Innovations produced in Primary Health Care during the COVID-19 pandemic: an integrative literature review

Tureck, Fernando; Chioro, Arthur; Tofani, Luís Fernando Nogueira; Lima, Carolina Loyelo; Vieira, Amanda da Cruz Santos; Andreazza, Rosemarie

doi:10.1590/1413-81232024296.07022023EN

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ARTICLE REVIEW • Ciênc. saúde coletiva 29 (06) • June 2024 • https://doi.org/10.1590/1413-81232024296.07022023EN copy

Innovations produced in Primary Health Care during the COVID-19 pandemic: an integrative literature review

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Abstract

Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to keep up its provision of regular services as well. This article identifies the main arrangements made to provide PHC care in the context of the COVID-19 pandemic. An integrative literature review of articles found in PubMed, SciELO and LILACS databases was performed using the descriptors “Primary Health Care” and “COVID-19”. Findings were analyzed considering three questions: Information and Communication Technologies (ICT), Organizations of Work Processes and Non-COVID Chronic Diseases. The use of different forms of ICT to provide PHC is highlighted regarding patients with respiratory symptoms and chronic patients. Changes in team composition, service flows, physical spaces and working hours were also introduced. Although strategies aimed at monitoring chronic patients and at remote care may have helped minimize deterioration of their health, the decrease in the number of visits performed during this period could have resulted in an increased demand for PHC in post-pandemic years.

Key words:
COVID-19; Primary Health Care; Health Policy

Authors	Year	Study Location	Methodology	Main results
Adepoju et al.⁶⁷67 Adepoju OE, Chae M, Ayadi MF, Matuk-Villazon O, Liaw W. Early Impacts of the COVID-19 Pandemic on Telehealth Patterns in Primary Care, Mental Health, and Specialty Care Facilities in Texas. South Med J 2021; 114(9):593-596.	2021	USA	Quantitative	Use of ICT.
Adepoju et al.⁶⁸68 Adepoju O, Liaw W, Chae M, Ojinnaka C, Britton E, Reves S, Etz R. COVID-19 and Telehealth Operations in Texas Primary Care Clinics: Disparities in Medically Underserved Area Clinics. J Health Care Poor Underserved 2021; 32(2):948-957.	2021	USA	Quantitative	Use of ICT.
Albert et al.⁶⁴64 Albert SL, Paul MM, Nguyen AM, Shelley DR, Berry CA. A qualitative study of high-performing primary care practices during the COVID-19 pandemic. BMC Fam Pract 2021; 22(1):237.	2021	USA	Qualitative	Use of ICT; Home monitoring of chronic patients with sphygmomanometers, glucose meters, INR meters and sending these devices by mail.
Alboksmaty et al.²⁹29 Alboksmaty A, Kumar S, Parekh R, Aylin P. Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK - Qualitative assessment. PLoS One 2021; 16(3):e0248387.	2021	England	Qualitative	Proactivity in contact with chronic patients for monitoring; Use of ICT; Triage and selection of patients with most urgent needs.
Almeida et al.⁶⁹69 Gomes-de Almeida S, Marabujo T, Carmo-Gonçalves M, Almeida SG, Marabujo T, Carmo-Gonçalves M. Grado de satisfacción de los pacientes de la Unidad de Salud Familiar Vitrius con la teleconsulta durante la pandemia del COVID-19. Med Fam Semer 2021; 47(4):248-255.	2021	Portugal	Quantitative	Use of ICT.
Ashcroft et al.²⁵25 Ashcroft R, Donnelly C, Dancey M, Gill S, Lam S, Kourgiantakis T, Adamson K, Verrilli D, Dolovich L, Kirvan A, Mehta K, Sur D, Brown JB. Primary care teams' experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study. BMC Fam Pract 2021; 22(1):143-155.	2021	Canada	Qualitative	Use of ICT; Innovations in triage to detect patient needs early and refer them to specific groups.
Bhatti et al.³⁰30 Bhatti S, Commisso E, Rayner J. A Rapid Primary Healthcare Response to COVID-19: An Equity-Based and Systems- Thinking Approach to Care Ensuring that No One Is Left Behind. Healthc Q 2020; 23(3):29-33.	2020	Canada	Qualitative	Use of ICT; Active contact with patients; Partnership with voluntary entities to check food insecurity; Referral to shelters; Provision of tents; Triage at reception; Changes made to the physical structure of the unit; Consultations at home, shelters and asylums.
