Health care professionals’ perspectives on the utilisation of a remote surveillance and care tool for patients with COVID-19 in general practice: a qualitative study

Abstract

Background Most COVID-19 patients with severe symptoms are treated in hospitals. General practices are responsible for assessing most ambulatory patients. However, they face several challenges managing COVID-19 patients, and those with non-COVID-19 conditions. In April of 2020, we designed a software tool for the structured surveillance of high-risk home-quarantined COVID-19 patients in general practice (CovidCare) including several telephone monitorings, in order to support general practices and early identification of severe courses. This study presents the qualitative results of a mixed-methods process evaluation study on CovidCare. Methods In a qualitative process evaluation study conducted between March and May 2021, we explored the perspectives of seven general practitioners (GPs) and twelve VERAHs (medical care assistants with special training) on CovidCare using semi-structured interviews based on the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance). We used deductive qualitative content analysis employing the RE-AIM framework to assess the utilisation and implementation of CovidCare. Results Overall, most health care professionals were satisfied with CovidCare. They highlighted 1) a good orientation for the management of COVID-19 patients, especially due to a high level of uncertainty at the beginning of the pandemic, 2) the possibility to gain new knowledge, and 3) the structured data collection as facilitators for the implementation of CovidCare. Moreover, CovidCare reduced the workload for GPs while some VERAHs perceived a higher workload as they were responsible for large parts of the CovidCare management. However, CovidCare positively affected the VERAHs’ job satisfaction as most patients provided positive feedback and felt less anxious about coping with their disease. Previous experience with the software and an easy integration into daily practice were considered to be crucial utilisation drivers. Time and personnel resources were identified as major barriers. To further improve CovidCare, participants suggested a less comprehensive version of CovidCare, the expansion of inclusion criteria as well as an app for the patients’ self-management. Conclusion The COVID-19 surveillance and care tool for COVID-19 patients with increased risk was perceived as useful by GPs and VERAHs. Supportive remote health care tools such as CovidCare are a viable means to maintain comprehensive and continuous health care during a pandemic and may strengthen the primary care system. Trial registration German Clinical Trials Register DRKS00022054; date of registration: 02/06/2020.

Psychosocial working conditions and mental health among medical assistants in Germany: a scoping review

“…General practitioners support or lack thereof influenced the perceived stress. Incomplete knowledge on depression increased strain Burdening and relieving factors Interaction with depressed patients Collaboration with doctor Disease conception [ 53 ] Hoffmann et al 2022 12 v Qualitative, cross-sectional; semi-structured interviews To present the qualitative results from the process evaluation of an intervention for COVID-19 surveillance and care for COVID-19 patients with increased risk used by VERAHs (specially qualified MA) and general practitioners Sense of security The implementation of the intervention gave MA a sense of security and support. MA emphasized additional workload as particularly negative because the intervention added additional tasks and strain in the already tightly organized daily practice.…”

“…Qualitative studies that examined psychosocial working conditions of MA during the COVID-19 pandemic reported an increased workload [ 51 , 53 ], with one study reporting MA being overwhelmed by the situation [ 53 ]. Studies examining the implementation of interventions reported barriers in MA taking up new tasks and/or responsibilities in the context of these interventions due to an already existing lack of time [ 52 , 53 ].…”

“…A study conducted during the COVID-19 pandemic reported that MA felt that their role as frontline workers did not receive adequate recognition [ 51 ]. Positive feedback and gratitude from patients contributed to MA’s satisfaction with their work [ 53 , 59 ].…”

Experiencing COVID-19, home isolation and primary health care: A mixed-methods study

“…The German health care system is currently developing strategies to expand home-based care in order to decrease the burden placed upon the hospital sector ( 64 ). Remote home monitoring models could reassure patients during home based isolation and care ( 19 , 65 ), but more studies are needed to generate evidence for appropriate care ( 66 ) and the utility of different tools, such as pulseoxymetry ( 56 , 66 , 67 ). We showed that special attention should be placed on people living alone, with preexisting comorbidities or of old age.…”

“…During the course of the pandemic, health care systems had to prove resilience (17) finding new ways to ensure COVID-19 diagnosis and care, while adapting to hygiene, quarantine and isolation measures enforced to combat the spread of the disease. The adapted health structure included new modes of care and stakeholders: Telehealth services were rapidly expanded (18)(19)(20). In Germany, public health services (Öffentlicher Gesundheitsdienst) gained more influence and became a central player in patient management and implementing COVID-19 related policies (21) alongside general practitioners (GPs) who traditionally coordinate patient-centered prevention and care.…”