Strengthening the integration of primary care in pandemic response plans: a qualitative interview study of Canadian family physicians

Abstract

Background: As the first point of contact in healthcare, primary care providers play an integral role in pandemic response. Despite this, primary care has been overlooked in previous pandemic plans, with a lack of emphasis on ways in which the unique characteristics of family practice could be leveraged to create a more effective response. Aim: To explore family physicians’ perceptions of the integration of primary care in the COVID19 pandemic response. Design and Setting: Descriptive qualitative approach examining family physician roles during the COVID19 pandemic across four regions in Canada. Method: We conducted semi-structured qualitative interviews with family physicians and asked about their roles during each pandemic stage, as well as facilitators and barriers they experienced in performing these roles. Interviews were transcribed and a thematic analysis approach was employed to develop a unified coding template across the four regions and identify recurring themes. Results: Sixty-eight family physicians completed interviews. Four priorities for integrating primary care in future pandemic planning were identified: 1) improve communication with family physicians, 2) prioritize community-based primary care, 3) leverage the longitudinal relationship between patients and family physicians, and 4) preserve primary care workforce capacity. Across all regions, family physicians felt that primary care was not well-incorporated into the COVID19 pandemic response. Conclusion: Future pandemic plans require greater integration of primary care to ensure the delivery of an effective and coordinated pandemic response. Strengthening pandemic preparedness requires a broader reconsideration and better understanding of the central role of primary care in health system functioning.

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

“…During COVID-19, PPE held deep symbolic meaning for FPs, representing the health system's lack of respect for primary care. The lack of priority placed on primary care in pandemic responses, including in the planning for PPE, has been reported in other highincome countries [38][39][40][41]. The limited representation of primary care leaders in pandemic response decisionmaking bodies [9,42] contributed to hospital-centric PPE plans, and under-appreciated both the potential risk of COVID-19 to primary care providers [43], as well as the contribution of primary care in alleviating demand for hospital-based services [16].…”

“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.…”

Practice- and System-Based Interventions to Reduce COVID-19 Transmission in Primary Care Settings: A Qualitative Study

“…We described practice- and system-based approaches used in four regions in Canada to mitigate the risk of COVID-19 in primary care settings. Many FPs in Canada and elsewhere felt poorly guided by public health and IPAC guidelines that largely focused on acute care settings ( Hoernke et al 2021 ; Houghton et al 2020 ; Khunti et al 2020 ; Mathews et al 2022 , 2023b ) and worked to tailor these guidelines to suit primary care settings. FPs who participated in our study demonstrated their ability to enact all five IPAC elements in their practices (see Table 1 ), despite PPE shortages.…”