scholarly journals The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tingting Zhang ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Linhai Zhao ◽  
Debin Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Rural China ◽  
Antibiotic Prescribing ◽  
Epidemic Control ◽  
Primary Health ◽  
Tract Infections ◽  
The Impact

Abstract Background In China, the primary health care (PHC) system has been designated responsible for control and prevention of COVID-19, but not treatment. Suspected COVID-19 cases presenting to PHC facilities must be transferred to specialist fever clinics. This study aims to understand the impact of COVID-19 on PHC delivery and on antibiotic prescribing at a community level in rural areas of central China. Methods Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and analysed thematically. Results PHC practitioners reported a major shift in their work away from seeing and treating patients (due to government-mandated referral to specialist Covid clinics) to focus on the key public health roles of tracing, screening and educating in rural areas. The additional work, risk, and financial pressure that PHC practitioners faced, placed considerable strain on them, particularly those working in village clinics. Face to face PHC provision was reduced and there was no substitution with consultations by phone or app, which practitioners attributed to the fact that most of their patients were elderly and not willing or able to switch. Practitioners saw COVID-19 as outside of their area of expertise and very different to the non-COVID-19 respiratory tract infections that they frequently treated pre-pandemic. They reported that antibiotic prescribing was reduced overall because far fewer patients were attending rural PHC facilities, but otherwise their antibiotic prescribing practices remained unchanged. Conclusions The COVID-19 pandemic had considerable impact on PHC in rural China. Practitioners took on substantial additional workload as part of epidemic control and fewer patients were seen in PHC. The reduction in patients seen and treated in PHC led to a reduction in antibiotic prescribing, although clinical practice remains unchanged. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and increased public health roles and, in the case of the village clinics, remain financially viable.

scholarly journals The Impact of COVID-19 on Primary Health Care and Antibiotic Prescribing in Rural China: Qualitative Study

2021 ◽  
Author(s):  
Tingting Zhang ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Linhai Zhao ◽  
Debin Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Rural China ◽  
Antibiotic Prescribing ◽  
Epidemic Control ◽  
Primary Health ◽  
Tract Infections ◽  
The Village

Abstract Background: Primary health care (PHC) system is designated to be responsible for epidemic control and prevention during the outbreak of COVID-19 in China, while COVID-19 suspected cases in PHC are required to be transferred to specialist fever clinics at higher level hospitals. This study aims to understand to impact of COVID-19 on PHC delivery and antibiotic prescribing at community level in the rural areas of central China.Methods: Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and thematically analysed.Results: Practitioners’ and patients’ views and perspectives on COVID-19 impacts on PHC services and antibiotic prescribing are organised into four broad themes. PHC practitioners took on a key public health role of tracing, screening and educating in rural areas, while their original role in seeing and treating patients was reduced since government required patients to be diverted. The additional work, risk, and financial pressure that PHC practitioners faced placed considerable strain on them, particularly those working in the village clinics. PHC largely diminished that related to the difficulty of PHC workforce with limited medical training and the high number of elderly patients in rural areas, and as a result of epidemic, rural patients found it more difficult to access health care. Antibiotic prescribing practices for non-COVID-19 respiratory tract infections remained unchanged and were not seen as relevant to practitioners’ knowledge of COVID-19, although overall antibiotic treatments were reduced because fewer patients were attending rural PHC clinics. Conclusions: Our study identified the considerable impact of COVID-19 epidemic on PHC in rural China. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and prevention and public health roles and, in the case of the village clinics, remain financially viable.

scholarly journals The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study

2021 ◽  
Author(s):  
Tingting Zhang ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Linhai Zhao ◽  
Debin Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Central China ◽  
Antibiotic Prescribing ◽  
Epidemic Control ◽  
Primary Health ◽  
Tract Infections ◽  
The Impact

