COVID-19’s impact on primary care and related mitigation strategies: A scoping review

Abstract

Background

The COVID-19 pandemic has had a substantial impact on primary care throughout Europe and globally.

Objectives

This review aims to ascertain how the pandemic has impacted primary care service provision/patients and to examine strategies to mitigate these impacts.

Methods

The scoping review framework comprised a six-stage process developed by Arksey and O'Malley. The search process was guided by the Joanna Briggs Institute three-step search strategy and involved searching the PubMed, Embase, Scopus, CINAHL Plus, and Cochrane Library databases. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A thematic analysis approach by Braun and Clarke was used to interpret the findings.

Results

Thirty-two studies from 18 countries and six continents were included, 13 reported original research, three were reviews, and 16 were case reports reporting healthcare systems’ experiences of dealing with the pandemic. Emerging themes concerned the COVID-19 pandemic’s impact on primary care service provision and patients, the impact of the rapid transition to telemedicine due to COVID-19 on primary care, and strategies to mitigate the impact of COVID-19 on primary care (i.e. infection prevention and control measures, alternatives/modifications to traditional service delivery or workflow, government policy responses, and education).

Conclusion

The COVID-19 pandemic has considerably impacted on primary care at both service and patient levels, and various strategies to mitigate these impacts have been described. Future research examining the pandemic’s ongoing impacts on primary care, as well as strategies to mitigate these impacts, is a priority.

Keywords:

• Infectious diseases
• general practice/family medicine
• general
• public health and community medicine
• health care organisation and management

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Box 1 Methodology used for this scoping review

Stage 1: Identifying the research question

Two research questions were developed to guide the review:

1. How has the COVID-19 pandemic impacted on primary service provision and primary care patients? (both those with and without COVID-19 infection).

2. What strategies might best address this impact?

Stage 2: Identifying relevant studies

This review utilised a three-step search strategy recommended in standard Joanna Briggs Institute (JBI) systematic reviews (2005) [51]. This process involved:

• Initial searching of relevant peer-reviewed electronic databases (i.e. PubMed, Embase, Scopus, CINAHL Plus, and the Cochrane library) on the 16 August 2020.

• Analysis of text words contained in article titles and abstracts

• Analysis of index terms used to describe studies

• Searching using identified keywords and index terms

• Manually searching reference lists of included studies for additional relevant studies.

Details of our search strategy can be viewed in Figure 1.

Stage 3: Study selection

The study selection process involved two levels of screening.

1. The titles and abstracts of identified studies were screened by JL to assess their relevancy to the study topic.

2. As per Arksey & O’Malley (2005) [17] stages three and six, the full text of studies was assessed by JL with assistance from a second full text reviewer (JB) and consulted stakeholders (i.e. clinicians and researchers with primary care and infectious diseases expertise). Full text reviewing also facilitated familiarisation with the data as per ‘Phase 1’ of Braun and Clarke’s (2008) thematic analysis approach [19].

Eligibility criteria were developed according to the JBI reviewer’s manual (2005) [20] which suggests the use of the mnemonic PCC (population, concept, and context) to target the review’s focus and scope. In accordance with this framework, studies were included if they documented the impact of COVID-19 on primary care service provision and/or primary care patients. No restrictions were in place regarding the country or countries in which studies were conducted. Consistent with scoping review methodology, this study was broad in its inclusion of different types of literature and an assessment of methodological quality was not performed to include or exclude studies based on quality scores [17]. Studies were excluded if they did not focus on COVID-19’s impact on primary care service provision and/or patients. Also, only articles in English were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-SCR) flow diagram as illustrated in Figure 2 outlines the results of the literature search.

Stage 4: Charting the data

Data that answered our research questions (i.e. How has the pandemic impacted primary care, and what strategies have been used to mitigate these impacts?) was extracted from the included studies and inputted into Supplementary Table 1. Charting also satisfied the expectations of Braun and Clarke’s (2008) ‘Phase 2’ (i.e. generating initial codes).

Stage 5: Collating, summarising, and reporting the results

The table’s contents were collated, summarised, and reported according to guidelines set by both Arksey and O’Malley (2005) ‘Stage 5’, and Braun and Clarke’s (2008) phases 3, 4, 5, & 6.

Stage 6: Stakeholder consultation

Clinicians working in the areas of primary care and infectious diseases were consulted to assist with study selection and the interpretation of study findings.

Additional information

Funding

We are grateful to the Health Research Board of Ireland who supported this study through the ‘North-Dublin COVID-19 Cohort (‘ANTICIPATE’) grant [COV19-2020-123], as well as the Ireland East Hospital Group/UCD College of Health & Agricultural Sciences, and the School of Medicine who supported this study through internal funding.