Covid-19: how coronavirus will change the face of general practice forever

Thornton, Jacqui

doi:10.1136/bmj.m1279

Cited by 124 publications

(121 citation statements)

References 2 publications

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“…For example, in Italy, GPs have historically played an important and personal role in the lives of families, but in this pandemic situation, GPs modified their practice methods by using telephone calls and other digital approaches ( Fiorino et al, 2020 ). With these changes, some typical functions of primary care, including physical examinations and immunizations, have been unavoidably neglected ( Thornton, 2020 ) while GPs are tasked with new responsibilities, such as additional safety protocols, learning new technology, and daily e-mails for prescriptions.…”

Section: Introductionmentioning

confidence: 99%

From Resilience to Burnout: Psychological Features of Italian General Practitioners During COVID-19 Emergency

et al. 2020

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During the COronaVIrus Disease 2019 (COVID-19) pandemic in Italy, general practitioners (GPs) are ensuring continued access to primary care for citizens while also absorbing more of the impact of the crisis than most professional groups. The aim of this study is to explore the relationships between dimensions of burnout and various psychological features among Italian GPs during the COVID-19 emergency. A group of 102 GPs completed self-administered questionnaires available online through Google Forms, including Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and Coping Inventory for Stressful Situations (CISS). Cluster analysis highlighted four distinct burnout risk profiles: Low Burnout, Medium Risk, High Risk, and High Burnout. The High Burnout group showed both lower Resilience and lower CISS Task-oriented coping strategy than the Medium Risk group and higher IU Prospective than the Low Burnout group. Results of a linear regression analysis confirmed that CISS Emotion-oriented style positively predicted MBI Emotional Exhaustion, CISS Task-oriented and Emotion-oriented emerged as significant predictors (negatively and positively, respectively) of MBI Depersonalization, and Resilience positively predicted MBI Personal Accomplishment. In conclusion, the results showed that the COVID-19 emergency had a significant impact on GPs’ work management. Implementing task-oriented problem management, rather than emotional strategies, appears to protect against burnout in these circumstances. It is possible that the emotions related to the pandemic are too intense to be regulated and used productively to manage the professional issues that the COVID-19 pandemic presents.

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Section: Introductionmentioning

confidence: 99%

From Resilience to Burnout: Psychological Features of Italian General Practitioners During COVID-19 Emergency

et al. 2020

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“…New arrangements aimed at bring primary, hospital, long term and social care closer together are now of paramount importance. 15 These are likely to provide further stimuli for change in all these sectors: home care and increased telephone and video consultations and referrals [16][17][18] ; better defined roles in the health system for hospitals 19 ; immediate and forceful adoption of personal care plans for managing long term care and anticipating acute needs 20 ; better recognition of the relevance of social prescribing. 21 The extraordinary performance of healthcare professionals and the personal risks they incurred during the current crisis will also provide further impetus for a new kind of policies favoring better working conditions for the healthcare professions.…”

Section: Pandemic-related Intermediate Development Stagesmentioning

confidence: 99%

From Viral City to Smart City: Learning from Pandemic Experiences

Sakellarides

2020

Acta Med Port

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Acta Med Port 2020 xxx;33(AOP):xxx-xxx ▪ https://doi.org/10.20344/amp.13841 Flu city, Smart cityPublic health global threats have become increasingly frequent over the last two decades: Avian flu, SARS, H1N1 flu, MERS, Ebola, Zika and now COVID-19.Looking at the way public health preparedness took place regarding avian flu and SARS global threats, it seemed apparent that there was a striking discontinuity between ongoing community health practices and the command-and-control mode of public health emergency preparedness and action.This issue was addressed in a short assay -Flu City-Smart City: applying health promotion principles to a pandemic threat 1 -in 2006. A mindset change, from threat to ingenuity, is suggested: "The critical triangle consists of a unique and dynamic inter-face between three components: knowledge, values and innovation. If we want to be prepared for a major flu epidemic, we must understand not only the virus and how it spreads but also cities and how they function, organizations and how they operate, communities and how they relate, and individuals and how they make choices".In preparing for and following the development of the 2009 H1N1 flu pandemic, this same framework was adopted to analyze the 'social response' to the pandemic threat. 2 However, the aftermath of the 2009 pandemic turned out to be unfriendly to innovative thinking. The H1N1 virus was partially 'known' by the aged; disease incidence was comparable to that of a moderate seasonal flu, which led to community perceptions that the approaches adopted for preparing for the pandemic where exaggerated; the acquisition of large amounts of antiviral oseltamivir were sharply criticized; there was limited adherence to the vaccination program for the mildly pandemic H1N1. Nevertheless, the traditional public health emergency model came out untouched from this pandemic experience.In "The next outbreak? We are not prepared", Bill Gates stressed in 2015, 3 that we were well prepared for the next war, but not equally well prepared for the next pandemic. Gates addressed the hardware and software of global preparedness but not the "humanware" of local community intelligence.Neither were part of this pandemic preparedness. 4

