Relationship between the perceived strength of countries' primary care system and COVID-19 mortality: an international survey study.
Relationship between the perceived strength of countries' primary care system and COVID-19 mortality: an international survey study.
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DOI：
10.3399/bjgpopen20x101129
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发表时间：
2020-10-01
期刊：
影响因子：
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通讯作者：
Phillips, Robert L Jr
中科院分区：
文献类型：
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作者：
Goodyear-Smith, Felicity;Kinder, Karen;Phillips, Robert L Jr
背景：强大的初级卫生保健（PHC）是全民健康覆盖和国家卫生应急反应的基石。初级保健包括公共卫生和初次接触初级保健。在国际上，COVID-19的传播和死亡率差异很大。作者假设，被认为具有强大初级卫生保健的国家的COVID-19死亡率较低。目的：比较PC专家对PC系统强度、大流行防范和应对的看法与全球各国的COVID-19死亡率。设计与设置：国际初级保健专家（临床医生、研究人员和政策制定者）的方便样本完成了一项关于国家级PC属性和流行病应对的在线调查（英语或西班牙语）。方法：对38个反应≥5的国家进行感知PC强度、大流行计划使用、边境管制、行动限制和COVID-19死亡率检测分析。结果：总共收到了来自111个国家的1035份回复，每个国家有1至163名回复者。38个反应≥5个的国家被纳入分析。世界所有区域和经济阶层都有代表。PC强度与死亡率无相关性。国家级死亡率与严格的边境管制、行动限制和检测制度负相关。结论：专家与会者认为拥有准备好的大流行计划和强大的个人电脑系统的国家不一定会降低COVID-19死亡率。能否以及何时实施该计划，以及如何动员初级保健中心作出反应，似乎对遏制疫情产生了影响。影响传播和结果的因素很多。重要的应对措施首先是限制COVID-19跨境进入，然后动员初级保健，整合公共卫生和个人保健部门，通过卫生、保持身体距离、检测、分诊和合同追踪措施减轻传播并减轻医院的负担。
BACKGROUND: Strong primary health care (PHC) is the cornerstone for universal health coverage and a country's health emergency response. PHC includes public health and first-contact primary care (PC). Internationally, the spread of COVID-19 and mortality rates vary widely. The authors hypothesised that countries perceived to have strong PHC have lower COVID-19 mortality rates.AIM: To compare perceptions of PC experts on PC system strength, pandemic preparedness, and response with COVID-19 mortality rates in countries globally.DESIGN & SETTING: A convenience sample of international PHC experts (clinicians, researchers, and policymakers) completed an online survey (in English or Spanish) on country-level PC attributes and pandemic responses.METHOD: Analyses of perceived PC strength, pandemic plan use, border controls, movement restriction, and testing against COVID-19 mortality were undertaken for 38 countries with ≥5 responses.RESULTS: In total, 1035 responses were received from 111 countries, with 1 to 163 responders per country. The 38 countries with ≥5 responses were included in the analyses. All world regions and economic tiers were represented. No correlation was found between PC strength and mortality. Country-level mortality negatively correlated with perceived stringent border control, movement restriction, and testing regimes.CONCLUSION: Countries perceived by expert participants as having a prepared pandemic plan and a strong PC system did not necessarily experience lower COVID-19 mortality rates. What appears to make a difference to containment is if and when the plan is implemented, and how PHC is mobilised to respond. Many factors contribute to spread and outcomes. Important responses are first to limit COVID-19 entry across borders, then to mobilise PHC, integrating the public health and PC sectors to mitigate spread and reduce burden on hospitals through hygiene, physical distancing, testing, triaging, and contract-tracing measures.