Quality of primary health care for older adults during the COVID-19 pandemic: a systematic review

Silva, Camila Caroline da; Silva, Vanessa de Lima; Medeiros, Géssica Cazuza de; Arruda, Jonathas de Lima; Moreira, Rafael da Silveira

doi:10.1590/1981-22562024027.230239.en

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Revista Brasileira de Geriatria e Gerontologia

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Original Articles • Rev. bras. geriatr. gerontol. 27 • 2024 • https://doi.org/10.1590/1981-22562024027.230239.en copy

Quality of primary health care for older adults during the COVID-19 pandemic: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

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

DATABASE	SEARCH STRATEGIES
WEB OF SCIENCE	aged (Topic) OR aged 80 AND over (Topic), AND Quality Indicators, Health Care (Topic) OR quality of Health Care (Topic), OR Health Care Quality, Access, AND Evaluation (Topic).
EMBASE	'health care quality'/exp or (access, and 'evaluation study'/exp)', coronavirus disease 2019'/exp,'primary healthcare'/exp, 'aged'/exp, or 'very elderly'/exp.
SCOPUS	(( KEY ( "Quality Indicators" ), OR KEY ( "Quality of Health Care" ), OR KEY ( "Access, and Evaluation" ) ) ), AND ( KEY ( "covid-19" ) ), AND ( KEY ( "primary health care" ) ), AND ( ( KEY ( aged ), OR KEY ( "aged, 80 and over " ) ) ).
MEDLINE/PUBMED	((COVID-19[MeSH Terms]) AND (((Quality Indicators, Health Care[MeSH Terms]), OR (Quality of Health Care[MeSH Terms])), OR (Health Care Quality, Access, AND Evaluation[MeSH Terms]))), AND ((aged[MeSH Terms]), OR (aged 80 AND over[MeSH Terms]))), AND (Primary Health Care[MeSH Terms]).

Joanna Briggs Institute Checklist for Cohort studies
Study (year)	1	2	3	4	5	6	7	8	9	10	11
Rand et al.²⁶26 Rand 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.000000000000... , (2021)	yes	yes	yes	no	not applicable	no	unclear	not applicable	not applicable	not applicable	yes
Steeg et al.²⁷27 Steeg 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-2021-052... , (2022)	yes	yes	yes	not applicable	not applicable	no	yes	not applicable	not applicable	not applicable	yes
Smith et al.²⁸28 Smith 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... , (2022)	yes	yes	not applicable	not applicable	not applicable	no	yes	not applicable	yes	not applicable	yes
Inglin et al.²⁹29 Inglin 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... , (2022)	yes	yes	yes	yes	yes	no	yes	yes	yes	not applicable	yes
Joanna Briggs Institute Checklist for Cross-sectional studies
Study (year)	12		13	14	15		16	17	18		19
Blackstone et al.³⁰30 Blackstone 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... , (2002)	unclear		yes	yes	yes		not applicable	not applicable	not applicable		yes
Bronskill et al.³¹31 Bronskill 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.... , (2022)	yes		yes	yes	not applicable		not applicable	not applicable	not applicable		yes
Almeida et al.³²32 Gomes-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... , (2021)	yes		yes	yes	yes		yes	yes	yes		yes

Author/Year	Country	Design	Sample size	Study population	Study venues
Rand et al.²⁶26 Rand 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.000000000000... , (2021)	USA	Cohort	513	Patients 19-80+	Outpatient clinic in San Francisco hospital for Veterans
Steeg et al. ²⁷27 Steeg 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-2021-052... , (2022)	UK	Cohort	52987	Patients 10-80+	UK primary care
Smith et al.²⁸28 Smith 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... , (2022)	USA	Cohort	14406	Older adults ≥65 years	Community and academic health systems
Inglin et al.²⁹29 Inglin 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... , (2022)	Finland	Cohort	11458	Older adults ≥70 with type 2 diabetes	North Karelia Social and Health Services
Blackstone et al.³⁰30 Blackstone 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... , (2002)	USA	Cross-sectional	23745	Patients 18-80+	Charlottesville, VA, in Family Medicine Department.
Bronskill et al.³¹31 Bronskill 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.... , (2022)	Canada	Cross-sectional	2363742	Older adults ≥ 65 years	Data from Ontario health system
Almeida et al.³²32 Gomes-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... , (2021)	Spain	Cross-sectional	2017	Older adults ≥ 65 years	Users of Vitrius Family Health Unit

Author/Year	Type of service evaluated	Parameter of quality evaluation	Outcome of quality evaluation
Rand et al.²⁶26 Rand 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.000000000000... , (2021)	Vaccination	Vaccination coverage	Increase in vaccination coverage for veterans after intervention.
Steeg et al.²⁷27 Steeg 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-2021-052... , (2022)	Outpatient service	3-month follow-up by multiprofessional health team and increase in referrals to mental health services.	Follow-up services remained unchanged with patterns similar to prepandemic levels.
Smith et al.²⁸28 Smith 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... , (2022)	Outpatient service	Reduction in mortality of patients with follow-up.	Services had increased mortality with decrease in number of Medicare users and increase in telehealth.
Inglin et al.²⁹29 Inglin 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... , (2022)	Outpatient service	Number of follow-up consultations of patients in PHC.	Reduction in face-to-face appointments and increase in remote consultations, and reduction in emergency visits led to worsening in evaluation of service.
Blackstone et al.³⁰30 Blackstone 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... , (2002)	Anamnesis in outpatient service	Proportion of patients with up-to-date depression screening record.	Improved completion of records during screenings.
Bronskill et al.³¹31 Bronskill 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.... , (2022)	Outpatient service	Interruptions in health service care.	Excess mortality on service evaluation.
Almeida et al.³²32 Gomes-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... , (2021)	Telemedicine service	Satisfaction with service – Likert scale (1-very unsatisfied to 5-very satisfied)	Users were satisfied with telemedicine care service

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[1] Correspondence Camila Caroline da Silva camila.caroline@ufpe.br

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Quality of primary health care for older adults during the COVID-19 pandemic: a systematic review

Abstract

﻿Objective

Method

Results

Conclusion

Objective