Family physicians’ responses to personal protective equipment shortages in four regions in Canada: a qualitative study

Abstract

Background Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians’ (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. Methods As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. Results A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. Conclusions During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic.

Barriers to healthcare-worker adherence to infection prevention and control practices in British Columbia during the coronavirus disease 2019 (COVID-19) pandemic: A cross-sectional study

“…Shortages of PPE were common in 2020 for multiple reasons and were often more pronounced in non–acute care settings. 31 , 32 In addition to limited supply, PPE fatigue and impaired function were commonly reported in our survey, consistent with published literature showing these to be barriers to IPAC practices. 33 …”

“…Shortages of PPE were common in 2020 for multiple reasons and were often more pronounced in non-acute care settings. 31,32 In addition to limited supply, PPE fatigue and impaired function were commonly reported in our survey, consistent with published literature showing these to be barriers to IPAC practices. 33 Further qualitative research to better understand barriers from the frontline worker experience would be an excellent complement to this study, particularly focused on groups that may have been underrepresented among respondents in our survey, such as physicians or care providers without regular access to computers (eg, environmental services staff).…”

“Family doctors are also people”: a qualitative analysis of how family physicians managed competing personal and professional responsibilities during the COVID-19 pandemic

“…Recognising this limitation, many FPs continued to provide in-person care throughout the pandemic but did so in the face of COVID-19 exposure concerns for both them and their family members [ 13 ]. These concerns were most prominent early in the pandemic when less was known about COVID-19 transmission and as FPs struggled to secure appropriate PPE, particularly those without access to government PPE supplies [ 40 – 42 ]. Though the FPs we interviewed displayed resilience and resourcefulness in navigating these health concerns and PPE deficiencies, quicker and easier access to PPE for all FPs in future pandemics should help ameliorate their personal and family health concerns and better support their participation in a pandemic response [ 40 ].…”

“There’s nothing like a good crisis for innovation”: a qualitative study of family physicians’ experiences with virtual care during the COVID-19 pandemic

“…The provision of virtual care became an expected role for FPs during the COVID-19 pandemic [54] and is part of a multi-pronged strategy to minimise exposure risks for patients, FPs, and clinic staff [55] while mitigating PPE needs associated with in-person consultations [56] during a pandemic. Future research should evaluate the effectiveness of increasing the use of virtual modalities in primary care during flu seasons and for clinically vulnerable patients to reduce infection risks.…”