Introduction:In countries such as New Zealand, where there has been little community spread of COVID-19, psychological distress has been experienced by the population and by health workers.COVID-19 has caused changes in the model of care that is delivered in New Zealand general practice. It is unknown, however, whether the changes wrought by COVID-19 have resulted in different levels of strain between rural and urban general practices. This study aims to explore these differences from the impact of COVID-19. Methods: This study is part of a four-country collaboration (Australia, New Zealand, Canada and the USA) involving repeated cross-sectional surveys of primary care practices in each respective country. Surveys were undertaken at regular intervals throughout 2020 of urban and rural general practices throughout New Zealand. Five core questions were asked at each survey, relating to experiences of strain, capacity for testing, stressors experienced, types of consultations being carried out and numbers of patients seen. Simple descriptive statistics were used to analyse the data.Results: A total of 1516 responses were received with 20% from rural practices. A moderate degree of strain was experienced by Rural and Remote Health rrh.org.au
BackgroundStarfield describes importance of system-level components of primary care (first-contact, continuous, comprehensive, coordinated), on countries’ health systems. We postulate at the individual-level, interpersonal interactions and relationship-centred care are central to primary care.AimExplore impact of COVID-19 on disruption to doctor-patient relationship and subsequent development of new models of care.Design & settingSeries of 11 cross-sectional ‘surveys of New Zealand urban and rural primary care doctors, nurses and managers, May 2020 to February 2021, to understand and monitor responses to pandemic.MethodUsing inductive content analysis, cumulated qualitative data from doctors was examined through the lenses of doctor-patient relationship, its disruption and resulting changes in models of care.Results1519 responses representing 482 unique participants, 86% doctors. Four key themes of move to transactional consultations; task shifting with team changes; creating a production line; and diminished communication and coordination across services emerged.ConclusionAdvent of pandemic led to severe and ongoing strain on practices requiring rapid change to model of care. Team members took on new roles for triaging, testing and separating respiratory from non-respiratory patients. Rapid move to telehealth, with policies developed on where face-to-face consultations necessary. Practice strain exacerbated by disruption to coordination with secondary and other referral services. As new models of general practice develop, further disruptions to development of doctor-patients relationships must be avoided. This work extends Starfield’s system-level paradigm to the individual level with the core value of primary care the doctor-patient relationship. Successful sustainable models likely to be where relationships are centralised.
The impact of climate change is devastating in developing countries where flood protection and insurance schemes are limited. Certain parts of Ho Chi Minh City, Vietnam are under the constant threat of inundation due to sea-level rise. We integrate the hedonic property model in a difference-in-differences framework and spatial econometric analysis into a single analytical framework to estimate the economic effect of pluvial flooding. We find prices for affected houses were discounted by 9% after a large flood event on 30 September 2017. This research contributes to the existing literature as follows. First, we study the economic impact of pluvial floods, which has received less attention in existing studies where large and irregular floods are their focus. Second, the inclusion of legal status as a control variable accounts for the unique character of the Vietnamese housing market. Third, we also identify the recovery of house prices after the flood event.
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