![]() 12 With strong government and public support for the public health measures, the Netherlands has had a moderate number of cases ( Table 2). ![]() 1 However, initial limited access to testing and PPE resulted in a large number of nursing home residents and healthcare professionals becoming infected. 10, 11 Within the first week of the epidemic, family practices were able to reorganise their flow of patients from mainly face-to-face to virtual consultations, and separate practice visits of suspected from non-COVID patients. It incentivised family physicians to assess all potential COVID-19 patients. The Netherlands has universal health coverage and had a current pandemic plan. However, there has been strong government and public support for the public health measures. 9 It had a moderate number of cases, 8 due to initial delays in testing and in implementing travel restrictions, challenges encountered in maintaining PPE supplies, and in sub-optimal infection control in long-term care facilities. Canada had a recently updated pandemic plan and identified primary care as responsible for assessing ambulatory patients. An extensive public health response has been required to deal with the problem, the cause of which appears linked with major deficiencies in the management of international travellers in quarantine.Ĭanada, the Netherlands, and the UK all have universal health coverage, but had varying degrees of pandemic readiness. However, at the time of submission, Melbourne, Australia began experiencing a substantial second wave of active infections. Currently most cases in NZ are in returning New Zealanders, picked up during mandatory quarantine. This is believed to be due to early implementation of travel restrictions, comprehensive physical distancing, intense community-based testing, and strong government and public support for the health measures. 7 Until July 2020, both Australia and NZ had relatively few cases of COVID-19 8 ( Table 2). 6 Some government support was provided to primary care for their increased workload, although many practices still had a shortfall. ![]() 5 NZ also had an updated pandemic plan, and District Health Boards led the pandemic response with generally good coordination of primary care and public health. 3, 4 Widespread testing was rapidly established, and national and state governments assisted in the provision of personal protective equipment (PPE) to general practice. In Australia, guidelines were in place for GPs for both pandemic influenza and public health emergencies. Both had universal health coverage and up-to-date pandemic plans. Of the six countries, Australia and NZ were the best prepared. We define support for public health measures as endorsement and general abidance with travel restrictions, physical distancing, use of masks, and minimising numbers of social contacts. Physicians often deferred routine follow-up visits in their offices, instead offering patients remote assessments by telephone, email, and videoconferencing, and assisting in assessment centres.Ĭountries differed, however, in terms of pre-existing universal health coverage, pandemic readiness, and the level of government and public support for public health measures. They decided who could be managed at home, and who needed specialist referral or hospital admission. In all six countries, primary care physicians participated in the initial assessment and triage of people with possible COVID-19, although how that was done varied between countries, and was rarely in the physician’s office ( Table 1). Although primary care has been on the front line with COVID-19 cases, this has come at great cost. 2 This article comments on what is happening to primary care provision in six well-resourced countries: Australia, New Zealand (NZ), Canada, the Netherlands, the UK, and the US. Yet primary care physicians (family doctors and GPs) can constitute up to 50% of the medical workforce 1 and are highly susceptible to contracting emerging infectious diseases themselves, as they are often the first point of contact people have with the health system. With the focus of the COVID-19 pandemic on the many challenges in public health, acute and long-term care, what has happened within primary care has remained largely below the radar.
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