Krist AH et al.18, 2020, United States |
Presenting actions to be adopted by PHC during the pandemic, according to the protocol of the Centers for Disease Control and Prevention (CDC). |
Descriptive study |
The plan to tackle the Covid-19 pandemic in PHC was organized into six phases: 1) surveillance, notification, and monitoring of cases; 2) physical distancing, increasing virtual appointments, and postponing non-urgent appointments; 3) implementation of actions to flatten the epidemiological curve; 4) referral of only severe cases to hospitals; 5) care actions for convalescent patients; 6) addressing the consequences of the pandemic. |
Morreel S et al.19, 2020, Belgium |
Assessing the organization and characteristics of PHC appointments performed outside office hours and comparing them with those in the same period in 2019. |
Observational study |
By telephone screening, patients were classified as suspected or regular. All suspected Covid-19 cases were treated virtually, and, if necessary, referred to exclusive care units for Covid-19 suspected patients (Corona Units), or in home visits, or referred to emergency departments. In comparison with 2019, the workload increased due to phone calls, however, the number of face-to-face appointments decreased by 45%. |
Fernandes LMM et al.20, 2020, Brazil |
Analyzing the adaptation of a PHC center in Recife, which improved its telehealth and remote monitoring. |
Case report |
Reorganization of the internal flow of the unit, by separating symptomatic from asymptomatic patients; discontinuation of collective activities; maintenance of the follow-up of patients with chronic diseases; telemedicine and remote monitoring; and active surveillance actions promoted by the health team in the territory. |
Sigurdsson EL et al.21, 2020, Iceland |
Analyzing how PHC in Iceland changed its strategy to tackle the Covid-19 pandemic. |
Observational descriptive study |
Early detection of suspected cases; effective screening; separation of symptomatic and asymptomatic patients; maintenance of activities aimed at maternity and childcare; change from face-to-face care to telemedicine; alternative office hours. Change in the 10 main diagnoses—immunization, depression, hypothyroidism, and low back pain were no longer among the 10 main diagnoses. These changes showed a very solid PHC, with great flexibility in its organization. |
Dias EG22, 2020, Brazil |
Discussing the management of care and health education in PHC to tackle the Covid-19 pandemic. |
Experience report |
Immediate identification of respiratory symptoms; space reserved to wait for an appointment; discontinuation of some care activities; telemedicine and telemonitoring; home visit or face-to-face care, if necessary; health education by radio, sound cars, flyers, posters, social networks, and phone. |
Vieira DS et al.23, 2020, Brazil |
Developing an experience of organizational planning in nursing along with the family health team in a rural area of Igreja Nova, AL, during the Covid-19 pandemic. |
Experience report |
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This study followed three strategies:
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•Community guidance on the problem of health prevention and promotion actions.
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•Permanent health education for the health team, in order to qualify professionals.
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•Organization of the provision of health services, establishment of an exclusive room to treat respiratory symptoms, and organization of the care of patients of programs in the unit.
