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LitCovid-sentences  

PMC:7536478 JSONTXT 17 Projects

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Id Subject Object Predicate Lexical cue
T1 0-39 Sentence denotes The Role of Primary Care in a Pandemic:
T2 40-90 Sentence denotes Reflections During the COVID-19 Pandemic in Canada
T3 92-100 Sentence denotes Abstract
T4 101-269 Sentence denotes As COVID-19 cases began to rise in Ontario, Canada, in March 2020, increasing surge capacity in hospitals and intensive care units became a large focus of preparations.
T5 270-370 Sentence denotes As part of these preparations, primary care physicians were ready to be redeployed to the hospitals.
T6 371-498 Sentence denotes However, due to the effective implementation of community-wide public health measures, the hospital system was not overwhelmed.
T7 499-691 Sentence denotes As Ontario prepares now for a potential second wave of COVID-19, primary care physicians have an opportunity to consider the full breadth and depth of scope for primary care during a pandemic.
T8 692-823 Sentence denotes From planning to surveillance to vaccination, primary care physicians are positioned to play a unique and vital role in a pandemic.
T9 824-896 Sentence denotes Nevertheless, there are specific barriers that will need to be overcome.
T10 898-910 Sentence denotes Introduction
T11 911-1021 Sentence denotes As COVID-19 cases began to rise in Ontario, the public health and healthcare sectors began to rapidly prepare.
T12 1022-1189 Sentence denotes A core component of preparations was to increase surge capacity in hospitals, anticipating a large influx of patients that would require critical care and ventilation.
T13 1190-1276 Sentence denotes Plans were made for family physicians to be redeployed to work in hospitals if needed.
T14 1277-1387 Sentence denotes However, as societal physical distancing measures took effect, the rate of transmission fortunately decreased.
T15 1388-1545 Sentence denotes In most areas in Ontario, mainly outside of the Greater Toronto Area, the expected surge did not impact hospitals to the degree that was feared and expected.
T16 1546-1634 Sentence denotes Instead, the majority of cases were managed in the community by primary care physicians.
T17 1635-1706 Sentence denotes Family medicine, as a specialty, is defined by several characteristics:
T18 1707-1723 Sentence denotes community-based;
T19 1724-1743 Sentence denotes continuity of care;
T20 1744-1767 Sentence denotes first point-of-contact;
T21 1768-1800 Sentence denotes comprehensive whole-person care;
T22 1801-1859 Sentence denotes coordination of intersectoral and multidisciplinary team.1
T23 1860-2022 Sentence denotes While other medical specialties may at times incorporate some of these attributes, none exemplify all of these characteristics in the same way as family medicine.
T24 2023-2315 Sentence denotes Importantly, there has been extensive research to demonstrate that access to a family physician improves patient satisfaction, hospitalization rates, clinical outcomes and equity.2-4 It is precisely these characteristics that place family physicians in a unique position in pandemic response.
T25 2316-2462 Sentence denotes In this article, we outline some of the vital functions of primary care during a pandemic, based on studies and experiences of previous pandemics.
T26 2463-2699 Sentence denotes Working through the course of a pandemic, from onset, peak, recovery and planning for the next pandemic, we demonstrate the need for support for primary care to explore and perform its role in a pandemic, outside of the hospital system.
T27 2701-2724 Sentence denotes Educate and Communicate
T28 2725-2942 Sentence denotes Many patients will inevitably turn to their family physicians as “trusted and credible sources of information.”5 In fact, family physicians may be considered more reliable by patients than public health organizations.
T29 2943-3550 Sentence denotes This may be due to the longstanding relationship between a patient and their family physician, but also due to mistrust amongst some groups of governmental organizations, including public health organizations.5 Therefore, family physicians have a duty to remain up-to-date with the best evidence as the pandemic progresses, and public health organizations must maintain open lines of communication with primary care.6 Family physicians have the opportunity to provide patients with advice on individual preventative measures, self-management of symptoms and to correct sometimes detrimental misinformation.7
T30 3551-3707 Sentence denotes Another opportunity for family physicians that may be overlooked and under-utilized is to emphasize with patients with COVID-19 the importance of isolation.
T31 3708-3813 Sentence denotes Case-contact tracing and reinforcing self-isolation is one of the core responsibilities of public health.
T32 3814-4097 Sentence denotes Nevertheless, when a patient is diagnosed, there is an opening for their family physician to contact them and reinforce public health measures.8,9 Similarly, if a patient were to identify themselves to their physician as a contact to a case, the role of quarantine can be emphasized.
T33 4098-4165 Sentence denotes In this way, family physicians help to slow the spread of COVID-19.
T34 4167-4179 Sentence denotes Surveillance
T35 4180-4357 Sentence denotes Primary care physicians are a key component of surveillance systems, with the responsibility to report to public health when they identify communicable diseases of significance.
T36 4358-4836 Sentence denotes For example, as a patient’s first point-of-contact, primary care tends to identify a spike in seasonal influenza earlier than emergency departments, and can serve as a reliable indicator of underlying trends in community transmission.5,10 This function will become increasingly important in post-peak surveillance, when primary care physicians will be the ones to whom patients are most likely to first present, and may therefore be the first to identify resurgence of COVID-19.
