Impact of COVID-19 Pandemic on Family Medicine Clinical Practices During the Second Wave

Yıl 2023, Cilt: 13 Sayı: 4, 609 - 614, 31.07.2023

Duygu Ayhan Başer , Raziye Şule Gümüştakım , Murat Çevik , Ekrem Basara

https://doi.org/10.16899/jcm.1243122

Öz

Background/Aims: It is seen that there are various changes brought by the process within the legislation and in various practices in primary health care services in extraordinary health situations such as pandemics. In this study, it was aimed to determine the effects of the COVID-19 pandemic on some clinical practices of family physicians in Turkey.
Methods: The descriptive study was applied to family physicians working actively in family health centers between February 15, 2021 and April 1, 2021. Family physicians working actively in family health centers formed the universe. Physicians were asked through online-survey questions regarding specific follow-ups and changes they made in some clinical practices, the changes in the number of applications, and the arrangements they made in this regard.
Results: 912 people participated in the study. 59.9% were male, 60.2% had been practicing family medicine for more than 10 years. 63.9% had PCR test and 26.8% had antibody test. 16.1% were diagnosed with COVID-19. 84% of them went to Family Health Center (FHC) every day during the pandemic. While 48.2% of them were doing triage, 53.6% of the participants stated that the number of applications decreased. 65.2% of them did their pregnant-baby-child follow-ups during the COVID-19 pandemic as before the pandemic, 24.7% carried out by appointment. 54.3% made a change in the FHC layout and terms. 50.2% stated that they did not follow up on chronic diseases during the COVID-19 period, 59.2% stated that there was a decrease in the number. 66.7% of them made their childhood vaccinations during the COVID-19 pandemic as before the pandemic, 24.7% carried out by appointment, and the number of applications for 73.6% did not change. 63.6% of them made adult vaccines during the COVID-19 pandemic as before the pandemic, the number of applications increased by 58.2%, and 73% were encouraging individuals. The number of those who came for general health status reports (driver's license, mental ability, job security, etc.) did not change by 53%, but increased by 23.6%.
Conclusion: The pandemic period has caused serious changes in family medicine clinical practices; family physicians have made various arrangements to carry out their current work in this period and have made an effort to convey this situation to the public.

Anahtar Kelimeler

Covid-19 Pandemic, Family Physicians, Clinical Practices

COVID-19 Pandemisinin İkinci Dalga Sırasında Aile Hekimliği Klinik Uygulamalarına Etkisi

