Abstract
Objective
To evaluate the quality of primary healthcare services for older adults during the COVID-19 pandemic through studies evaluating health services.
Method
A systematic literature review was conducted. The search for articles covered the databases Web of Science, Embase, Scopus, and Medline/Pubmed. Original scientific articles with a case-control or cross-sectional design, involving populations that included older adults, focusing on primary healthcare, and assessing the quality of health services were included. Exclusion criteria were studies without specific analysis for older adults, studies evaluating health access or economic evaluation of health. The risk of bias analysis was conducted according to JBI protocols, and data synthesis was performed using SWiM guidelines.
Results
Seven studies were included in the review. The primary care services evaluated were mostly outpatient, with diverse quality assessment parameters related to individual care. The evaluation of quality identified a decrease in in-person consultations and visits, and an increase in the use of telehealth, with good satisfaction ratings among older adults.
Conclusion
The studies highlighted the difficulties maintaining and accessing in-person services during the COVID-19 pandemic, which directly contributed to a reduction in consultations and exams, usage of and access to health services, and the quality of primary healthcare.
Keywords
Primary Health Care; Aged People; Aged 80 and Over; COVID-19
Resumo
Objetivo
Avaliar a qualidade da atenção primária à saúde voltada para pessoas idosas, durante a pandemia de covid-19, por meio de estudos de avaliação de serviços de saúd
Método
Foi realizada uma revisão sistemática da literatura. A busca de artigos abrangeu as bases de dados Web of Science, Embase, Scopus e Medline/Pubmed. Foram incluídos artigos científicos originais, com desenho, caso-controle ou seccional, população contendo pessoas idosas, objeto do estudo atenção primária à saúde e estudos sobre a qualidade dos serviços de saúde. Os critérios de exclusão adotados foram: estudos sem análise específica para idosos, estudos de avaliação do acesso ou avaliação econômica da saúde. A análise do risco de viés foi realizada de acordo com os protocolos JBI e a síntese de dados foi realizada com as diretrizes SWiM.
Resultados
Foram incluídos na revisão sete estudos. Os serviços de atenção primária avaliados foram, em sua maioria, ambulatoriais, com parâmetros de avaliação da qualidade diversos, relacionados ao cuidado individual. A avaliação da qualidade identificou diminuição de consultas e visitas presenciais e aumento do uso de telessaúde, com boa avaliação da satisfação por pessoas idos
Conclusão
Os estudos evidenciaram as dificuldades na manutenção e no acesso aos serviços presenciais durante a pandemia de covid-19, o que impactou diretamente na redução da oferta de consultas e exames, na utilização e acesso aos serviços de saúde e na qualidade da assistência à saúde na atenção primária.
Palavras-Chave:
Atenção Primária à Saúde; Idoso; Idoso de 80 Anos ou Mais; Covid-19
INTRODUCTION
The aim of Primary Healthcare (PHC) is to provide accessible, comprehensive organized care that meets the health needs of users and the community. The main strategy centers on creating ties which allow continued care over the long-term¹.
It is widely recognized that PHC constitutes the first level of care in health systems, and its scope of services entails providing services such as medical and nursing consultations, quality support using the risk classification scale, oral healthcare, dispensing and administration of medications, immunization, home visits, group activities, mental health care, etc. All these services are geared to meet the more common health needs of a given population22 Giovanella L. A atenção primária à saúde nos países da União Européia: configurações e reformas organizacionais na década de 1990. Cad. Saúde Pública. Rio de Janeiro, 2006; 22(5): 951-96. DOI: https://doi.org/10.1590/S0102-311X2006000500008.
https://doi.org/10.1590/S0102-311X200600...
. Over time, the implementation of PHC has been influenced by a host of economic, political and cultural factors, reflecting the specific contexts, eras and different social actors involved33 Starfield B. Atenção Primária: equilíbrio entre necessidades de saúde, serviços e tecnologia.UNESCO. Disponível em: https://unesdoc.unesco.org/ark:/48223/pf0000130805. Acesso em: 06 de maio de 2024..