ABSTRACTIntroductionPrimary health care (PHC) system is designated to be responsible for epidemic control and prevention during the outbreak of COVID-19 in China, while COVID-19 suspected cases in PHC are required to be transferred to specialist fever clinics at higher level hospitals. This study aims to understand to impact of COVID-19 on PHC delivery and antibiotic prescribing at community level in the rural areas of central China.MethodsQualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres (THCs) and nine village clinics (VCs) in two rural residential areas of Anhui province. Interviews were transcribed verbatim and thematically analysed.ResultsPractitioners’ and patients’ views and perspectives on COVID-19 impacts on PHC services and antibiotic prescribing are organised into four broad themes: switch from PHC to epidemic prevention and control, concerns and challenges faced by those delivering PHC, diminished PHC, and COVID-19 as a different class of illness.ConclusionThe COVID-19 epidemic has had a considerable impact on the roles of rural PHC clinics in China that shifted to public health from principal medical, and highlighted the difficulties in rural PHC including inadequately trained practitioners, additional work and financial pressure, particularly in VCs. Antibiotic prescribing practices for non-COVID-19 respiratory tract infections remained unchanged since the knowledge of COVID-19 was not seen as relevant to practitioners’ antibiotic treatment practices, although overall rates were reduced because fewer patients were attending rural PHC clinics. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and public health roles and, in the case of the VCs, remain financially viable.

scholarly journals Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review

10.2196/23482 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e23482 ◽  
Author(s):  
Seung Min Han ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Antibiotic Prescribing ◽  
Remote Consultation ◽  
Face To Face ◽  
Primary Health ◽  
The Impact ◽  
Remote Consultations

Background There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. Objective This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. Methods Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). Results In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. Conclusions There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

scholarly journals Perspectives of health workers regarding primary health care delivery to the rural population in the Bothaville district*

Curationis ◽  
1999 ◽  
Vol 22 (4) ◽  
Author(s):  
E Janse van Rensburg
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Delivery ◽  
Rural Areas ◽  
Information Dissemination ◽  
Health Workers ◽  
Care Delivery ◽  
Public Health Services ◽  
Primary Health

This article reports on the views of public health workers regarding recent changes in the delivery of primary health care to people living and working in the Bothaville rural area. These changes in mobile health care form part of the Initiative for Sub-District Support’s programme to provide sustained, concerted support to sub-districts to bring about improvements in health care management and health care delivery. Main shortcomings of the recent changes were identified as inadequate transportation facilities in rural areas, insufficient information dissemination to rural dwellers and lack of farmers’ participation in rural health matters. Furthermore, poor communication and co-operation between different public health services prevailed and the need for an integration of these services was emphasised.

scholarly journals Assessment of primary laboratory facilities for rural health care preparedness in Osmanabad District, India

2019 ◽  
Author(s):  
Rahi Jain ◽  
Bakul Rao
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health Status ◽  
Rural Health ◽  
Rural Health Care ◽  
Rural Areas ◽  
Public Health Response ◽  
Primary Health ◽  
Laboratory Services

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centers (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in terms of laboratory services are essential in primary health care facilities.

scholarly journals Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (Preprint)

2020 ◽  
Author(s):  
Seung Min Han ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Antibiotic Prescribing ◽  
Remote Consultation ◽  
Face To Face ◽  
Primary Health ◽  
The Impact ◽  
Remote Consultations

BACKGROUND There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. OBJECTIVE This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. METHODS Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). RESULTS In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. CONCLUSIONS There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

scholarly journals Zimbabwe's New Diploma in Psychiatric Health

1983 ◽  
Vol 7 (4) ◽  
pp. 69-71
Author(s):  
W. Murdoch
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Communities ◽  
Medical School ◽  
Rural Areas ◽  
Medical Services ◽  
Specialist Care ◽  
Primary Health

Psychiatry in a land of 7 1/2 million (National Census, August 1982) people with relatively advanced general medical services, but only eight psychiatrists, has great problems. The facilities have been described elsewhere (Murdoch, 1982). Historically poorly related to population needs, and with immense difficulties in serving the rural communities that still comprise over half the population (National Census), Zimbabwe has concentrated its post-independence effort on the development of primary health care in village, district and small town. With a medical school expanding (current intake 80 students per annum) and good central facilities for training and specialist care, primary care in public health and general medical services are developing on a sound basis. In psychiatry, a mere 1200 beds for the country (only 141 in the capital, Harare, which, with dormitory towns, has an ‘official’ population of 1.1 million and serves a further four million in remote rural areas) the training and specialist facilities are sketchy indeed.

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