Öz

Giriş/Amaç: Pandemi gibi olağanüstü sağlık durumlarında birinci basamak sağlık hizmetlerinde mevzuat ve çeşitli uygulamalarda sürecin getirdiği çeşitli değişiklikler olduğu görülmektedir. Bu çalışmada, COVID-19 pandemisinin Türkiye'deki aile hekimlerinin bazı klinik uygulamalarına etkilerinin belirlenmesi amaçlanmıştır.
Yöntem: Tanımlayıcı tipteki araştırma, 15 Şubat 2021-1 Nisan 2021 tarihleri arasında aile sağlığı merkezlerinde aktif olarak görev yapan aile hekimlerine uygulandı. Evreni, aile sağlığı merkezlerinde aktif olarak görev yapan aile hekimleri oluşturdu. Hekimlere spesifik takipler ve bazı klinik uygulamalarda yaptıkları değişiklikler, başvuru sayısındaki değişiklikler ve bu konuda yaptıkları düzenlemeler online anket soruları ile sorulmuştur.
Bulgular: Çalışmaya 912 kişi katıldı. %59,9'u erkekti, %60,2'si 10 yıldan uzun süredir aile hekimliği yapıyordu. %63,9'unda PCR testi, %26,8'inde antikor testi vardı. %16,1'ine COVID-19 teşhisi kondu. Bunların %84'ü pandemi süresince her gün Aile Sağlığı Merkezi'ne (ASM) gitti. Katılımcıların %48,2'si triyaj yaparken, %53,6'sı başvuru sayısının azaldığını belirtti. %65,2'si gebe-bebek-çocuk takiplerini pandemi öncesinde olduğu gibi COVID-19 pandemisi sırasında, %24,7'si randevu ile gerçekleştirmiştir. %54,3'ü ASM düzeninde ve koşullarında değişiklik yaptı. %50,2'si COVID-19 döneminde kronik hastalık takibi yapmadığını, %59,2'si ise sayısında azalma olduğunu belirtti. %66,7'si çocukluk aşılarını pandemi öncesinde olduğu gibi COVID-19 salgını sırasında yaptırmış, %24,7'si randevu ile yaptırmış, %73,6'sı için başvuru sayısı değişmemiştir. Pandemi öncesinde olduğu gibi COVID-19 pandemisinde de %63,6'sı erişkin aşılarını yaptırırken, başvuru sayısı %58,2 arttı ve %73'ü bireyleri teşvik ediyordu. Genel sağlık durum raporu (sürücü ehliyeti, akli ehliyet, iş güvenliği vb.) için gelenlerin sayısı %53 değişmeyerek %23,6 arttı.
Sonuç: Pandemi dönemi aile hekimliği klinik uygulamalarında ciddi değişikliklere neden olmuş; aile hekimleri bu dönemde mevcut işlerini yürütmek için çeşitli düzenlemeler yapmışlar ve bu durumu topluma aktarmak için çaba sarf etmişlerdir.