The Dawson report, published in 1920, is considered a landmark document in the formulation of PHC as a form of organizing public health systems into different levels of care. Under this model, the level of care must be able to resolve most health problems and serve as the main doorway to the health system, besides coordinate the healthcare network44 Portela GZ. Atenção Primária à Saúde: um ensaio sobre conceitos aplicados aos estudos nacionais. Physis [Internet]. 2017; 27(2):255–76. DOI: https://doi.org/10.1590/s0103-73312017000200005
https://doi.org/10.1590/s0103-7331201700...
.
Primary Healthcare differs to the biomedical model in its emphasis on promoting health and preventing disease as key pillars for effective, equitable health systems, contributing to an increased life expectancy. As population aging continues unabated in many countries, the challenges facing society regarding structuring healthcare networks grow55 Giovanella L, Mendonça MHMD, Buss PM, Fleury S, Gadelha CAG, Galvão LAC, et al. De Alma-Ata a Astana. Atenção primária à saúde e sistemas universais de saúde: compromisso indissociável e direito humano fundamental. Cad Saúde Pública [Internet]. 2019 ;35(3):e00012219. DOI: https://doi.org/10.1590/0102-311x00012219
https://doi.org/10.1590/0102-311x0001221...
.
The care model needs to be in step with the changes in profile of diseases prevailing in the population and with the constant shifts in demographic and epidemiologic transitions, which are already showing the increase in prevalence and incidence of chronic non-communicable diseases (NCDs) and neurodegenerative disorders. In order to promote successful aging, as recommended by the World Health Organization (WHO), planning strategies take account of these changes. This includes measures for monitoring chronic conditions, which require continued care, and also tracking changes in medications, dietary counseling, support for treatment adherence and access to information. Also, to ensure integrative care, the aspects involving the health of users in the territory need to be identified, revealing that a large contingent of older adults have different degrees of dependence and that many are cared for by family members and caregivers66 Mendes E Vilaça. O cuidado das condições crônicas na atenção primária à saúde: o imperativo da consolidação da estratégia da saúde da família. Brasília, DF: Organização Pan-Americana da Saúde; 2012. 512 p. [internet] Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/cuidado_condicoes_atencao_primariasaude.pdf. ISBN: 978-85-7967-078-7 Acesso em: 20 de março de 2024.. These groups should be supported by providing guidance to improve quality of life and tools for early detection of cognitive decline77 Moreira MD, Caldas CP. A importância do cuidador no contexto da saúde do idoso. Esc Anna Nery [Internet]. 2007;11(3):520–5. DOI: https://doi.org/10.1590/S1414-81452007000300019
https://doi.org/10.1590/S1414-8145200700...
.
Studies conducted by Grumbach et al.88 Grumbach K. Redesign of the Health Care Delivery System: A Bauhaus “Form Follows Function” Approach. JAMA [Internet]. 2009;302(21):2363. DOI: https://doi.org/10.1001/jama.2009.1772
https://doi.org/10.1001/jama.2009.1772...
show that PHC-based health systems have better outcomes and lower costs compared with other levels of care. In parallel, assessing the quality of services delivered, as highlighted by Moore et al.99 Moore L, Lavoie A, Bourgeois G, Lapointe J. Donabedian’s structure-process-outcome quality of care model: Validation in an integrated trauma system. Journal of Trauma and Acute Care Surgery [Internet]. 2015;78(6):1168–75. DOI: https://doi.org/10.1097/TA.0000000000000663
https://doi.org/10.1097/TA.0000000000000...
, is crucial for improving processes and achieving positive outcomes in the lives of individuals. This involves assessing the structure, process and outcomes, with respect to the resultant human and financial resources of the actions performed. Lastly, the promotion of health and delivery of quality care to older adults, catering for their specific needs, plays a key role in the prevention, early diagnosis and management of common health conditions associated with aging 1010 Backes DS, Backes MS, Erdmann AL, Büscher A. O papel profissional do enfermeiro no Sistema Único de Saúde: da saúde comunitária à estratégia de saúde da família. Ciênc saúde coletiva [Internet]. 2012;17(1):223–30.DOI: https://doi.org/10.1590/S1413-81232012000100024
https://doi.org/10.1590/S1413-8123201200...