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“…However, the novel coronavirus pandemic (SARS-CoV-2) rapidly changed ICU practice internationally [9]. Challenges include an inadequate number of beds to meet the staggering increase in the number of patients with COVID-19 infections [10] and unbalanced interprofessional staff resources to meet the demand [11].…”

Section: Introductionmentioning

confidence: 99%

ABCDEF Bundle and Supportive ICU Care Practices for patients with COVID-19 infection: An international point prevalence study ~The ISIIC Study~

Liu

Nakamura²,

Katsukawa³

et al. 2020

Preprint

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BackgroundAlthough the number of patients with COVID-19 infection is increasing and concerns for their long-term disabilities are increasing, there is a lack of data about the delivery of the ABCDEF-bundle and supportive care in Intensive Care Units (ICUs). The aim of this study is to investigate the implementation of the ABCDEF-bundle and supportive care provided to patients with COVID-19 infections in ICUs. MethodsThis was a world-wide two-day point prevalence study, on June 3 and July 1, 2020. A total of 212 ICUs in 38 countries (166 ICUs on Day 1 and 212 on Day 2) participated. Clinicians in each participating ICU completed web-based online surveys. The implementation rate for elements of the ABCDEF-bundle, other supportive ICU care measures and implementation associated structures were investigated.RESULTSData for 262 patients was collected during the two-day study. Of patients included, 124 (47.3%) underwent mechanical ventilation (MV) and 12 (4.6%) patients were treated with extracorporeal membrane oxygenation (ECMO). The proportion of patients with implementation of each element was: Element A (regular pain assessment) 45%; B (both spontaneous awakening and breathing trials) 28%; C (regular sedation assessment) 52%; D (regular delirium assessment) 38%; E (early mobility and exercise) 47%; and F (family engagement and empowerment) 16%. The implementation of element E for patients on MV was 16% and ECMO was 17%. Supportive care, such as providing protein throughout the ICU stay (under 1.2g/kg for more than 50% of the patients) and introduction of an ICU diary (25%) was inadequate. A higher implementation rate of elements A and D were recognized in ICUs with specific protocols for ICU care and lower numbers of ICU beds exclusively for patients with COVID-19 infection. Element E was implemented at a higher rate in ICUs with more ICU beds for patients with COVID-19 infection.CONCLUSIONSThis worldwide two-day point prevalence study found low implementation of the ABCDEF-bundle. Specific protocols and the number of ICU beds reserved for patients with COVID-19 infections might be key factors to deliver appropriate supportive care.Trial registration: UMIN, UMIN000040405. Registered 14 May 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000046103

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Covid-19: how coronavirus will change the face of general practice forever

Abstract: GPs say the covid-19 pandemic will bring about lasting change in how they work, Jacqui Thornton reports

Cited by 124 publications

References 2 publications

From Resilience to Burnout: Psychological Features of Italian General Practitioners During COVID-19 Emergency

From Resilience to Burnout: Psychological Features of Italian General Practitioners During COVID-19 Emergency

From Viral City to Smart City: Learning from Pandemic Experiences

ABCDEF Bundle and Supportive ICU Care Practices for patients with COVID-19 infection: An international point prevalence study ~The ISIIC Study~

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