T37 4838-4895 Sentence denotes Triage and Treatment of Pandemic Illness in the Community
T38 4896-5130 Sentence denotes While a small subset of patients with COVID-19 will inevitably require hospitalization, the majority will be seen first and solely by primary care because the majority of infected individuals experience only mild to moderate symptoms.
T39 5131-5795 Sentence denotes In Ontario, as of August 28, 2020, 11.6% of cases had ever been hospitalized, meaning that almost 90% of cases were managed in the community.11 Treating as many patients in the community as possible also removes strain from the hospital system, reducing the risk of overwhelming hospital capacity.12 Furthermore, reflecting on their experiences of COVID-19 in Italy, a group of intensive care physicians wrote, “We are learning that hospitals might be the main COVID-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. . .This disaster could be averted only by massive deployment of outreach services.
T40 5796-6400 Sentence denotes Pandemic solutions are required for the entire population, not only for hospitals.”13 Similarly, a model based on pandemic influenza and SARS found that a higher concentration of hospitals is linked with greater spread and mortality, while a higher concentration of community-based primary care clinics to triage, diagnose and treat the pandemic illness was associated with reduced transmission and mortality.14 Hence, primary care of COVID-19 in the community is critical to keep as many patients out of hospital as possible to reserve constrained hospital resources and prevent institutional outbreaks.
T41 6402-6453 Sentence denotes Prevention of Spread Amongst Vulnerable Populations
T42 6454-6608 Sentence denotes Certain populations will be at a higher risk of contracting communicable diseases, such as those who are unstably housed or living in congregate settings.
T43 6609-6759 Sentence denotes Still others are more vulnerable to worse outcomes from a respiratory illness, such as those who are immunocompromised or have multiple comorbidities.
T44 6760-6878 Sentence denotes Public health organizations will often attempt to broadly identify, inform, and provide support for these populations.
T45 6879-7162 Sentence denotes Yet, primary care physicians are in a unique position of being able to individually pinpoint who in their practice is most vulnerable.10 By proactively reaching out to these patients, family physicians are able to provide education and support to prevent spread to these individuals.
T46 7163-7271 Sentence denotes No one else in the healthcare sector is able to perform this function in the way that family physicians can.
T47 7272-7417 Sentence denotes Moreover, in most communities, family physicians form the backbone of outreach services to the most vulnerable and to congregate living settings.
T48 7418-7613 Sentence denotes In these settings, family physicians may be expected to set the standards for infection prevention and control measures, as well as help coordinate response to outbreaks within the facility.15,16
T49 7615-7676 Sentence denotes Home and Community Care of Higher Acuity Non-Pandemic Illness
T50 7677-7817 Sentence denotes During a pandemic, primary care physicians will need to provide care in the community to an increasing number and higher acuity of patients.
T51 7818-7952 Sentence denotes Patients that may have typically been admitted to hospitals for short stays may need to be treated as an outpatient during a pandemic.
T52 7953-8151 Sentence denotes This is primarily to divert patients away from hospitals that are already stretched in terms of resources.12 Further, this prevents vulnerable patients from risking exposure in the hospital setting.
T53 8152-8347 Sentence denotes There are multiple potential avenues to provide this increased care, including continued adapted clinic-based care, strengthened multidisciplinary home care, tele-monitoring and virtual visits.17
T54 8349-8360 Sentence denotes Vaccination
T55 8361-8512 Sentence denotes If and when this becomes available for COVID-19, primary care physicians are going to play an important role in delivering population-wide vaccination.
T56 8513-8658 Sentence denotes While this process will likely be coordinated by public health, primary care offers a built-in infrastructure for rapid distribution of vaccines.
T57 8659-8965 Sentence denotes Moreover, in a survey on influenza vaccination in 2009, about a third of people were found to be reluctant to receive the vaccination even after public health messaging.18 Yet, due to longer-standing rapport, patients may be more likely to receive the vaccine after discussion with their family physician.9
T58 8967-8989 Sentence denotes Post-Pandemic Recovery
T59 8990-9191 Sentence denotes Considering the stringency of societal physical distancing measures, during which many lost jobs and social contact decreased, there will be a lot of rebuilding that must take place following COVID-19.
T60 9192-9550 Sentence denotes Some patients will have increased health needs due to the long period of physical distancing, and the impact that has had on their physical and mental health.19 Others will have avoided acute or delayed routine medical care due to fears over exposure to COVID-19.20 In the post-peak period, family physicians will have a large role in caring for these needs.
T61 9551-9772 Sentence denotes Following the relaxation of physical distancing measures, there will likely be an increase in demand of counselling and mental health services, higher volume of preventive care, and a higher acuity of medical complaints.9
T62 9774-9791 Sentence denotes Pandemic Planning
T63 9792-9919 Sentence denotes Finally, a core component of pandemic recovery is to assess lessons learned and begin to prepare and plan for another pandemic.
T64 9920-10238 Sentence denotes This needs to take place within each organization and across organizations in the public health and healthcare sectors.16 Traditionally, primary care specific planning has been limited.21 However, COVID-19 highlights the importance of having primary care representatives in the creation of pandemic preparedness plans.