During the waves of the COVID-19 pandemic, PHC drove actions of prevention and tracking of the disease and suffered major strain on physical resources and human capital, leading to scant attention dedicated to other conditions and practices1111 Teixeira CFDS, Soares CM, Souza EA, Lisboa ES, Pinto ICDM, Andrade LRD, et al. A saúde dos profissionais de saúde no enfrentamento da pandemia de Covid-19. Ciênc saúde coletiva [Internet]. 2020;25(9):3465–74. DOI: https://doi.org/10.1590/1413-81232020259.19562020
https://doi.org/10.1590/1413-81232020259...
. This created the need to analyze the quality of health care delivered to users during the COVID-19 pandemic and the strategies adopted to mitigate the deleterious impact of this process. This knowledge can ensure that future pandemics can be tackled without adversely affecting the other services offered. Therefore, the present study was prompted by the need to analyze and understand the performance of PHC services delivered to older users during the COVID-19 pandemic, and to help inform the devising of future strategies for dealing with public health emergencies.
METHOD
The present systematic review was conducted according to the core items of guidelines for reporting systematic reviews (PRISMA), as described in Page et al.1212 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. Epidemiologia e Serviços de Saúde [Internet]. 2022;31(2). DOI: https://doi.org/10.1590/s1679-49742022000200033
https://doi.org/10.1590/s1679-4974202200...
, and was registered on PROSPERO under protocol number CRD42022359711. The following guiding question was adopted: what was the quality of Primary Care for older adults during the COVID-19 pandemic in studies evaluating health services? The question was devised using the PICo (Population, phenomenon of Interest, Context) strategy which aids the defining of questions for reviews. For the purpose of the present study, the acronym was defined as follows: Population = older adults; Interest = the quality of healthcare delivered during the COVID-19 pandemic; and Context = primary care.
The bibliographic search was guided by controlled descriptors from the Medical Subject Headings (MeSH) and Descritores em Ciências da Saúde (DecS) “idoso” (aged), “idoso de 80 anos ou mais” (older adults aged 80 and over), “qualidade da assistência à saúde” (health care quality), “qualidade, acesso e avaliação da assistência à saúde” (health care quality, access and evaluation), “atenção primária à saúde” (primary health care), “indicadores de qualidade em assistência à saúde” (health care quality indicators) and “COVID-19”, using the Boolean operators AND OR. The systematic search strategy is presented in Chart 1.
The searches were performed on 8th September 2022 and no constraints on publication period or language were placed, so as to retrieve the maximum number of relevant studies possible.
Article screening was carried out in two stages. Abstract reading and full article reading was done by two of the authors of the present study in an independent fashion. Any disagreements were settled by a third reviewer at a consensus meeting. Initially, a pilot study of the first 100 abstracts was conducted to refine the inclusion and exclusion criteria. Subsequently, the remaining abstracts were read by two reviewers independently.
Inclusion criteria were original scientific articles, with cohort, case-control or cross-sectional designs. The study population contained older adults (≥60 years). Studies chosen were published from 2019 onwards and assessed PHC services in the context investigated.
The exclusion criteria were studies not specifically analyzing older individuals, studies assessing health economics, literature reviews, editorials, opinion studies, publications prior to 2019, clinical protocols and evaluations of medications.
The Kappa coefficient was employed to analyze degree of agreement between the two researchers and validation of the protocol criteria. A Kappa statistic of 0.88 was found for the pilot of the first 100 abstracts1313 McHugh ML. Interrater reliability: the kappa statistic. Biochem Med [Internet]. 2012;276–82. DOI: https://doi.org/10.11613/BM.2012.031
https://doi.org/10.11613/BM.2012.031...
. The Kappa value for the reading of abstracts and full reading of articles was 0.80, representing almost perfect agreement1313 McHugh ML. Interrater reliability: the kappa statistic. Biochem Med [Internet]. 2012;276–82. DOI: https://doi.org/10.11613/BM.2012.031
https://doi.org/10.11613/BM.2012.031...
. Data were extracted from articles by pairs of reviewers independently, using a protocol devised by the researchers.
Data were extracted for the following variables: author(s), title, year of publication, language, country, objective, study population, age studied, study design, study period, sample size, service type evaluated, service quality evaluation parameter, study venue, measure of service quality, outcome of service quality evaluation, outcome of service evaluation.
