应对。初级保健从业者（PCP）和初级保健服务在支持全球卫生系统应对新冠疫情方面发挥了关键作用。然而，这些贡献是有代价的，对初级保健服务产生了影响，并波及患者护理。这项对来自国际初级保健环境的综合系统评价数据进行的二次分析，旨在识别和描述初级保健从业者及初级保健服务在为新冠疫情应对做出贡献的背景下所经历的负担和挑战。
我们进行了一项综合系统评价和叙述性分析，检索了PubMed/Medline、Scopus、ProQuest Central和Cochrane系统评价数据库，以及关键出版物的参考文献列表。纳入的研究发表在同行评审的英文或中文期刊上，描述了在初级保健环境中或由初级保健从业者对新冠疫情做出的集体应对措施。使用归纳编码和主题分析方法提取并分析了关于对初级保健服务的影响以及初级保健从业者所经历挑战的叙述性数据。
在筛选的1745篇论文中，纳入了代表90个国家的108篇。其中78篇包含了初级保健中遇到的负面影响、挑战或问题的数据。确定了新冠疫情期间影响初级保健的10个“压力点”，分为四个主题：采用新工作方式的需求；应对社区需求波动的压力；初级保健资源和系统的紧张；以及与更广泛的卫生和社会护理系统互动中的模糊性。
在新冠疫情期间，初级保健从业者和初级保健服务对卫生系统的响应能力做出了关键的功能性贡献。然而，由于初级保健环境需求的变化以及该部门额外要求带来的运营负担，在此期间从业者和初级保健机构都受到了个体和集体的影响，为未来的疫情提供了经验教训。本研究阐明了10个基于实证得出的“压力点”，初步揭示了新冠疫情期间国际初级保健部门所承受的负担和需求。这些贡献的影响应为未来的疫情规划提供参考，其指导原则是让初级保健从业者参与公共卫生防范和政策设计。