Blazey-Martin et al.²⁸28 Blazey-Martin D, Barnhart E, Gillis J, Vazquez GA. Primary Care Population Management for COVID-19 Patients. J Gen Intern Med 2020; 35(10):3077-3080.	2020	USA	Experience Report	Use of ICT.
Breton et al.⁷⁰70 Breton M, Deville-Stoetzel N, Gaboury I, Smithman M, Kaczorowski J, Lussier M, Haggerty J, Motulsky A, Nugus P, Layani G, Paré G, Evoy G, Arsenault M, Paquette J, Quinty J, Authier M, Mokraoui N, Luc M, Lavoie M. Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic. Healthc Policy 2021; 17(1):73-90.	2021	Canada	Quali -Quantitative	Use of ICT.
Breton et al.⁴⁴44 Breton M, Sullivan EE, Deville-Stoetzel N, McKinstry D, DePuccio M, Sriharan A, Deslauriers V, Dong A, McAlearney AS. Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC Fam Pract 2021; 22(1):192-205.	2021	USA and Canada	Qualitative	Use of ICT.
Brey et al.⁶³63 Brey Z, Mash R, Goliath C, Roman D. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. African J Prim Heal Care Fam Med 2020; 12(1):a2449.	2020	South Africa	Experience Report	Home delivery of medication for chronic patients.
Careyva et al.⁷¹71 Careyva BA, Greenberg G, Kruklitis R, Shaak K, Stoeckle JJ, Stephens J. Key Factors Promoting Rapid Implementation of Virtual Screening Modalities for the COVID-19 Pandemic Response. J Am Board Fam Med 2021; 34:55-60.	2021	USA	Experience Report	Use of ICT.
Carvalho et al.⁷²72 Carvalho EMR, Soster JC, Menezes ÉLC, Santana AF, Alves DCM, Prates MVB. Estratégias da gestão estadual da atenção básica diante da pandemia de covid-19, Bahia, 2020/2021. Rev Baiana Saude Publica 2021; 45:43-52.	2021	Brazil	Experience report	Use of ICT; Implementation of an active flu syndrome search form; Notebook for evaluation and monitoring of PHC indicators by the state government.
Cerqueira and Pinheiro⁷³73 Cerqueira AVS, Pinheiro APT. Guia orientador para o enfrentamento da pandemia: relato do uso em um município da Bahia. Rev Baiana Saude Publica 2021; 45:65-70.	2022	Brazil	Experience report	Implementation of a guideline for coping with the pandemic, defining responsibilities of care network points and creating health care lines based on PHC.
Chang et al.⁷⁴74 Chang JE, Lai AY, Gupta A, Nguyen AM, Berry CA, Shelley DR. Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. Milbank Q 2021; 99:340-368.	2021	USA	Quantitative	Use of ICT.
Cheng et al.⁷⁵75 Cheng A, Angier H, Huguet N, Cohen DJ, Strickland K, Barclay E, Herman E, McDougall C, Biagioli FE, Pierce K, Straub C, Straub B, DeVoe J. Launching a Statewide COVID-19 Primary Care Hotline and Telemedicine Service. J Am Board Fam Med 2021; 34:170-178.	2021	USA	Experience Report	Use of ICT.
Cirino et al.⁴⁹49 Cirino FMSB, Aragão JB, Meyer G, Campos DS, Gryschek ALDFPL, Nichiata LYI. Desafios da atenção primária no contexto da COVID-19. Rev Bras Med Familia Comun 2021; 16(43):2665.	2021	Brazil	Experience report	PHC participation in the COVID-19 contingency committee; Maintenance of priority health care lines; Open access for other demands; Separation of symptomatic flow and specific team for symptomatic care; Home visits to vulnerable patients; Easier renewal of prescriptions, delivered to family members; Extended prescription validity; Guidelines for preventive measures and distribution of masks by community health agents.
