The Impact of the COVID-19 Pandemic on the Healthcare System and on the Mental Health of Primary Health Care Providers
DOI:
https://doi.org/10.20344/amp.17632Keywords:
Anxiety, COVID-19, Depression, Health Services, Pandemics, Primary Health Care, Risk ManagementAbstract
Introduction: The COVID-19 pandemic forced the reorganization of primary health care services. The aim of this study was to describe how the health services responded to organizational requests; how the health services involved and supported their employees; how professionals perceived their involvement in the procedures and what support was provided to them. Additions aims included assessing the levels of anxiety and depression of professionals and their association with the perceived support, availability of personal protective equipment and involvement in pandemic-related tasks.
Material and Methods: Cross-sectional, analytical study directed at professionals from three health center groups using an online questionnaire. We collected information from sociodemographic data, access to personal protective equipment, perceived support, workload and levels of anxiety and depression. Between each variable and the levels of anxiety and depression, multivariate logistic regression was applied.
Results: There were responses from 237 professionals (83.8% women; mean age 43.7 years; 43.2% physicians). Almost 60% worked with COVID-19 patients. The availability of personal protective equipment in March versus June 2020 increased (17.7% vs 55.3%). There was a risk management plan in 86% of the workplaces. A high workload (90%) and time pressure (74.6%) were identified. Physicians and nurses had a higher prevalence of depression associated with workload and fatigue (p < 0.001). Protective anxiety factors were having space to talk about problems, support in face of these problems and having a place to relax in the health unit. A lower risk of depression was found in the administrative staff group, in those who felt supported, and in those who actively participated in the contingency plans.
Conclusion: The COVID-19 pandemic led to considerable changes in the dynamics of primary health care. The time pressure to carry out tasks and the level of concentration required were associated with a higher risk of mental disease. The support felt by healthcare professionals regarding their problems and concerns and the existence of places to relax in the health units were identified as protective factors. Health promotion, the maintenance of the social contacts of healthcare professionals and their involvement in the processes should be taken into account in the organizational dynamics of the institutions.
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References
World Health Organization. Report of the WHOChina joint mission on coronavirus disease 2019 (COVID19). 2020. [consultado 2020 mar 14]. Disponível em: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf.
Haines A, de Barros EF, Berlin A, Heymann DL, Harris MJ. National UK programme of community health workers for COVID-19 response. Lancet. 2020;395:1173-5. DOI: https://doi.org/10.1016/S0140-6736(20)30735-2
Direção Geral da Saúde. Plano nacional de preparação e resposta para a doença pelo novo coronavirus – COVID-19. [consultado 2020 mar 03]. Disponível em: https://www.dgs.pt/documentos-e-publicacoes/plano-nacional-de-preparacao-e-resposta-para-a-doenca-por-novocoronavirus-covid-19-pdf.aspx2020.
Macedo M. Gestão da emergência. Proteger 2016. Estoril: Associação Portuguesa de Segurança; 2016.
Seidler A, Thinschmid M, Deckert S, Then F, Hegewald J, Nieuwenhuijsn K, et al. The role of psychosocial working conditions on burnout and its core component emotional exhaustion – a systematic review. J Occup Med Toxicol. 2014;9:10. DOI: https://doi.org/10.1186/1745-6673-9-10
Edwards A, Cooper A, Joseph-Williams N, Lewis R, Law RJ. Rapid review on the impact of the COVID-19 pandemic on the mental health of health and social care workers within the UK. Report: RR00002. Wales COVID-19 Evidence Centre. July 2021. [consultado 2022 mai 02]. Disponível em: http://www.primecentre.wales/resources/RR/Clean/RR00002_Wales_Covid-19_Evidence_Centre-Rapid_Review_Mental_Health_Keyworkers_21-July-202.
Ontario Agency for Health Protection and Promotion (Public Health Ontario). COVID-19 – strategies adaptable from healthcare to public health settings to support the mental health and resilience of the workforce during the COVID-19 pandemic recovery. Toronto, ON: Queen’s Printer for Ontario; 2021. [consultado 2022 mai 01]. Disponível em: https://www.publichealthontario.ca/-/media/documents/ncov/ipac/2021/08/covid-19-public-health-workforce-recovery.pdf?sc_lang=en.