Based on the extracted data, a risk of bias analysis of the studies was performed using JBI’s Critical Appraisal tools available for use in systematic reviews. The checklists for cohort and cross-sectional studies were applied. Data synthesis was performed based on the Synthesis Without Meta-Analysis-SWiM guideline1414 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ [Internet]. 2021; 71. DOI: https://doi.org/10.1136/bmj.n71
https://doi.org/10.1136/bmj.n71...
and subdivided into two subgroups: parameters for evaluation of quality; and type of service evaluated, with results presented in the form of charts.
RESULTS
The search for articles led to the retrieval of 807 studies which, after removal of 28 duplicates, gave a total of 778. A further 641 studies were excluded during the first stage of screening. There was reviewer disagreement on 110 articles, which were then read by a third reviewer at a consensus meeting, with 87 selected for the next stage (Figure 1). After full reading of the articles, independently, 77 articles were excluded, with disagreement on 3 cases, subsequently examined by a third reviewer. Following a consensus meeting, agreement was reached and 2 of these articles were included in the review.
A total of seven articles were included in this systematic review, comprising four cohort and three cross-sectional studies. The analysis of risk of bias of the studies reviewed showed that most reported the essential details, such as sample size, target population and statistical analyses, justifying the relevance of the analysis of the quality of the services in question (Chart 2).
Analysis of risk of bias using Joanna Briggs Institute Checklist. Recife, Pernambuco state, Brazil, 2023.
The country of study encompassed a total of five different nations, namely: the USA, Canada, Finland, the UK, and Spain, spanning the two continents of North America and Europe. All of the articles reviewed were published in English between 2021 and 2022. Sample sizes ranged from 513 to 2,363,742 participants. In terms of age groups of the populations investigated, most of the studies adopted an age cut-off of 65 years or over. However, four articles opted for a broader age range from 10 to 80 years or older. In these studies, the older population accounted for over half of the total participants. With regard to study venues, most of the studies reviewed took place in PHC facilities (Chart 3).
. Characteristics of studies included in systematic review. Recife, Pernambuco state, Brazil, 2023.
The PHC services evaluated were mostly outpatient facilities, with the inclusion of one study about vaccination services and another investigating telemedicine. A variety of different parameters were used for evaluating the quality of services. The vast majority were related to services involving individual care, such as vaccination coverage, number of follow-up consultations, interruptions in the care process, referrals to mental health services, mortality levels and satisfaction with telemedicine care service (Chart 4).
The studies exposed the difficulties in maintaining services during the COVID-19 pandemic. The crisis directly impacted the quality of care, with a decline in the number of in-person Medicare users, and a drop in emergency visits during lockdown period and then a rebound effect. Also, two of the studies reported increased mortality of the older population followed for chronic NCDs and neurodegenerative and immune preventable diseases.
An increase in vaccination coverage was achieved among veterans, as well as improved work processes, such as completeness of screening records. One study reported maintenance of the number of outpatient consultations, with broadly similar patterns to pre-pandemic levels. An increase in the use of telehealth services was reported in two articles, as a technological tool for serving the population during lockdown, while another study reported good satisfaction of older users with the service.
DISCUSSION
The quality of healthcare for older patients during the COVID-19 pandemic in Primary Healthcare (PHC) services was investigated in different regions including North America and Europe. However, it is important to note these regions represent developed countries, characterized by different health and economic systems, extensive availability of more robust resources, and greater access to technology. Although analyses carried out in these regions are valuable, they may be poorly representative of the global panorama because they lack studies in developing or low-income countries1515 Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ [Internet]. 2020; l6890. DOI: https://doi.org/10.1136/bmj.l6890
https://doi.org/10.1136/bmj.l6890...
.
The absence of studies in these regions can give rise to gaps in knowledge on the specific challenges faced by these nations with regard to care for older individuals during the pandemic. This situation may also hamper the identification of effective strategies for improving healthcare in settings with limited resources1616 Podell R, Kaufman-Shriqui V, Sagy YW, Manor O, Ben-Yehuda A. The quality of primary care provided to the elderly in Israel. Isr J Health Policy Res [Internet]. 2018 ;7(1):21. DOI: https://doi.org/10.1186/s13584-018-0214-3
https://doi.org/10.1186/s13584-018-0214-...
.