Crowley et al.⁵⁹59 Crowley T, Kitshoff D, Lange-Cloete F, Baron J, Lange S, Young C, Esterhuizen T, Couper I. Reorganisation of primary care services during COVID-19 in the Western Cape, South Africa: Perspectives of primary care nurses. South African Fam Pract 2021; 63(1):a5358.	2021	South Africa	Quali -Quantitative	Greater number of pills to increase time between consultations and take out of medication; Home delivery of medication in partnership with social organizations; Use of ICT; Exclusive care areas for Covid and non-Covid patients.
Danhieux et al.³¹31 Danhieux K, Buffel V, Pairon A, Benkheil A, Remmen R, Wouters E, Olmen J. The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium. BMC Fam Pract 2020; 21(1):255-261.	2020	Belgium	Qualitative	Space was reorganized to create Covid patient areas; Use of ICT; Active monitoring of chronic patients considered at higher risk.
Donnelly et al.⁵⁷57 Donnelly C, Ashcroft R, Bobbette N, Mills C, Mofina A, Tran T, Vader K, Williams A, Gill S, Miller J. Interprofessional primary care during COVID-19: a survey of the provider perspective. BMC Fam Pract 2021; 22(1):31-43.	2021	USA	Qualitative	Use of ICT; Changes in job tasks, since usual activities could not be performed in the same way working online.
Driver et al.⁵⁷57 Donnelly C, Ashcroft R, Bobbette N, Mills C, Mofina A, Tran T, Vader K, Williams A, Gill S, Miller J. Interprofessional primary care during COVID-19: a survey of the provider perspective. BMC Fam Pract 2021; 22(1):31-43.	2021	USA	Quantitative	Use of ICT.
Fernandes et al.⁷⁶76 Fernandes RS, Fank EI, Mendes LEF, Araújo RS, Barbosa DS. Potencialidades da Educação Popular em tempos de pandemia da Covid-19 na Atenção Primária à Saúde no Brasil. Interface (Botucatu) 2022; 26:e210142.	2022	Brazil	Qualitative	Use of Popular Health Education to keep up and strengthen ties with the community and to develop community actions to fight and prevent Covid.
Fernandez et al.²²22 Fernandez M, Lotta G, Corrêa M. Desafios para a Atenção Primária à Saúde no Brasil: uma análise do trabalho das agentes comunitárias de saúde durante a pandemia de Covid-19. Trab Educ Saude 2021; 19:e210142.	2021	Brazil	Qualitative	Use of ICT; Home visits by Health Care Agents were suspended; Visits took only place at the gate and focused on information and guidance.
Fernemark et al.⁵⁰50 Fernemark H, Skagerström J, Seing I, Hårdstedt M, Schildmeijer K, Nilsen P. Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden. BMJ Open 2022; 12(2):e055035.	2021	Sweden	Qualitative	Use of ICT; Definition of separate teams and locations to care for symptomatic patients or patients with confirmed Covid; Face-to-face work meetings and training replaced by remote meetings.
Fifolt et al.⁵³53 Fifolt M, White-Williams C, Shirey MR, Su W, Talley M. The Association of COVID-19 on Organizational Attitudes in Primary Care Among Interprofessional Practice Clinics. J Ambul Care Manage 2022; 45(2):95-104.	2022	USA	Qualitative	Use of ICT
Franzosa et al.⁵⁴54 Franzosa E, Gorbenko K, Brody AA, Leff B, Ritchie CS, Kinosian B, Ornstein KA, Federman AD. "At Home, with Care": Lessons from New York City Home-based Primary Care Practices Managing. J Am Geriatr Soc 2021; 69(2):300-306.	2021	USA	Qualitative	Use of ICT; Delivery of oximeters to Covid and suspected Covid patients and monitoring by phone; Assessment of need for drugs and supplies; Virtual team meetings.
Franzosa et al.⁷⁷77 Franzosa E, Gorbenko K, Brody AA, Leff B, Ritchie CS, Kinosian B. "There Is Something Very Personal About Seeing Someone's Face": Provider Perceptions of Video Visits in Home-Based Primary Care During COVID-19. J Appl Gerontol 2021; 40:1417-1424.	2021	USA	Qualitative	Use of ICT.