Giorgi G, Lecca LI, Alessio F, Finstad GL, Bondanini G, Lulli LG, et al. COVID-19-related mental health effects in the workplace: a narrative review. Int J Environ Res Public Health. 2020;17:7857. DOI: https://doi.org/10.3390/ijerph17217857
Grange E, Neil E, Stoffel M, Singh AP, Tseng E, Resco-Summers K, et al. Responding to COVID-19: the UW medicine information technology services experience. App Clin Inform. 2020;11:26575. DOI: https://doi.org/10.1055/s-0040-1709715
Williams R, Murray E, Neal A, Kemp V. The top ten messages for supporting healthcare staff during the COVID-19 pandemic. A discussion document. London: Royal College of Psychiatrists; 2020.
World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. 2020. [consultado 2020 mar 03]. Disponível em: https://www.who.int/publications-detail/mentalhealth-and-psychosocial-considerations-during-the-covid-19-outbreak.
World Health Organization. Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health. 2020. [consultado 2020 mar 14]. Disponível em: https://www.who.int/publicationsdetail/coronavirus-disease-(covid-19)-outbreak-rights-roles-andresponsibilities-of-health-workers-including-key-considerations-foroccupational-safety-and-health.
Conselho Nacional das Escolas Médicas Portuguesas. Comunicado do Conselho Nacional das Escolas Médicas Portuguesas (CEMP) de 25 de Março de 2020. [consultado 2020 abr 15]. Disponível em: https://www.cemp.pt/2020/03/25/comunicado-25-de-marco-2020/.
Ordem dos Farmacêuticos. Plano contingência covid-19 farmácia. CEDIME. 2020 Março. [consultado 2020 abr 15]. Disponível em: https://www.ordemfarmaceuticos.pt/fotos/documentos/plano_de_contingencia_da_farmacia_para_o_covid_19_5774390585e60fd3b28fbc.pdf.
Ordem dos Enfermeiros. Prioridades para vencer o combate ao COVID-19. 2020. [consultado 2020 abr 15]. Disponível em: https://www.ordemenfermeiros.pt/centro/noticias/conteudos/prioridades-paravencer-o-combate-ao-covid-19/
Ordem dos Médicos. Colégio de Especialidade de Medicina Geral e Familiar. Reorganização dos serviços em Medicina Geral e Familiar no contexto de exceção no combate à COVID-19. 2020. [consultado 2020 abr 25]. Disponível em: https://ordemdosmedicos.pt/reorganizacaode-servicos-em-medicina-geral-e-familiar-no-contexto-de-excecao-docombate-a-covid-19/.
Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychol Health Med. 2007;12:225-35; quiz 35-7. DOI: https://doi.org/10.1080/13548500500524088
Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020;12:e1-4. DOI: https://doi.org/10.4102/phcfm.v12i1.2607
Marques NP, Silveira DM, Marques NC, Martelli DR, Oliveira EA, Martelli-Junior H. Cancer diagnosis in Brazil in the COVID-19 era. Semin Oncol. 2021;48:156-9. DOI: https://doi.org/10.1053/j.seminoncol.2020.12.002
Daumas RP, Silva GA, Tasca R, Leite ID, Brasil P, Greco DB, et al. The role of primary care in the Brazilian healthcare system: limits and possibilities for fighting COVID-19. Cad Saude Publica. 2020;36:e00104120. DOI: https://doi.org/10.1590/0102-311x00104120
Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, et al. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health. 2020;17:8358. DOI: https://doi.org/10.3390/ijerph17228358
Direção Geral da Saúde. Normas de Orientação. Norma nº 004/2020 de 23/03/2020 atualizada a 19/04/2020, COVID-19: Abordagem do doente com suspeita ou confirmação de COVID-19. 2020. [consultado 2020 abr 25]. Disponível em: https://covid19.min-saude.pt/wp-content/uploads/2021/04/Norma_004_2020_act_19_04_2021.pdf.