Outpatient services offered in PHC worldwide play a crucial role, particularly in controlling chronic non-communicable diseases (NCDs) and neurodegenerative diseases, which have a major impact on increased mortality of older adults1717 Bernocchi P, Crotti G, Beato E, Bonometti F, Giudici V, Bertolaia P, et al. COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy). Front Cardiovasc Med [Internet]. 2023 ;10:1062232. DOI: https://doi.org/10.3389/fcvm.2023.1062232
https://doi.org/10.3389/fcvm.2023.106223...
.
During the COVID-19 pandemic, these services faced unique challenges, particularly regarding adaptation to remote working. Although teleconsultation proved a promising alternative for care continuity, some health conditions require a more face-to-face closer approach, especially in cases requiring physical examinations or specific procedures1818 Plans-Rubió P. Strategies to Increase the Percentages of Vaccination Coverage. Vaccines (Basel) [Internet]. 2022; 10(12):2103. DOI: https://doi.org/10.3390/vaccines10122103 PMID: 36560513
https://doi.org/10.3390/vaccines10122103...
.
This transition to a distance care model raised questions as to the adequacy and efficacy of monitoring chronic conditions and over the ability to deliver preventive interventions effectively. Consequently, many older patients may have faced difficulties managing their health conditions during the pandemic, highlighting the need for adaptive innovative strategies for ensuring continuity and quality of health care in crisis situations1919 Chadwick A, Kaiser J, Vaccari C, Freeman D, Lambe S, Loe BS, et al. Online Social Endorsement and Covid-19 Vaccine Hesitancy in the United Kingdom. Social media + Society [Internet]. 2021; 7(2):205630512110088. DOI: https://doi.org/10.1177/20563051211008817
https://doi.org/10.1177/2056305121100881...
.
The studies conducted in North America and Europe revealed some of the main challenges during the COVID-19 pandemic, allowing the evaluation of the quality of healthcare gleaned from understanding the responses to these challenges. The implementation of teleconsultation played a crucial role in maintaining care continuity, reducing the burden on health systems, while minimizing risk of exposure to the virus2020 Neri AJ, Whitfield GP, Umeakunne ET, Hall JE, DeFrances CJ, Shah AB, et al. Telehealth and Public Health Practice in the United States—Before, During, and After the COVID-19 Pandemic. Journal of Public Health Management and Practice [Internet]. 2022; 28(6):650–6. DOI: https://doi.org/10.1097/PHH.0000000000001563
https://doi.org/10.1097/PHH.000000000000...
.
However, difficulty accessing technology emerged as a major obstacle to implementing teleconsultation, raising concerns over the equity of access, particularly among older users. The main challenge encountered by these studies was a lack of familiarity with the technologies, access to appropriate devices and usability in this group. Nevertheless, on the evaluation of quality, teleconsultation favored the reduction of exposure of older adults to health services overloaded by COVID-19 cases, representing an experience widely replicated on a global level2121 Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare [Internet]. 2020; 26(5):309–13. DOI: https://doi.org/10.1177/1357633X20916567
https://doi.org/10.1177/1357633X20916567...
,2222 Contreras CM, Metzger GA, Beane JD, Dedhia PH, Ejaz A, Pawlik TM. Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. Journal of Gastrointestinal Surgery [Internet]. 2020; 24(7):1692–7. DOI: https://doi.org/10.1007/s11605-020-04623-5
https://doi.org/10.1007/s11605-020-04623...
.
Another challenge seen in the studies was the low vaccination coverage during the pandemic, representing an obstacle in promoting and prevention of the spread of the virus and a significant threat to public health, especially for more vulnerable groups, such as older adults2323 Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ [Internet]. 2020; m1182. Doi: https://doi.org/10.1136/bmj.m1182
https://doi.org/10.1136/bmj.m1182...
.
Lower vaccination rates can lead to an increase in immune preventable diseases, such as influenza, pneumonia and other serious respiratory infections, which pose a particular threat to older adults due to their susceptibility to serious complications and associated mortality2424 Armstrong BG, Mangtani P, Fletcher A, Kovats S, McMichael A, Pattenden S, et al. Effect of influenza vaccination on excess deaths occurring during periods of high circulation of influenza: cohort study in elderly people. BMJ [Internet]. 2004 Sep 18; 329(7467):660. DOI https://doi.org/10.1136/bmj.38198.594109.AE
https://doi.org/10.1136/bmj.38198.594109...
.
Amid this scenario, it is imperative to implement effective strategies encouraging vaccination to ensure rates of vaccination coverage are restored and maintained at adequate levels. This includes the running of public information campaigns at strategic locations where older adults meet up to clear up doubts and dispel myths about the vaccines, to highlight their importance in preventing serious diseases, and emphasize their proven safety and efficacy, expanding the vaccination coverage in the study2525 Immunization Agenda 2030: A Global Strategy To Leave No One Behind [Internet]. Disponível em: https://www.who.int/publications/m/item/immunization-agenda-2030-a-global-strategy-to-leave-no-one-behind. Acesso em : 06 de maio de 2024..
However, it is important to underscore that the dearth of studies in lower income countries may constitute a major limitation in this analysis, given that the lack of comparisons of the strategies adopted in these regions precludes a deeper understanding of the global response to the pandemic.
Given the present study centered on the analysis of literature within the descriptors constructed based on the search strategy, comparing against different study designs or the grey literature may have contributed to an approach centered on countries with different publications and concerns with evaluating these services.
Indeed, the lack of studies in Brazil enabling the identification of specific strategies in the Brazilian health system amid the pandemic also represents a limitation. Most of the studies reviewed were conducted in Europe and the USA, limiting the generalization of results to other world regions.
Importantly, the selection of articles, omitting those in poorer countries or grey literature, represents a bias masking the understanding of the true situation of the adverse effects of the COVID-19 pandemic on the older population.
CONCLUSION
Important lessons were learned from the COVID-19 pandemic on the need to reorganize health systems worldwide. The outbreak also revealed weaknesses in aspects of health promotion and prevention of illness. The low vaccination coverage among older adults had a significant impact on the increased mortality in this population group, prompting the implementation of strategic measures to address this issue. Measures ranging from low-cost informational actions to heavy investment were adopted to reach this target public.
There was a clear need to expand and valorize PHC as a key public health instrument, a strategy of utmost importance which featured in all of the studies reviewed.
One of the main findings identified in these studies was increased mortality among older patients and low vaccination coverage, underscoring the urgent need to strengthen public health policies and promote effective actions to protect more vulnerable groups during public health emergencies, such as the COVID-19 pandemic.
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Funding: the present study was financially supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001
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DATA AVAILABILITY
The complete dataset underpinning the results of the present study is available upon request from the corresponding author of the article.
REFERÊNCIAS
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1Atenção primária à saúde - OPAS/OMS | Organização Pan-Americana da Saúde [Internet]. 2023. Acesso em 06 de maio de 2024. Disponível em: https://www.paho.org/pt/topicos/atencao-primaria-saude
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2Giovanella L. A atenção primária à saúde nos países da União Européia: configurações e reformas organizacionais na década de 1990. Cad. Saúde Pública. Rio de Janeiro, 2006; 22(5): 951-96. DOI: https://doi.org/10.1590/S0102-311X2006000500008.
» https://doi.org/10.1590/S0102-311X2006000500008 -
3Starfield B. Atenção Primária: equilíbrio entre necessidades de saúde, serviços e tecnologia.UNESCO. Disponível em: https://unesdoc.unesco.org/ark:/48223/pf0000130805. Acesso em: 06 de maio de 2024.
-
4Portela GZ. Atenção Primária à Saúde: um ensaio sobre conceitos aplicados aos estudos nacionais. Physis [Internet]. 2017; 27(2):255–76. DOI: https://doi.org/10.1590/s0103-73312017000200005
» https://doi.org/10.1590/s0103-73312017000200005 -
5Giovanella L, Mendonça MHMD, Buss PM, Fleury S, Gadelha CAG, Galvão LAC, et al. De Alma-Ata a Astana. Atenção primária à saúde e sistemas universais de saúde: compromisso indissociável e direito humano fundamental. Cad Saúde Pública [Internet]. 2019 ;35(3):e00012219. DOI: https://doi.org/10.1590/0102-311x00012219
» https://doi.org/10.1590/0102-311x00012219 -
6Mendes E Vilaça. O cuidado das condições crônicas na atenção primária à saúde: o imperativo da consolidação da estratégia da saúde da família. Brasília, DF: Organização Pan-Americana da Saúde; 2012. 512 p. [internet] Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/cuidado_condicoes_atencao_primariasaude.pdf. ISBN: 978-85-7967-078-7 Acesso em: 20 de março de 2024.
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7Moreira MD, Caldas CP. A importância do cuidador no contexto da saúde do idoso. Esc Anna Nery [Internet]. 2007;11(3):520–5. DOI: https://doi.org/10.1590/S1414-81452007000300019
» https://doi.org/10.1590/S1414-81452007000300019 -
8Grumbach K. Redesign of the Health Care Delivery System: A Bauhaus “Form Follows Function” Approach. JAMA [Internet]. 2009;302(21):2363. DOI: https://doi.org/10.1001/jama.2009.1772
» https://doi.org/10.1001/jama.2009.1772 -
9Moore L, Lavoie A, Bourgeois G, Lapointe J. Donabedian’s structure-process-outcome quality of care model: Validation in an integrated trauma system. Journal of Trauma and Acute Care Surgery [Internet]. 2015;78(6):1168–75. DOI: https://doi.org/10.1097/TA.0000000000000663
» https://doi.org/10.1097/TA.0000000000000663 -
10Backes DS, Backes MS, Erdmann AL, Büscher A. O papel profissional do enfermeiro no Sistema Único de Saúde: da saúde comunitária à estratégia de saúde da família. Ciênc saúde coletiva [Internet]. 2012;17(1):223–30.DOI: https://doi.org/10.1590/S1413-81232012000100024
» https://doi.org/10.1590/S1413-81232012000100024 -
11Teixeira CFDS, Soares CM, Souza EA, Lisboa ES, Pinto ICDM, Andrade LRD, et al. A saúde dos profissionais de saúde no enfrentamento da pandemia de Covid-19. Ciênc saúde coletiva [Internet]. 2020;25(9):3465–74. DOI: https://doi.org/10.1590/1413-81232020259.19562020
» https://doi.org/10.1590/1413-81232020259.19562020 -
12Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. Epidemiologia e Serviços de Saúde [Internet]. 2022;31(2). DOI: https://doi.org/10.1590/s1679-49742022000200033
» https://doi.org/10.1590/s1679-49742022000200033 -
13McHugh ML. Interrater reliability: the kappa statistic. Biochem Med [Internet]. 2012;276–82. DOI: https://doi.org/10.11613/BM.2012.031
» https://doi.org/10.11613/BM.2012.031 -
14Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ [Internet]. 2021; 71. DOI: https://doi.org/10.1136/bmj.n71
» https://doi.org/10.1136/bmj.n71 -
15Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ [Internet]. 2020; l6890. DOI: https://doi.org/10.1136/bmj.l6890
» https://doi.org/10.1136/bmj.l6890 -
16Podell R, Kaufman-Shriqui V, Sagy YW, Manor O, Ben-Yehuda A. The quality of primary care provided to the elderly in Israel. Isr J Health Policy Res [Internet]. 2018 ;7(1):21. DOI: https://doi.org/10.1186/s13584-018-0214-3
» https://doi.org/10.1186/s13584-018-0214-3 -
17Bernocchi P, Crotti G, Beato E, Bonometti F, Giudici V, Bertolaia P, et al. COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy). Front Cardiovasc Med [Internet]. 2023 ;10:1062232. DOI: https://doi.org/10.3389/fcvm.2023.1062232
» https://doi.org/10.3389/fcvm.2023.1062232 -
18Plans-Rubió P. Strategies to Increase the Percentages of Vaccination Coverage. Vaccines (Basel) [Internet]. 2022; 10(12):2103. DOI: https://doi.org/10.3390/vaccines10122103 PMID: 36560513
» https://doi.org/10.3390/vaccines10122103 PMID: 36560513 -
19Chadwick A, Kaiser J, Vaccari C, Freeman D, Lambe S, Loe BS, et al. Online Social Endorsement and Covid-19 Vaccine Hesitancy in the United Kingdom. Social media + Society [Internet]. 2021; 7(2):205630512110088. DOI: https://doi.org/10.1177/20563051211008817
» https://doi.org/10.1177/20563051211008817 -
20Neri AJ, Whitfield GP, Umeakunne ET, Hall JE, DeFrances CJ, Shah AB, et al. Telehealth and Public Health Practice in the United States—Before, During, and After the COVID-19 Pandemic. Journal of Public Health Management and Practice [Internet]. 2022; 28(6):650–6. DOI: https://doi.org/10.1097/PHH.0000000000001563
» https://doi.org/10.1097/PHH.0000000000001563 -
21Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare [Internet]. 2020; 26(5):309–13. DOI: https://doi.org/10.1177/1357633X20916567
» https://doi.org/10.1177/1357633X20916567 -
22Contreras CM, Metzger GA, Beane JD, Dedhia PH, Ejaz A, Pawlik TM. Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. Journal of Gastrointestinal Surgery [Internet]. 2020; 24(7):1692–7. DOI: https://doi.org/10.1007/s11605-020-04623-5
» https://doi.org/10.1007/s11605-020-04623-5 -
23Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ [Internet]. 2020; m1182. Doi: https://doi.org/10.1136/bmj.m1182
» https://doi.org/10.1136/bmj.m1182 -
24Armstrong BG, Mangtani P, Fletcher A, Kovats S, McMichael A, Pattenden S, et al. Effect of influenza vaccination on excess deaths occurring during periods of high circulation of influenza: cohort study in elderly people. BMJ [Internet]. 2004 Sep 18; 329(7467):660. DOI https://doi.org/10.1136/bmj.38198.594109.AE
» https://doi.org/10.1136/bmj.38198.594109.AE -
25Immunization Agenda 2030: A Global Strategy To Leave No One Behind [Internet]. Disponível em: https://www.who.int/publications/m/item/immunization-agenda-2030-a-global-strategy-to-leave-no-one-behind. Acesso em : 06 de maio de 2024.
-
26Rand ML. Nursing Interventions Increase Influenza Vaccination Quality Measures for Home Telehealth Patients. Journal of Nursing Care Quality [Internet]. 2022; 37(1):47. DOI: https://doi.org/10.1097/NCQ.0000000000000577
» https://doi.org/10.1097/NCQ.0000000000000577 -
27Steeg S, Carr M, Trefan L, Ashcroft D, Kapur N, Nielsen E, et al. Primary care clinical management following self-harm during the first wave of COVID-19 in the UK: population-based cohort study. BMJ Open [Internet]. 2022; 12(2):e052613. DOI: https://doi.org/10.1136/bmjopen-2021-052613
» https://doi.org/10.1136/bmjopen-2021-052613 -
28Smith M, Vaughan Sarrazin M, Wang X, Nordby P, Yu M, DeLonay AJ, et al. Risk from delayed or missed care and non-COVID-19 outcomes for older patients with chronic conditions during the pandemic. J American Geriatrics Society [Internet]. 2022; 70(5):1314–24. DOI: https://doi.org/10.1111/jgs.17722
» https://doi.org/10.1111/jgs.17722 -
29Inglin L, Wikström K, Lamidi M-L, Laatikainen T. The adverse effect of the COVID-19 pandemic on health service usage among patients with type 2 diabetes in North Karelia, Finland. BMC Health Services Research [Internet]. 2022; 22(1):725. DOI: https://doi.org/10.1186/s12913-022-08105-z
» https://doi.org/10.1186/s12913-022-08105-z -
30Blackstone SR, Sebring AN, Allen C, Tan JS, Compton R. Improving Depression Screening in Primary Care: A Quality Improvement Initiative. J Community Health [Internet]. 2022; 47(3):400–7. DOI: https://doi.org/10.1007/s10900-022-01068-6
» https://doi.org/10.1007/s10900-022-01068-6 -
31Bronskill SE, Maclagan LC, Maxwell CJ, Iaboni A, Jaakkimainen RL, Marras C, et al. Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic. JAMA Health Forum [Internet]. 2022; 3(1):e214599. Doi: https://doi.org/10.1001/jamahealthforum.2021.4599
» https://doi.org/10.1001/jamahealthforum.2021.4599 -
32Gomes-de Almeida S, Marabujo T, do 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. Medicina de Familia SEMERGEN [Internet]. 2021; 47(4):248–55. DOI: https://doi.org/10.1016/j.semerg.2021.01.005
» https://doi.org/10.1016/j.semerg.2021.01.005
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Data availability
The complete dataset underpinning the results of the present study is available upon request from the corresponding author of the article.
Publication Dates
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Publication in this collection
12 Aug 2024 -
Date of issue
2024
History
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Received
18 Oct 2023 -
Accepted
10 June 2024