T65 10240-10248 Sentence denotes Barriers
T66 10249-10407 Sentence denotes Though primary care has many important roles in a pandemic, there are also many barriers or challenges to family physicians being able to fulfill these roles.
T67 10408-10413 Sentence denotes Time:
T68 10414-10497 Sentence denotes Family physicians are often already feeling pressured in terms of time commitments.
T69 10498-10574 Sentence denotes Expanding and adapting clinical practice during a pandemic can be difficult.
T70 10575-10589 Sentence denotes Communication:
T71 10590-10805 Sentence denotes Following SARS and H1N1 influenza, one of the largest barriers identified by surveyed family physicians was the sense of lack of communication or miscommunication between public health agencies and primary care.6,22
T72 10806-10833 Sentence denotes Governance of primary care:
T73 10834-11014 Sentence denotes Compared to public health agencies, hospitals, paramedic services, and other healthcare organizations, primary care in Ontario does not often have a central hierarchical structure.
T74 11015-11138 Sentence denotes This creates challenges in coordinating a unified primary care pandemic response, though it certainly does not preclude it.
T75 11139-11150 Sentence denotes Technology:
T76 11151-11325 Sentence denotes Many of the functions of primary care in a pandemic would be made easier by technology, including enabling virtual care, communication and enhanced triaging and surveillance.
T77 11326-11450 Sentence denotes While COVID-19 has certainly forced a progression in technological development and adoption, there is still room for growth.
T78 11451-11475 Sentence denotes Recognition and support:
T79 11476-11644 Sentence denotes As previously discussed, pandemic responses have often been focused on secondary and tertiary care, without a clear understanding of the important role of primary care.
T80 11645-12252 Sentence denotes As Rust et al state, “Authorities may designate mainly hospitals as surge sites, neglecting to designate primary care community health center networks.”5 Similarly, in an analysis of the response to SARS, Lee and Chuh wrote, “SARS has highlighted the inadequate interface between primary and secondary care and valuable health care resources were thus inappropriately matched to community needs.”9 Lack of understanding of the role family physicians play in the community during a pandemic leads to primary care being inadequately equipped in terms of personal protective equipment and workforce investment.
T81 12254-12269 Sentence denotes Recommendations
T82 12270-12449 Sentence denotes As Ontario passes the first peak of COVID-19, it is now necessary to reflect on lessons learned in order to best prepare for any subsequent waves, as well as for future pandemics.
T83 12450-12572 Sentence denotes Based on the discussed roles of primary care in a pandemic, and the related barriers, several recommendations can be made:
T84 12573-12613 Sentence denotes Prioritize primary care in PPE provision
T85 12614-12699 Sentence denotes Improve access and use of data generated from primary care for syndromic surveillance
T86 12700-12877 Sentence denotes Include primary care representatives on pandemic planning and response committees in all healthcare sectors and formulate primary care specific pandemic plans for each community
T87 12878-13017 Sentence denotes Creation of clinical care pathways and guidelines to support family physicians in providing care for higher acuity illness in the community
T88 13018-13106 Sentence denotes Governmental investment in technology in primary care to improve quality of virtual care
T89 13107-13176 Sentence denotes Consider creation of community-based clinics for triage and treatment
T90 13177-13227 Sentence denotes Expansion of home-based care by primary physicians
T91 13228-13377 Sentence denotes Timely and open avenues of communication between public health organizations and primary care, with clear messages for physicians to give to patients
T92 13378-13555 Sentence denotes Lastly, though this review found several useful commentaries, guidelines and qualitative studies, evidence of how primary care can best respond to a pandemic is limited overall.
T93 13556-13623 Sentence denotes COVID-19 presents an opportunity for further research on this area.
T94 13625-13635 Sentence denotes Conclusion
T95 13636-13739 Sentence denotes The response to COVID-19 has required extensive adaptation and flexibility by all healthcare providers.
T96 13740-13877 Sentence denotes Nevertheless, the focus, particularly at the beginning of the outbreak, was on the impact on and response of secondary and tertiary care.
T97 13878-14018 Sentence denotes The primary care sector’s duties in the response focused on how it could participate in the response of secondary and tertiary care centers.
T98 14019-14141 Sentence denotes However, due to effective public health measures, much of the created hospital surge capacity was thankfully not required.
T99 14142-14249 Sentence denotes There is now time to reflect and learn from this experience in order to best prepare for a subsequent wave.
T100 14250-14382 Sentence denotes The entire breadth and depth of the role of primary care during outbreaks and pandemics remains to be fully recognized and utilized.
T101 14384-14421 Sentence denotes Declaration of Conflicting Interests:
T102 14422-14557 Sentence denotes The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
T103 14558-14566 Sentence denotes Funding:
T104 14567-14676 Sentence denotes The author(s) received no financial support for the research, authorship, and/or publication of this article.
T105 14677-14686 Sentence denotes ORCID iD:
T106 14687-14739 Sentence denotes Joanne Kearon https://orcid.org/0000-0002-7039-6894