Healthcare professionals’ perceptions of impacts of the Covid-19-pandemic on outpatient care in rural areas: a qualitative study

Abstract

Background Measures to manage the COVID-19 pandemic have led to impacts on healthcare systems and providers worldwide. Outpatient healthcare professionals (HCPs) provide the majority of patient care. Insight into their experiences during a pandemic is rare. Therefore, we explored how primary and secondary care HCPs in a rural area in Germany experienced their work during the pandemic and what health-related outcomes they perceived in their patients. In this context, we also examined the impact on access to and utilization of healthcare and working conditions. Methods We conducted a qualitative interview study with outpatient HCPs. We recruited by e-mail, telephone, professional networks and personal contacts. Data were collected between August 2020 and January 2021. All interviews were audio recorded, transcribed, and analysed using qualitative content analysis. Results Our sample consisted of 28 HCPs (15 family physicians, 7 cardiologists, and 6 non-physician assistants, 12 female) from Saxony-Anhalt, Germany. HCPs experienced fewer consultations as well as cancellations by hospitals and secondary care physicians, especially at the beginning of the Covid-19-pandemic, while they continued throughout to provide outpatient care. They quickly adopted changes in practice organisation and healthcare provision. There was a shift towards telephone consultations, home visits as well as unconventional consultations e.g. through the practice window. Family physicians used personal relationships to support utilization of healthcare and to avoid health-related effects. Social tension and burden seemed to interact with a perceived lack of preparedness, the pandemic-related changes in their working condition as well as access to and utilization of healthcare. Chronic disease monitoring was postponed, which could have consequences in the course of disease of patients. HCPs experienced effects on patients’ psychological well-being. Conclusion Our study demonstrates the impacts of Covid-19-pandemic on outpatient care in rural areas and emphasizes its importance. HCPs experienced impacts on access to and utilization of healthcare, working conditions and health-related outcomes. Health policy should create a framework for healthcare to support outpatient care in rural areas with a looming undersupply of primary and secondary care in order to maintain healthcare and reduce pandemic impacts.

Providing ambulatory healthcare for people aged 80 and over: Views and perspectives of physicians and dentists from a qualitative survey

“…Approximately one third of a representative sample of the general population stated to have a medical, dental or therapeutical appointment postponed or cancelled (by themselves or the providers) [56]. This mostly regarded preventive and routine examinations, especially in dental care [56,57]. However, decreases were especially seen among people aged 35 years or younger and in the field of GP care, while specialist consultations, particularly among people aged 75 or 80 and over, remained stable [56][57][58].…”

“…This mostly regarded preventive and routine examinations, especially in dental care [56,57]. However, decreases were especially seen among people aged 35 years or younger and in the field of GP care, while specialist consultations, particularly among people aged 75 or 80 and over, remained stable [56][57][58]. In the course of 2021, a general stabilization of ambulatory healthcare utilization occurred, despite on-going or relaunched legislative protection measures [58,59].…”

“…In the course of 2021, a general stabilization of ambulatory healthcare utilization occurred, despite on-going or relaunched legislative protection measures [ 58 , 59 ]. Apart from the partially volatile patient numbers, healthcare providers were facing an additional burden especially due to diagnosis and treatment of COVID-19 in ambulatory healthcare practices, increasing alternative modes of consultation such as telephoning, infection protection measures in the practice and increased social tensions or deteriorated working climate [ 57 , 59 , 60 ]. Hence, what do the pandemic circumstances mean for the study in hand?…”

Health Service Accessibility, Mental Health, and Changes in Behavior during the COVID-19 Pandemic: A Qualitative Study of Older Adults

“…Older adults pointed out the frequent postponement of medical specialist consultations during the pandemic. The pandemic has had a major impact on waits for elective surgeries, where many scheduled interventions are being canceled or postponed [ 38 ]. With the main focus being preventing the spread of the virus, many health services were negatively affected, including consultations and their rescheduling.…”

Life Satisfaction and Perceived Stress versus Health Promoting Behavior among Medical Students during the COVID-19 Pandemic

“…Preventive behaviors during this particular period could be associated with increased stress for various reasons. During the pandemic, access to health care was significantly limited; therefore, it became difficult to conduct any preventive examinations during this period [ 46 , 47 , 48 , 49 ]. On the other hand, constant reminding and emphasizing the need to maintain social distance, wearing masks, and frequent hand washing could generate stress by the very fact of the enormous importance that these behaviors acquired during this time [ 50 , 51 ].…”