Anahtar Kelimeler

Covid-19 Pandemic, Family Physicians, Clinical Practices

Kaynakça

• 1. Kearon J, Risdon C. The role of primary care in a pandemic: Reflections during the COVID-19 pandemic in Canada. J Prim Care Community Health 2020;11:2150132720962871. doi:10.1177/2150132720962871.
• 2. Huston P, Campbell J, Russell G, Goodyear-Smith F, Phillips RL, Weel C, Hogg W. COVID-19 and primary care in six countries. BJGP Open 2020;4(4): bjgpopen20X101128. doi:10.3399/bjgpopen20X101128.
• 3. Dunlop C, Howe A, Allen LN. The coronavirus outbreak: The central role of primary care in emergency preparedness and response. BJGP Open 2020;4(1): bjgpopen20X101041. doi: 10.3399/bjgpopen20X101041.
• 4. Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study. Lancet Glob Health 2020;8(6):e790-e798. doi: 10.1016/S2214-109X(20)30204-7.
• 5. Verhoeven V, Tsakitzidis G, Philips H, et al. Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs. BMJ Open 2020;10:e039674.
• 6. Ardebili ME, Naserbakht M, Bernstein C, Alazmani-Noodeh F, Hakimi H, Ranjbar H. Healthcare providers experience of working during the COVID-19 pandemic: A qualitative study and there is no study from Turkey. AJIC 2020;1−8.
• 7. https://www.oecd.org/health/covid-19.htm
• 8. Aktura B. Pandemic Management in Family Medicine Centers. Jour Turk Fam Phy 2020; 11 (1): 45-7.
• 9. Güler S, Topuz İ, Ulusoy F. Experiences of family health center workers in the Covid-19 pandemic. J Public Health Nurs 2020; 2(3): 143-51.
• 10. Esmeray O, Öner C, Çetin H, Şimşek EE. Evaluation of The Covid-19 pandemia experience of a family health center. Acta Medica Nicomedia 2021; 4(2):56-63.
• 11. Türk Tabipleri Birliği Merkez Konseyi. 7 Ağustos 2020 Basın Açıklaması. [online] Available at: < https://www.istabip.org.tr/koronavirus/Haberler/6024/ttb-birinci-basamak-ta-covid-19-pandemisine-iliskin-durum-arastirmasi-nin-sonuclarini-acikladi-birinci-basamak-pandemi-surecinin-disina-atildi> [Accessed 04 December 2022].
• 12. Lau J, Knudsen J, Jackson H, Wallach AB, Bouton M, Natsui S, et al. Staying connected in the COVID-19 pandemic: telehealth at the largest safety-net system in the United States. Health Aff (Millwood) 2020;39(8):1437–42.
• 13. Olayiwola JN, Magana C, Harmon A, Nair S, Esposito E, Harsh C, et al. Telehealth as a bright spot of the COVID-19 pandemic: recommendations from the virtual frontlines ("Frontweb"). JMIR Public Health Surveill 2020;6(2):e19045.
• 14. Sinha S, Kern LM, Gingras LF, Reshetnyak E, Tung J, Pelzman F, et al. Implementation of video visits during COVID-19: lessons learned from a primary care practice in New York City. Front Public Health 2020;8:514. Doi:10.3389/fpubh.2020.00514
• 15. Corlette S, Berenson R, Wengle E, Lucia K, Thomas T. Impact of the COVID-19 pandemic on primary care practices. Washington, DC: The Urban Institute; 2021
• 16. Shatla M, Alharthi BT, Alharbi AG, Khan ZA, Althaqfi AA, Babkoor AA, Almalki AA. The Impact of the COVID-19 Pandemic on Family Medicine Practices in Saudi Arabia. Cureus. 2021;15;13(12):e20437. doi: 10.7759/cureus.20437.
• 17. Tu K, Sarkadi Kristiansson R, Gronsbell J on behalf of INTRePID, et alChanges in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID) BMJ Open 2022;12:e059130. doi: 10.1136/bmjopen-2021-059130
• 18. Butt DA, Stephenson E, Kalia S, Moineddin R, Tu. Patient visits and prescriptions for attention-deficit/hyperactivity disorder from 2017–2021: Impacts of COVID-19 pandemic in primary care. PLoS ONE 2023;18(3):e0281307. doi:10.1371/journal.pone.0281307
• 19. Turkish Medical Association. Covid-19 Epidemic Family Health Center Guideline. [online] Available at: < https://www.ttb.org.tr/userfiles/files/ahk%20covid%20rehberi.pdf > [Accessed 04 December 2022].
• 20. Bayraktar M. Triage during the COVID-19 pandemic in family medicine. Set T, editor. Family Medicine and the COVID-19 Pandemic. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.20-4.
• 21. Vosburg RW, Robinson KA. Telemedicine in Primary Care During the COVID-19 Pandemic: Provider and Patient Satisfaction Examined. Telemed J E Health 2021;17. doi: 10.1089/tmj.2021.0174.
• 22. Teresita Gomez, Yohualli B. Anaya, Kevin J. Shih, Derjung M. Tarn. A Qualitative Study of Primary Care Physicians’ Experiences with Telemedicine During COVID-19. J Am Board Fam Med 2021, 34 (Supplement) S61-S70; DOI: 10.3122/jabfm.2021.S1.200517
• 23. Demirgan S, Kargı Gemici E, Çağatay M, Altınel Y, Demirgan EB, Güneyli HC, et al. Being a Physician in Coronavirus Disease 2019 Pandemic and Alternative Health Care Service: Telemedicine: Prospective Survey Study. Telemed J E Health. 2021.1355-62. Doi:10.1089/tmj.2020.0546
• 24. Muhaidat N, Fram K, Thekrallah F, Qatawneh A, Al-Btoush A. Pregnancy During COVID-19 Outbreak: The Impact of Lockdown in a Middle-Income Country on Antenatal Healthcare and Wellbeing. Int J Womens Health 2020;12:1065-73. doi: 10.2147/IJWH.S280342
• 25. UNICEF. Rutin Bağışıklama Devam Etmeli. [online] Available at: <https://www.unicefturk.org/yazi/covid19_bagisiklama_ > [Accessed 04 December 2022]