Disruption caused by the COVID-19 pandemic response from a Western Australian metropolitan general practice perspective: a qualitative descriptive study
Diane E. Arnold-Reed
A * , Caroline E. Bulsara B C and Lucy Gilkes A
A School of Medicine, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA 6959, Australia.
B School of Nursing and Midwifery, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA 6959, Australia.
C Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA 6959, Australia.
Australian Journal of Primary Health 29(4) 385-394 https://doi.org/10.1071/PY22136
Submitted: 29 June 2022 Accepted: 29 December 2022 Published: 23 January 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY)
Abstract
Background: In 2020 and 2021, Western Australia (WA) was an early adopter of the ‘COVID zero’ policy, eliminating community transmission and pursuing vaccine roll out to enable a ‘soft landing’ once coronavirus disease 2019 (COVID-19) infiltrated the community in 2022. Optimisation and augmentation of general practice services were at the forefront of policies. This study explores metropolitan general practice responses to the resulting disruption caused.
Methods: Qualitative descriptive methodology, purposive sampling and template analysis were used. Semi-structured interviews were undertaken from March to June 2021 with teams from six general practices in metropolitan WA; six general practitioners, four practice nurses and three practice managers.
Results: Staff at all levels responded rapidly amid uncertainty and workload challenges with marked personal toll (anxiety and fear of exposure to risks, frustrations of patients and balancing work and family life). Self-reliance, teamwork and communication strategies built on inclusivity, autonomy and support were important. Responding to changes in general patient behaviour was to the fore. Increasing use of telehealth (telephone and video) became important to meet patient needs. Lessons learned from what was implemented in early-stage lockdowns provided practices with preparedness for the future, and smoother transitions during subsequent lockdowns.
Conclusion: The study demonstrates the self-reliance, teamwork and adaptability of the general practice sector in responding to a sudden, unexpected major disruption, yet maintaining ongoing service provision for their patients. Although the COVID-19 landscape has now changed, the lessons learned and the planning that took place will help general practice in WA adapt to similar future situations readily.
Keywords: COVID-19 disruption, COVID-19 pandemic, general practice, general practitioner, practice manager, practice nurse, primary care, qualitative descriptive study.
References
Ashley C, James S, Stephen C, Mursa R, McInnes S, Williams A, Calma K, Halcomb E (2021) Primary health care nurses’ perceptions of risk during COVID-19: a qualitative study. Journal of Nursing Scholarship 53, 689–697.| Primary health care nurses’ perceptions of risk during COVID-19: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
Ashley C, Halcomb E, James S, Calma K, Stephen C, McInnes S, Mursa R, Williams A (2022) The impact of COVID-19 on the delivery of care by Australian primary health care nurses. Health & Social Care in the Community 30, e2670–e2677.
| The impact of COVID-19 on the delivery of care by Australian primary health care nurses.Crossref | GoogleScholarGoogle Scholar |
Australian Government Department of Health (2021) Primary health care in Australia. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/primarycare
Australian Government Department of Health (2022) Medicare. Available at https://www.health.gov.au/health-topics/medicare
Australian Institute for Health and Welfare (2021) The first year of COVID-19 in Australia: direct and indirect health effects, AIHW Cat. No. PHE 287. Australian Institute for Health and Welfare, Canberra, ACT.
Brooks J, McCluskey S, Turley E, King N (2015) The utility of template analysis in qualitative psychology research. Qualitative Research in Psychology 12, 202–222.
| The utility of template analysis in qualitative psychology research.Crossref | GoogleScholarGoogle Scholar |
Bryman A (2012) ‘Social research methods.’ (Oxford University Press)
Chen C, Xu L, Zhao D, Xu T, Lei P (2020) A new model for describing the urban resilience considering adaptability, resistance and recovery. Safety Science 128, 104756–104756.
| A new model for describing the urban resilience considering adaptability, resistance and recovery.Crossref | GoogleScholarGoogle Scholar |
Colorafi KJ, Evans B (2016) Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal 9, 16–25.
| Qualitative descriptive methods in health science research.Crossref | GoogleScholarGoogle Scholar |
Department of Health (2022) COVID-19 vaccine rollout update. (Australian Government: Canberra, ACT) Available at https://www.health.gov.au/sites/default/files/documents/2022/06/covid-19-vaccine-rollout-update-7-june-2022.pdf
Desborough J, Hall Dykgraaf S, de Toca L, Davis S, Roberts L, Kelaher C, Kidd M (2020) Australia’s national COVID-19 primary care response. The Medical Journal of Australia 213, 104–106.e1.
| Australia’s national COVID-19 primary care response.Crossref | GoogleScholarGoogle Scholar |
Government of Western Australia Department of Health (2022) Coronavirus COVID-19 in Western Australia. Available at https://experience.arcgis.com/experience/359bca83a1264e3fb8d3b6f0a028d768 [Accessed 7 June 2022]
Haldane V, Zhang Z, Abbas RF, Dodd W, Lau LL, Kidd MR, Rouleau K, Zou G, Chao Z, Upshur REG, Walley J, Wei X (2020) National primary care responses to COVID-19: a rapid review of the literature. BMJ Open 10, e041622
| National primary care responses to COVID-19: a rapid review of the literature.Crossref | GoogleScholarGoogle Scholar |
Haldane V, De Foo C, Abdalla SM, Jung A-S, Tan M, Wu S, Chua A, Verma M, Shrestha P, Singh S, Perez T, Tan SM, Bartos M, Mabuchi S, Bonk M, McNab C, Werner GK, Panjabi R, Nordström A, Legido-Quigley H (2021) Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nature Medicine 27, 964–980.
| Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries.Crossref | GoogleScholarGoogle Scholar |
Kidd MR (2020) Five principles for pandemic preparedness: lessons from the Australian COVID-19 primary care response. British Journal of General Practice 70, 316–317.
| Five principles for pandemic preparedness: lessons from the Australian COVID-19 primary care response.Crossref | GoogleScholarGoogle Scholar |
King N (2012) Doing template analysis. In ‘Qualitative organizational research’. (Eds G Symon, C Cassell) pp. 426–450. (SAGE Publications, Inc.: Thousand Oaks, CA)
Krist AH, DeVoe JE, Cheng A, Ehrlich T, Jones SM (2020) Redesigning primary care to address the COVID-19 pandemic in the midst of the pandemic. The Annals of Family Medicine 18, 349–354.
| Redesigning primary care to address the COVID-19 pandemic in the midst of the pandemic.Crossref | GoogleScholarGoogle Scholar |
Kunin M, Engelhard D, Thomas S, Ashworth M, Piterman L (2015) Challenges of the pandemic response in primary care during pre-vaccination period: a qualitative study. Israel Journal of Health Policy Research 4, 32
| Challenges of the pandemic response in primary care during pre-vaccination period: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
Lau J, Tan DH-Y, Wong GJ, Lew Y-J, Chua Y-X, Low L-L, Koh GC-H, Kwek T-S, Toh S-AE-S, Tan K-K (2021) The impact of COVID-19 on private and public primary care physicians: a cross-sectional study. Journal of Infection and Public Health 14, 285–289.
| The impact of COVID-19 on private and public primary care physicians: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
Lim J, Broughan J, Crowley D, O’Kelly B, Fawsitt R, Burke MC, McCombe G, Lambert JS, Cullen W (2021) COVID-19’s impact on primary care and related mitigation strategies: a scoping review. European Journal of General Practice 27, 166–175.
| COVID-19’s impact on primary care and related mitigation strategies: a scoping review.Crossref | GoogleScholarGoogle Scholar |
Malatzky DC, Gillespie J, Couch DDL, Cosgrave DC (2020) Why place matters: a rurally-orientated analysis of COVID-19’s differential impacts. Social Sciences & Humanities Open 2, 100063
| