Organization of primary health care in pandemics

  1. Thiago Dias Sarti
  2. Welington Serra Lazarini
  3. Leonardo Ferreira Fontenelle
  4. Ana Paula Santana Coelho Almeida

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Abstract

Background: The world is experiencing one of the greatest public health emergencies in history with the global spread of COVID-19. Health systems, including Primary Health Care (PHC) services, are pillars of pandemic coping strategies. Objective: To systematic review of the literature that analyzes the effectiveness of PHC organization strategies in the context of epidemics. Methods: We performed a rapid systematic literature review on MEDLINE (via PubMed), EMBASE and LILACS (via VHL), in order to analyze empirical studies on the effectiveness of PHC organization strategies in the context of epidemics to improve access and reduce morbidity and mortality. There was no assessment of risk of bias, and the synthesis was narrative. PROSPERO CRD42020178310.Results: We selected seven articles, which studied the responses to different epidemic–s in different parts of the world. In terms of access, the studies suggest positive results with the adoption of adjustments of work processes of the teams and the structure of the services, combined with diversification of actions (including call center), adequate provision of inputs and personal protective equipment, adequate action plans and communication strategies, and effective integration with public health services and other levels of care. No study analyzed population morbidity and mortality. The included studies suggest also that community-oriented PHC is more effective in crisis scenarios, indicating the necessity of strengthening of the Family Health Strategy in the Brazilian context. Conclusion: PHC can be effective in coping with public health emergencies. Action plans should be built with broad participation by the actors involved in coping with the epidemic. Emphasis is placed on the importance of empowering the link between the healthcare service and its registered population.

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  1. Version published to 10.5712/rbmfc16(43)2655
  2. ScreenIT

    SciScore for 10.1101/2020.07.05.20146811: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Systematic searches for articles were made on April 1, 2020 by one of the authors (APSC) on MEDLINE (via PubMed), EMBASE, and LILACS (via VHL).
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    This search strategy was built from MeSH (Medical Subject Headings) and Emtree (Embase subject headings) descriptors, adapting the searches to the MEDLINE and EMBASE databases, respectively; the MEDLINE search strategy was reused in LILACS.
    MeSH
    suggested: (MeSH, RRID:SCR_004750)
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Some limitations of this work must be considered. Rapid reviews are good options for producing and systematizing knowledge in a timely manner for evidence-based decision making 12,28,29 at the cost of some flexibility in essential steps of systematic reviews. We chose to qualify some steps recommended for quick reviews, which increases its internal validity: we searched three databases of impact; we kept two independent researchers in the screening stages, selecting the corpus of articles for narrative review, and extracting the data; time limits and geography were not adopted in the selection of studies; and we incorporated articles in more than one language. The main limitations in this study are the lack of individualized analysis of the quality of the selected articles and the failure to carry out manual searches and gray literature, which may have excluded from the review relevant papers available in institutional technical reports or papers not published in indexed journals. In summary, this review points to the need to build action plans with broad participation by the actors involved in coping with the epidemic, whose determinations consider the context in which the service is inserted, condensing work process adjustments and structuring healthcare flows, diversification of care practices and integration with the whole of the care network, especially with the public health apparatus. Emphasis is placed on the importance of empowering the service link with its register...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.07.05.20146811v1 on medRxiv