Many regions and countries implemented stay-at-home orders to flatten the curve as the virus continues to plague the world at an alarming rate, said Dan Schwarz and Beth Tritter of Health Policy Watch, an independent global health reporting.
Citizens from China all the way to Italy have witnessed the impacts of the rapid spread of the virus, with hospitals overwhelmed and medical professionals forced to make dilemmas about who lives and dies. Emergency response can also go so far if primary health care—also known as the health system’s first line of defense—is not capable of dealing with the pandemic.
The Status of Primary Care During the Pandemic
Primary Care Collaborative (PCC), a coalition of over 1,000 organizations and individuals, found in their week 5 survey (April 10-13) that 12% of clinicians see disparities among racial minorities, 27% among low-income patients, and 20% among those lacking computer/internet access. 29% also saw disparities among those with mental health conditions and 33% among the elderly.
Two-thirds of respondents reported “rising family and economic concerns among patients” as a stress on their professions while 60% cited family and income concerns among practice members. 42% of respondents mentioned the “need to layoff or furlough practice members” as a stress on their practice. 46% had enough patient volume to stay open for the next four weeks while 47% had enough cash on-hand to stay open for the next four weeks.
10% said they were not likely to receive payment for video and e-based care, while 43% were unsure. When asked if they were likely to receive payment for telephone-based care, 44% said unsure and 16% answered no. Further, 70% of clinicians cited trends in reasons for COVID-19-related health disparities and burdens. 54% of clinicians were focused on continued stress related to finances, testing availability and accuracy, and PPE.
23% of clinicians focused on payment and access, including frustrations with telehealth and policy-driven obstacles to care. 21% of respondents discussed primacy care clinicians employed within systems suffering from greater risk and lack of autonomy.
According to a report by the Australian Primary Health Care Nurses Association (APNA), a peak professional body for nurses, 81.8% worked as registered nurses, 9.4% were enrolled nurses, 6% were nurses and midwives, and 2.8% were nurse practitioners. 67% of respondents were experienced nurses working in primary health care, 14% of them were new to primary health care, and 9% were recently graduated nurses (three years or less in the workforce). Regarding primary health care nurse activities on a daily basis, 62% were in infection control, 73% were in cold chain management, and 54% were in patient triage.
Other activities included wound care (65%), immunizations (54%), and administer medicines (63%). Nurses chose primary because there was work-life balance (60%), regular hours (59%), and no shiftwork (45%). Nurses were the most dissatisfied with pay in primary health care, with 45% either very dissatisfied or dissatisfied with their wages. The APNA found that that the average hourly pay for all respondents was $37.67.
What Is Primary Healthcare?
Primary healthcare refers to “a whole-of-society approach to health and well-being centered on the needs and preferences of individuals, families, and communities,” according to UN agency the World Health Organization (WHO), as quoted by Maria Cohut, Ph.D of Medical News Today, a web-based outlet for medical news. The WHO explained that primary healthcare ensures that individuals receive comprehensive care such as promotion, prevention, treatment, rehabilitation, and palliative care. Primary healthcare should be as close as possible to people’s everyday environment.
Impacts of COVID-19 to Primary Healthcare
Healthcare providers have minimized in-person contact with patients due to the virus, affecting prenatal care, which ensures that pregnant women and developing babies stay healthy throughout pregnancy. The Office on Women’s Health at the Department of Health and Human Services recommends frequent checkups and screenings for pregnant women.
These should include one checkup a month during weeks 4-28 of the pregnancy, two per month during weeks 28-36, and weekly checkups from there until birth. Sadly, the pandemic has disrupted or made these screenings impossible. For example, obstetricians in the US reportedly switched to having less frequent in-person appointments or resorted to telemedicine.
Specialists assert that telemedicine is safer and more convenient as it allows pregnant women to receive the support they need without going to the clinic in person, which places them at risk of infection. But pregnant women may be fearful of the pandemic for other reasons such as the possibility of contracting the virus and their birthing experience.
The pandemic also exposed disparities in access to primary healthcare. For most people across the globe, accessing quality care depends on where they live and how much income they earn. In developed and developing countries, primary healthcare is underfunded and deprioritized. In the US, for example, fragmented care and poor communication from experts left people anxious, prompting to make unnecessary visits to emergency rooms.
Over the last decade, funding Italy’s health system has been slashed, leading to dire consequences such as shortages in supplies and medical staff. Across Africa, misinformation and mistrust of healthcare could prevent people from seeking medical care, akin to that of Liberia and other West African countries during the Ebola outbreak from 2014 to 2016.
What Should be Done to Improve Primary Care?
In these trying times, primary care providers should be deemed as central partners and first respondents in the short run. Primary care providers test and triage patients who are most at risk of infection and easing the burden off overwhelmed hospitals. Leaders should provide them with reliable information and tools, additional support for logistics and staffing, and medical supplies like PPEs.
In the long run, states must bolster spending on quality primary care to ensure that it is affordable and well-resourced. This way, no patient will have to choose between paying for their bills or daily needs and seeking care. States and donors should resist designating all funds solely to addressing COVID-19.
There should also be funds allotted to primary care. Flexible funds for primary care should be spent to curb the pandemic and prevent disruptions in life-saving services such as treating chronic illnesses and delivering babies. This approach will ward off future pandemics rather than offer a Band-Aid solution that fails to address the root cause.
Governments should pinpoint any weaknesses in their health systems and address them with long term solutions to manage future pandemics. Investing in primary care helps prevent unnecessary disruptions in patient care, especially patients with chronic conditions and pregnant women.