Ghafri et al.²³23 Ghafri T Al, Al Ajmi F, Anwar H, Balushi LA, Balushi ZA, Fahdi FA, Lawati AA, Hashmi SA, Ghamari AA. Harthi MA, Kurup P, Lamki MA, Manji AA, Aharji AA, Harthi SA, Gibson E. The Experiences and Perceptions of Health-Care Workers During the COVID-19 Pandemic in Muscat, Oman: A Qualitative Study. J Prim Care Community Health 2020; 11:2150132720967514.	2020	Oman	Qualitative	Use of ICT; Definition of exclusive care areas for symptomatic and confirmed Covid patients.
Gilkey et al.⁷⁸78 Gilkey MB, Kong WY, Huang Q, Grabert BK, Thompson P, Brewer NT. Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals. J Med Internet Res 2021; 23(9):e31240.	2021	USA	Quantitative	Use of ICT.
Glazier et al.⁷⁹79 Glazier RH, Green ME, Wu FC, Frymire E, Kopp A, Kiran T. Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada. Can Med Assoc J 2021; 193:200-210.	2021	Canada	Quantitative	Use of ICT.
Grossman et al.⁸⁰80 Grossman Z, Chodick G, Reingold SM, Chapnick G, Ashkenazi S. The future of telemedicine visits after COVID-19: perceptions of primary care pediatricians. Isr J Health Policy Res 2020; 9(1):53-62.	2020	Israel	Quantitative	Use of ICT.
Hasani et al.⁸¹81 Hasani S Al, Ghafri T Al, Al Lawati H, Mohammed J, Mukhainai AA, Ajmi FA, Anwar H. The Use of Telephone Consultation in Primary Health Care During COVID-19 Pandemic, Oman: Perceptions from Physicians. J Prim Care Community Health 2020; 11:2150132720976480.	2020	Oman	Qualitative	Use of ICT.
James et al.³⁴34 James S, Ashley C, Williams A, Desborough J, Mcinnes S, Calma K, Mursa R, Stephen C, Halcomb EJ. Experiences of Australian primary healthcare nurses in using telehealth during COVID-19: a qualitative study. BMJ Open 2021; 11(8):e049095.	2021	Australia	Qualitative	Use of ICT.
Johnson et al.⁵⁶56 Johnson C, Dupuis JB, Goguen P, Grenier G. Changes to telehealth practices in primary care in New Brunswick (Canada): A comparative study pre and during the COVID-19 pandemic. PLoS One 2021; 16(11):e0258839.	2021	Canada	Quali-Quantitative	Use of ICT.
Joy et al.⁸²82 Joy M, McGagh D, Jones N, Liyanage H, Sherlock J, Parimalanathan V, Akinyemi O, Vlymen J, Howsam G, Marshall M, Hobbs FDR, Lusignan S. Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK. Br J Gen Pract 2020; 70(697):540-547.	2020	UK	Quantitative	Use of ICT.
Knierim et al.⁸³83 Knierim K, Palmer C, Kramer ES, Rodriguez RS, VanWyk J, Shmerling A, Smith P, Holmstrom H, Bacak BS, Levey SMB, Staton EW, Holtrop JS. Lessons Learned During COVID-19 That Can Move Telehealth in Primary Care Forward. J Am Board Fam Med 2021; 34:196-202.	2021	USA	Experience Report	Use of ICT.
Koster et al.³⁵35 Koster ES, Philbert D, Bouvy ML. Impact of the COVID-19 epidemic on the provision of pharmaceutical care in community pharmacies. Res Soc Adm Pharm 2021; 17(1):2002-2004.	2020	Netherlands	Quantitative	Use of ICT; Automated drug dispensers; Home delivery of medication.
Kunwar et al.⁶⁰60 Kunwar A, Durgad K, Kaur P, Sharma M, Swasticharan L, Mallela M, Saxena A, Tayade S, Gill S, Gopal BK, Pathni AK, Tullu FT, Dhaliwal RS, Bhargava B. Interventions to Ensure the Continuum of Care for Hypertension During the COVID-19 Pandemic in Five Indian States-India Hypertension Control Initiative. Glob Heart 2021; 16(1):82.	2021	India	Quantitative	Distribution of medication in community health centers; Delivery of greater number of pills to increase time between consultations and take out of medication at health care centers.