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Jacobson, NA et al.28, 2020, Brazil |
Addressing a collaborative effort to care for a community during the Covid-19 pandemic from the development of a clinic. |
Experience report |
The authors analyzed the adaptation of a clinic with PHC exclusively for Covid-19 patients. Nurses determined if patients would need emergency care or care at the Covid-19 clinic by a virtual evaluation, by Zoom. Later, patients had a face-to-face appointment scheduled at the specific unit. In order to maximize social distancing, the physical space was adjusted. |
Saint-Lary O et al.29, 2020, France |
Analyzing how general physicians adapted their practices to ensure and maintain access to care during the epidemic phase. |
Descriptive observational study |
A total of 5,424 French general physicians were interviewed. Of them, 70.9% changed face-to-face care to remote care, 66.5% increased the number of remote appointments, and 42.7% created a specific flow for suspected Covid-19 patients. Of the 70.9% who adapted their practice, 91.7% used phones, 27.6% email, and 30.7% increased their use of video calls. |
Majeed A et al.30, 2020, England |
Assessing the response of primary health care for Covid-19 in the National Health Service (NHS) in England. |
Descriptive observational study |
Change from face-to-face care to remote care; care of suspected or confirmed Covid-19 patients in specific clinics; implementation of home visits specific for Covid-19 care; complete computerization of all National Health Service units; use of electronic medical records; online access of patients to health services (such as making appointments, asking for prescriptions, and seeing medical records); electronic sending of prescriptions, directly to the pharmacies of the patient’s choice. |
Al Ghafri T et al.32, 2020, Oman |
Assessing experiences and perceptions of PHC health professionals during the Covid-19 pandemic in relation to medical response experiences, sociocultural and religious reforms, psychological impressions, and lessons learned. |
Qualitative and phenomenological study |
Rapid reorganization of PHC services; use of technology; challenges of working in the Covid-19 pandemic; changes in social and religious standards; emergence of gaps in the access of vulnerable groups to health care; emergence of psychological disorders due to social distancing; management of corpses; exhaustion of health professionals; risk of exposure; and development of epidemiological and public health capacities, improving access to health care. |
Blazey-Martin D et al.33, 2020, United States |
Developing an innovative population management approach to remotely manage Covid-19 patients. |
Experience report |
An algorithm was used to guide screening decisions, including the frequency of contact with patients, depending on the day of the onset of symptoms and risk factors, and identify clinical findings that showed if patients were safe to stay at home or required further evaluation. These interventions, when performed on time, reduced the demand of hospitals and emergency care. |
Verhoeven V et al.34, 2020, Flandres |
Assessing the consequences of the Covid-19 outbreak experienced by physicians on the front line on the core competencies of family and community medicine. |
Experience report |
Screening and appointments performed by phone for all patients; clinical decision-making focused on respiratory evaluation and screening; impairment of acute care due to the change of focus to only Covid-19 and patients that did not seek care for problems that were not related to Covid-19; postponement of chronic care. |
Karim SI et al.35, 2020, Saudi Arabia |
Analyzing the strategies adopted to reorganize PHC during the Covid-19 pandemic in a hospital in the capital of Saudi Arabia. |
Experience report |
Services were adapted based on surveillance and case detection, clinical management, prevention of the spread, and maintenance of essential services. These changes were made by the Department of Family Medicine and all appointments started to be performed remotely, by WhatsApp and virtual clinics. Moreover, new means of communication, such as websites, portal messages, and social networking, started to be used. |
Motlhatlhedi K et al.36, 2020, Botswana |
Assessing the action of family health physicians during the pandemic. |
Descriptive observational study |
Family health physicians were responsible for infection control, disease prevention measures, identification of cases, dissemination of information, and continuity of medical care, especially for patients. The use of WhatsApp has expanded to include online webinars, as well as to disseminate information about Covid-19 from various sources and the national coordination center. |
Sinha S et al.37, 2020, United States |
Evaluating the implementation of a video care program at a large academic PHC clinic in New York. |
Case study |
In total, 1,030 video appointments were performed for 817 patients. Of them, 42% were due to Covid-19 symptoms and 58% due to acute or chronic conditions. Most patients were young adults, women, and people with commercial insurance. The degree of satisfaction was high (mean of 4.6 on a 5-point scale [SD = 0.97]). |
Joy M et al.38, 2020, England |
Assessing the responsiveness and prioritization of the type of PHC appointment for older adults during the Covid-19 pandemic. |
Cross-sectional study |
The rate of phone and video appointments more than doubled during the study period (106.0% and 102.8%, respectively). Face-to-face appointments decreased by 64.6% and home visits by 62.6%. This process coincided with national policy changes. The relative increase in the number of appointments was associated with people taking ≥ 10 medicines in comparison with those who did not take any. |
Al Ghafri T et al.39, 2020, Oman |
Assessing responses to PHC units from January to April 2020, including public health measures in Muscate, Oman. |
Descriptive study |
The number of appointments decreased from 115,324 in January to 109,719 in March 2020. Essential services were guaranteed in all health centers, especially for vulnerable groups, women, and children. Health centers were opened for 24 hours to ensure the force of testing and isolation. Telemedicine and virtual communications were adopted. Campaigns on the importance of social distancing and hand hygiene were promoted. |
Bressy S40, 2020, Italy |
Assessing the experience of PHC management to tackle Covid-19 in Italy during the beginning of the pandemic. |
Experience report |
Technological support and remote approach are essential to assess Covid-19 primary care. The use of telemedicine and the aid of technology allowed an efficient monitoring of patients at home, reducing inadequate hospitalizations, as patients were referred to a hospital only when necessary. |
Mantovani W et al.41, 2020, Italy |
Assessing the organization and the role of the Department of Prevention of the Local Health Unit of Trento in the prevention of the dissemination and management of Covid-19, according to general physicians and pediatricians during the initial phase of the pandemic. |
Observational descriptive study |
More than 80% of physicians notified patients. The waiting time for phone interviews, epidemiological investigation, and availability of isolation progressively decreased from an average of six days to 0.4 days in the 12th and 16th weeks of 2020, respectively. The cumulative weekly notification rate of new cases ranged from 3.54 to 6.84 cases per 1,000 inhabitants in the 12th and 16th weeks, respectively. From the epidemiological investigation of 1,471 probable cases, 2,514 close contacts were identified and, in turn, quarantined at home. |
Duarte RB et al.43, 2020, Brazil |
Assessing the actions of nurses working in the Estratégia Saúde da Família (ESF – Family Health Strategy) with regard to the role that community health agents played along with the population during the Covid-19 pandemic. |
Experience report |
The role of community health agents is to be a mediator between health teams and the population, developing guidance actions on the functioning of preventive services and self-care related to Covid-19 in the territories where they work. Nurses also play an important role in the training of community health agents regarding the reorganization of the work process during the pandemic and the appropriate use of personal protective equipment. |
Ximenes Neto FRG et al.44, 2020, Brazil |
Assessing strategic actions of care coordination, monitoring, and surveillance of Covid-19 cases in PHC. |
Experience report |
This study highlighted the importance of horizontal social isolation and home isolation of positive cases, the use of digital technologies to disseminate actions on the prevention of Covid-19 and implementation of telemedicine, the strengthening of intersectoral actions among health, education, and social assistance, and the structuring of the Rede de Atenção à Saúde (RAS – Health Care Network). |
Coma E et al.46, 2020, Spain |
Analyzing the effect of the Covid-19 epidemic and lockdown measures based on health care quality indicators and the control of chronic diseases. |
Retrospective descriptive study |
In total, 34 quality indicators were evaluated and 85% and 68% of them showed negative results in March and April 2020, respectively, when compared with the same period in 2019. Regarding treatment, monitoring, and chronic disease indicators, 100%, 80%, and 90% of them presented negative effects, respectively. |
Garg S et al.47, 2020, India |
Determining the preparation of PHC units for the provision of safe outpatient services during the Covid-19 pandemic in India. |
Cross-sectional study |
This study assessed 51 PHC services and identified problems in infrastructure and infection control. Care for chronic non-communicable diseases, immunization, prenatal care, and maternal and child health were the most affected areas. On the other hand, in screening sites for flu symptoms, the number of appointments increased. |
Danhieux K et al.48, 2020, Belgium |
Evaluating how PHC services aimed at chronic conditions was affected during the pandemic in Belgium. |
Qualitative research |
The health care organization changed, starting to focus on suspected Covid-19 cases and the use of telemedicine, and decreasing the provision of care for chronic conditions. Most professionals interviewed did not perform risk stratification and active search for patients at higher risk—telemedicine was used to evaluate and prescribe medicines and not to monitor chronic conditions. The provision of care for chronic conditions was sharply discontinued. |