Ensuring the continuation of routine primary care during the COVID-19 pandemic: a review of the international literature

Abstract

Background The COVID-19 pandemic has resulted in the diversion of health resources away from routine primary care delivery. This disruption of health services has necessitated new approaches to providing care to ensure continuity. Objectives To summarize changes to the provision of routine primary care services during the pandemic. Methods Rapid literature review using PubMed/MEDLINE, SCOPUS, and Cochrane. Eligible studies were based in primary care and described practice-level changes in the provision of routine care in response to COVID-19. Relevant data addressing changes to routine primary care delivery, impact on primary care functions and challenges experienced in adjusting to new approaches to providing care, were obtained from included studies. A narrative summary was guided by Burns et al.’s framework for primary care provision in disasters. Results Seventeen of 1,699 identified papers were included. Studies reported on telehealth use and public health measures to maintain safe access to routine primary care, including providing COVID-19 screening, and establishing dedicated care pathways for non-COVID and COVID-related issues. Acute and urgent care were prioritized, causing disruptions to chronic disease management and preventive care. Challenges included telehealth use including disparities in access and practical difficulties in assessing patients, personal protective equipment shortages, and financial solvency of medical practices. Conclusions Substantial disruptions to routine primary care occurred due to the COVID-19 pandemic. Primary care practices’ rapid adaptation, often with limited resources and support, demonstrates agility and innovative capacity. Findings underscore the need for timely guidance and support from authorities to optimize the provision of comprehensive routine care during pandemics.

Challenges and experiences of general practitioners during the course of the Covid-19 pandemic: a northern Italian observational study—cross-sectional analysis and comparison of a two-time survey in primary care

“…This study is among the first to illustrate the ongoing general practice response to Covid-19 during different stages of the pandemic. Our results, with some limitations around generalizability, confirm that the disaster has demanded extraordinary adaptation by GPs 4 , 12 as not only the workload increased for most GPs, 10 but also the way of working and the challenges modified over time.…”

“…8–10 , 13 GPs initially received lower PPE supply than hospitals 14 , 15 and felt neglected and not fully considered by health authorities, while the response to the pandemic was mainly concentrated on hospitals. 16 , 17 Moreover, in the initial phase, measures to prevent the spread of infection, to protect vulnerable patients and care providers and—at the same time—to ensure continuity of care 12 were implemented such as appointment-based visits and increased teleconsultations.…”

Exploring the effectiveness of a P4P scheme from the perspective of Italian general practitioners: A replication study

“…The COVID‐19 pandemic has modified organization and processes of primary care: it led to the adoption of new strategies and innovative models of care which fulfiled need to prevent the spread of COVID‐19 and to ensure continuity of care while protecting providers and patients 54,57–59 …”

International examples of primary care COVID-19 preparedness and response: a comparison of four countries

“…This was a key theme in a 2020 international study looking at the pandemic response in 111 countries, 16–18 and has also been recognised in a number of European studies. 19–21 PC frequently demonstrates agility and innovative capacity in the face of limited resources and a changing environment 22 contributing to the resilience required in the face of pandemics.…”