Portugal. Decreto-Lei n.º 298/2007. Diário da República, I Série, n.º 161 (2007/08/22). p.5587-96.
Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in china. Psychother Psychosom. 2020;89:242-50. DOI: https://doi.org/10.1159/000507639
Xiao Y, Bian Y, Zhang L. Mental health of chinese online networkers under COVID-19: a sociological analysis of survey data. Int J Environ Res Public Health. 2020;17:8843. DOI: https://doi.org/10.3390/ijerph17238843
Vizheh M, Qorbani M, Arzaghi SM, Muhidin S, Javanmard Z, Esmaeili M. The mental health of healthcare workers in the COVID-19 pandemic: a systematic review. J Diabetes Metab Disord. 2020:1-12. DOI: https://doi.org/10.1007/s40200-020-00643-9
Heath C, Sommerfield A, von Ungern-Sternberg BS. Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review. Anaesthesia. 2020;75:1364-71. DOI: https://doi.org/10.1111/anae.15180
Peng R, Zhou W, Zhou D, Chu M, Ling L. The mediating role of fatigue between mental health and its associated factors: evidence from Chinese healthcare workers during the COVID-19 pandemic. Front Psychiatry. 2021;12:665992. DOI: https://doi.org/10.3389/fpsyt.2021.665992
Li L, Xv Q, Yan J. COVID-19: the need for continuous medical education and training. Lancet Respir Med. 2020;8:e23. DOI: https://doi.org/10.1016/S2213-2600(20)30125-9
Antonello VS, Panzenhagen AC, Balanza-Martinez V, Shansis FM. Virtual meetings and social isolation in COVID-19 times: transposable barriers. Trends Psychiatry Psychother. 2020;42:221-2. DOI: https://doi.org/10.1590/2237-6089-2020-0065
Shah S, Diwan S, Kohan L, Rosenblum D, Gharibo C, Soin A, et al. The technological impact of COVID-19 on the future of education and health care delivery. Pain Physician. 2020;23:S367-80. DOI: https://doi.org/10.36076/ppj.2020/23/S367
Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. Lancet Infect Dis. 2020;20:777-8. DOI: https://doi.org/10.1016/S1473-3099(20)30226-7
Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: a cross-sectional study. Psychiatry Res. 2020;288:112936. DOI: https://doi.org/10.1016/j.psychres.2020.112936
Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901-7. DOI: https://doi.org/10.1016/j.bbi.2020.05.026
Baptista S, Teixeira A, Castro L, Cunha M, Serrao C, Rodrigues A, et al. Physician burnout in primary care during the COVID-19 pandemic: a cross-sectional study in Portugal. J Prim Care Community Health. 2021;12:21501327211008437. DOI: https://doi.org/10.1177/21501327211008437
Caldas de Almeida JM, Xavier M, Cardoso G, Gonçalves Pereira M, Gusmão R, Corrêa B, et al. Estudo epidemiológico nacional de saúde mental - 1º relatório. Lisboa: Faculdade de Ciências Médicas da Universidade Nova de Lisboa; 2013.
Busch IM, Moretti F, Mazzi M, Wu AW, Rimondini M. What we have learned from two decades of epidemics and pandemics: a systematic review and meta-analysis of the psychological burden of frontline healthcare workers. Psychother Psychosom 2021;90:178-90. DOI: https://doi.org/10.1159/000513733
Fiest KM, Parsons Leigh J, Krewulak KD, Plotnikoff KM, Kemp LG, Ng-Kamstra J, et al. Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review. BMC Psychiatry. 2021;21:91. DOI: https://doi.org/10.1186/s12888-021-03090-9
Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323:2133-4. DOI: https://doi.org/10.1001/jama.2020.5893
Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of coronavirus disease 2019 (COVID-19) beyond paranoia and panic. Ann Acad Med Singap. 2020;49:155-60. DOI: https://doi.org/10.47102/annals-acadmedsg.202043
Chan AO, Huak CY. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occup Med. 2004;54:190-6. DOI: https://doi.org/10.1093/occmed/kqh027
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