Kurotschka et al.⁶²62 Kurotschka PK, Serafini A, Demontis M, Serafini A, Mereu A, Moro MF, Carta MG, Ghirotto L. General Practitioners' Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study. Front Public Health 2021; 9:623904.	2021	Italy	Qualitative	Use of ICT.
Lim et al.²⁶26 Lim HM, Abdullah A, Ng CJ, Teo CH, Valliyappan IG, HAdi HA, Ng WL, Azhar AMN, Chiew TK, Liew CS, Chan CS. Utility and usability of an automated COVID-19 symptom monitoring system (CoSMoS) in primary care during COVID-19 pandemic: A qualitative feasibility study. Int J Med Inform 2021; 155:104567.	2021	Malaysia	Qualitative	Use of ICT.
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Murphy et al.⁸⁷87 Murphy M, Scott LJ, Salisbury C, Turner A, Scott A, Denholm R, Lewis R, Iyer G, Macleod J, Horwood J. Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Br J Gen Pract 2021; 71:166-177.	2021	England	Qualitative	Use of ICT.
Norman et al.⁴⁵45 Norman C, Wildman JM, Sowden S. COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic. Int J Environ Res Public Health 2021; 18(16):e8689.	2021	England	Qualitative	Remote work; Use of ICT
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Ritchie et al.⁵¹51 Ritchie CS, Gallopyn N, Sheehan OC, Sharieff SA, Franzosa E, Gorbenko K, Ornstein KA, Federman AD, Brody AA, Leff B. COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey. J Am Med Dir Assoc 2021; 22(7):1338-1344.	2021	USA	Quali -Quantitative	Use of ICT; Remote monitoring of patients using oximeters; Reorganization of personnel to provide care to symptomatic patients by a specific team; Professionals working with risk groups, elderly people and other patients who had to quarantine worked via video consultations; Provision of a larger number of pills to increase time between consultations and reduce take out at health care centers; Engagement in the community to raise money to buy medication, PPE and food for vulnerable patients; Assessment of food insecurity and burnout of caregivers and patients in social isolation.
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Sclarsky and Kumar³³33 Sclarsky H, Kumar P. Community-Based Primary Care Management for an Older Adult With COVID-19: A Case Report. Am J Occup Ther 2021; 75:e75112110030.	2021	USA	Experience Report	Use of ICT.
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Sinha et al.⁹⁰90 Sinha S, Kern LM, Gingras LF, Reshetnyak E, Tung J, Pelzman F, McGrath TA, Sterling MR. Implementation of Video Visits During COVID-19: Lessons Learned From a Primary Care Practice in New York City. Front Public Health 2020; 18:514.	2020	USA	Quantitative	Use of ICT.
Smyrnakis et al.⁵²52 Smyrnakis E, Symintiridou D, Andreou M, Dandoulakis M, Theodoropoulos E, Kokkali S, Manolaki C, Papageorgiou DI, Birtsou C, Paganas A, Stachteas P, Vlachopoulos N, Pagkozidis I, Zeimbekis A, Roka V, Giakoumis A, Kotsani M, Avakian I, Makridou E, Gavana M, Haidich A, Avgerinou C. Primary care professionals' experiences during the first wave of the COVID-19 pandemic in Greece: a qualitative study. BMC Fam Pract 2021; 22(1):174.	2021	Greece	Qualitative	Use of ICT; Acquisition of PPE on behalf of professionals of the public sector; Separate care hours for symptomatic patients.
Spelman et al.⁹¹91 Spelman JF, Brienza R, Walsh RF, Drost P, Schwartz AR, Kravetz JD, Pitkin P, Ruser C. A Model for Rapid Transition to Virtual Care, VA Connecticut Primary Care Response to COVID-19. J Gen Intern Med 2020; 35(10):3073-3076.	2020	USA	Experience Report	Use of ICT.
Srinivasan et al.⁹²92 Srinivasan M, Asch S, Vilendrer S, Thomas SC, Bajra R, Barman L, Edwards LM, Filipowicz H, Giang L, Jee O, Mahoney M, Nelligan I, Phadke AJ, Torres E, Artandi M. Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center. Ann Intern Med 2020; 173(7):527-535.	2020	USA	Qualitative	Use of ICT.
Steiner et al.⁶¹61 Steiner RJ, Zapata LB, Curtis KM, Whiteman MK, Brittain AW, Tromble E, Keys KR, Fasula AM. COVID-19 and Sexual and Reproductive Health Care: Findings From Primary Care Providers Who Serve Adolescents. J Adolesc Health 2021; 69(3):375-382.	2021	USA	Quantitative	Use of ICT; Renewal of contraception without the need for a face-to-face consultation; Provision of contraceptives for one year to reduce the need for consultations and take out at the health clinic; Guidance and provision of emergency contraception in advance of user need.
Stengel et al.⁹³93 Stengel S, Roth C, Breckner A, Peters-Klimm F, Schwill S, Möllinger S, Buhlinger-Göpfarth N, Szecsenyi J, Wensing M. Primärärztliche Strategien und Zusammenarbeit während der ersten Phase der COVID-19-Pandemie in Baden-Württemberg, Deutschland. Gesundheitswes 2021; 83(04):250-257.	2021	Germany	Quantitative	Use of ICT.
Tse et al.⁹⁴94 Tse DM-S, Li Z, Lu Y, Li Y, Liu Y, Wong WCW. Fighting against COVID-19: preparedness and implications on clinical practice in primary care in Shenzhen, China. BMC Fam Pract 2020; 21(1):271.	2020	China	Quantitative	Use of ICT.
van der Valden et al.⁹⁵95 Velden AW, Bax EA, Bongard E, Aabenhus RM, Anastasaki M, Anthierens S, Balan A, Bömer F, Bruno P, Chlabicz S, Coenen S, Colliers A, Emmerich S, Garcia-Sangenis A, Ghazaryan H, Linde SR, Malinia L, Pauer J, Tomacinschii A, Tonkin-Crine S, Vellinga A, Zastavnyy I, Verheij T, Goossens H, Butler CC. Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries. BMJ Open 2021; 11:e049257.	2021	Europe (16 countries)	Quantitative	Use of ICT.
Wanat et al.²⁷27 Wanat M, Hoste M, Gobat N, Anastasaki M, Böhmer F, Chlabicz S, Colliers A, Farrell K, Karkana MN, Kinsman J, Lionis C, Marciniowicz L, Reinhardt K, Skoglund I, Sundvall P, Vellinga A, Verheij TJM, Goossens H, Butler CC, Velden A, Snthierens S, Tonkin-Crine S. Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries. Br J Gen Pract 2021; 71(709):e634-e642.	2021	Europe (8 countries: England, Belgium, Ireland, Holland, Germany, Poland, Greece and Sweden)	Qualitative	Use of ICT; Separate places and times for symptomatic care.
Wilson et al.⁹⁶96 Wilson CG, Alexander S, Hitch WJ, Lorenz-Miller L, Matheson E, Fagan EB. Project ECHO (r) in Primary Care: Informing Providers about COVID-19 and Its Impact on Health Care Delivery. N C Med J 2022; 83(2):130-133.	2022	USA	Experience report	Online training of Primary Care professionals.
Wilson et al.³²32 Wilson G, Windner Z, Dowell A, Toop L, Savage R, Hudson B. Navigating the health system during COVID-19: primary care perspectives on delayed patient care. N Z Med J 2021; 134(1546):17-27.	2021	New Zealand	Qualitative	Use of ICT.
Wilson et al.³²32 Wilson G, Windner Z, Dowell A, Toop L, Savage R, Hudson B. Navigating the health system during COVID-19: primary care perspectives on delayed patient care. N Z Med J 2021; 134(1546):17-27.	2021	New Zealand	Qualitative	Increased interval between appointments for stable chronic patients; Use of ICT.
Xu et al.⁵⁸58 Xu Z, Ye Y, Wang Y, Qian Y, Pan J, Lu Y, Fang L. Primary Care Practitioners' Barriers to and Experience of COVID-19 Epidemic Control in China: a Qualitative Study. J Gen Intern Med 2020; 35(11):3278-3284.	2020	China	Qualitative	Use of ICT; Home visit of patients in social isolation.

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[1] Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva