Primary care-based health surveillance actions in response to the COVID-19 pandemic: contributions to the debate

Prado, Nilia Maria de Brito Lima; Biscarde, Daniela Gomes dos Santos; Pinto Junior, Elzo Pereira; Santos, Hebert Luan Pereira Campos dos; Mota, Sara Emanuela de Carvalho; Menezes, Erica Lima Costa de; Oliveira, Josilene Silva; Santos, Adriano Maia dos

doi:10.1590/1413-81232021267.00582021

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FREE THEMES • Ciênc. Saúde Colet. 26 (07) • July 2021 • https://doi.org/10.1590/1413-81232021267.00582021 copy

Primary care-based health surveillance actions in response to the COVID-19 pandemic: contributions to the debate

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We conducted an integrated literature review aimed at reflecting on the challenges related to primary care-based health surveillance actions in response to the COVID-19 pandemic in selected countries. The study included countries with different PHC models that adopted surveillance as an approach to control the transmission of COVID-19. We performed a search in October 2020 for relevant literature and norms and guidelines related to the organization of primary health care (PHC) in response to the pandemic on official government websites and the databases Web of Science and Science Direct. The integrated health surveillance actions demonstrated that efforts were more focused on risks, with some countries adopting innovative and effective measures to respond to COVID-19, considering emerging needs within PHC. However, in addition to ethical controversies and operational difficulties, access to technology was a challenge in actions developed by some countries due to social inequalities.

Key words:
Coronavirus infection; Public health surveillance; Primary health care; Health policy

Country	Type of health system	PHC model	Organization of PHC teams	Primary care response to the COVID-19 pandemic
South Africa	Mixed public and private coverage.	System based on community health centers; teams composed of one nursing professional and 4 to 6 community health workers. The family physician is multifaceted, playing an essential role in the point of entry to the health services and in quality management, continuous professional development, and the application of health and treatment guidelines and protocols.	The work of health teams is centered on home visits and the active search for patients, adopting a generalist approach and emphasizing care focusing on common diseases. The importance of community participation is recognized; the community has the right to plan and implement its own health programs and services.	28,000 community health professionals allocated to perform active home-to-home screening in high-risk communities and home visits.
Argentina	Mix of three large subsystems: 1. universal and free public system; 2. Social security with public investment and worker contributions; 3. Private system involving corporate services and pre-paid medical services.	In general, primary health care is provided by health centers under the management of municipal and provincial governments and is the preferred point of entry and filter for specialist care.	Model centered on specialties	Implementation of the Tele-Covid service with coverage provided exclusively by the public system and provision of video appointments. Tele-Covid used to screen suspected and confirmed cases of COVID-19 in order to prevent circulation and to share knowledge and care experiences and coordinate actions developed by PHC, emergency, hospital and laboratory services. Use of a Strategic Testing Device for Coronavirus in the Field of Argentina (DETeCTAr).
Australia	Mixed public (Medicare universal health care scheme) and private coverage.	PHC is the point of entry to the health system and is provided at home level or in community settings through general practices, private services, community health, the local government and non- governmental services. Medicare Locals and Local Hospital Networks work as local consumers and providers, developing integrated plans and services coordinated at local level.	Interprofessional teams.	Most vulnerable people receive medical care and primary care counseling, generally provided by Medicare GP teams. Online training for health professionals. Counseling and support for the public in relation to social distancing. Substantial investment in support for mental health for all Australians. Elderly care, services for disabled people and hospital services. Teleappointments, screening, electronic prescriptions, telemonitoring.
China	Mixed public and private coverage.	All citizens have the right to receive basic care services provided by the local government.	Mainly community physicians and health professionals in rural clinics, general practices in rural areas and urban community hospitals, and medical professionals in secondary and tertiary hospitals.	GPs actively involved in diagnosis and treatment, health education, active and passive surveillance, monitoring and counseling/appointments. GPs work together with local neighborhoods, committees and community police in joint defense, counseling, screening and monitoring. WeChat health screening networks for contact tracing and investigating sources of infections.
South Korea	Mixed public and private coverage.	Doctors treat patients in private practices.	Combination of tasks undertaken by a team of nursing professionals and social workers.	Mass diagnosis as part of a policy to test as many people as possible and use of technology for case screening.
US	Does not have a universal care system. Private health insurance and public health coverage.	Primary health care in the US is delivered by three specialties: family medicine, general internal medicine and general pediatrics.	Doctors, whose main role is to coordinate patient care, as well as nurses and physician assistants.	Poor organization of PHC services. Attempt to organize Medicare and Medicaid. Isolation of contacts and confirmed cases after laboratory confirmation. Urgent and emergency services paid by service users on an as-needed basis. Support available from other local and state government agencies and partner organizations. Difficulties in implementing telemedicine.
France	Universal.	General practitioners work in private practice or health centers.	Most outpatient care is delivered by nurses at home, especially in the case of elderly and disabled patients. Professionals include paramedics, dentists, pharmacists, physiotherapists and midwives, outpatient specialists, pediatricians, gynecologists, ophthalmologists and psychiatrists.	Two-level functional hierarchization of healthcare facilities. Expansion of telemedicine. City outpatient services and other health facilities continue to operate normally.
Italy	Universal.	GP model and some interprofessional outpatient care teams.	Care coordinated predominately by GPs and, in some regions, interprofessional collaboration to improve accessibility, equity and continuity of care.	Decentralization of health care services for potentially affected populations. Recruitment of health professionals for most affected regions (Lombardy). Establishment of solid public-private partnerships. Teleappointments. Electronic prescriptions interlinked to pharmacies.
India	Mixed public and private coverage. Provision is the responsibility of the states, which are often incapable of ensuring coverage in vulnerable and/or remote regions.	Healthcare for the poor is provided by small-scale, largely unregulated and often unlicensed commercial and not-for-profit providers.	Polyclinics have become an alternative to the capitalist system of health care provision, offering accessible services and GP medical residencies. Care provided to vulnerable populations, with special attention given to women and children.	Integrated Disease Surveillance Program using phone location and Bluetooth data. Continuous updates provided by the Ministry of Health and numerous helplines. Difficulties in convincing the population to adopt hygiene and social distancing measures.
United Kingdom	Universal.	GPs are the point of entry to the health system.	The primary care team includes GPs, nurses management/administrative professionals linked to a clinic or a geographically defined population.	Remote screening of patients by health teams, considering suspected cases, risk groups and the wider population. Clinical Commissioning Groups (CCGs). Large-scale emergency training program to recruit community health workers. Expansion of teleappointments and telemonitoring.
Singapore	Government health system based on the "3M framework": Medifund, Medisave and Medishield.	Primary care is the cornerstone of the health system and is provided through government polyclinics and clinics run by private GPs.	Primary care is delivered through a network of polyclinics and clinics run by GPs and supported by Family Medicine Clinics (FMCs), and by Community Health Centers (CHCs), which make up the Primary Care Networks (PCN).	Free appointments and examinations for all citizens during the outbreak. Strict contact tracing system, with criminal charges for breaching measures. Social distancing and payment of fines of up to US $7,000. Popular appointments in public hospitals organized with funding from the Ministry of Health. Information technology-mediated monitoring.

Países	Type of surveillance
	Active Involvement of health services and professionals in the identification of diseases or specific conditions			Passive Regular ongoing reporting of diseases and conditions by all health facilities in a given area				Mixed Use of active and passive monitoring techniques
	Community	Participatory research	Primary care	Information via communication channels	Environmental samples	Monitoring of behavioral risk factors	Digital monitoring	Sentinels	Combination of data collection methods
	Community involvement in the prevention of risks and illness	Use of self-reported data or participatory sites	Group/household risk screening and counseling	Use of communication channels for public health surveillance	Analysis of substances to monitor health risks	Continuous monitoring of risk factors/epidemiological data associated with health conditions	Collection of data from sites, applications or digital devices (mobile phones)	Continuous monitoring of data in services across different levels of care	Use of data from different information sources
South Africa	X							X
Argentina				X
Australia			X	X					X
China			X				X		X
South Korea	X		X	X			X		X
Cuba	X	X	X
US		X					X	X	X
France					X			X	X
Italy	X					X			X
India	X	X
UK		X	X			X			X
Singapore							X

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[1] Collaborations

All the authors contributed substantially to study conception and planning, data collection, analysis and interpretation, and to writing the article, revising it critically for important intellectual content and approving the final version to be published.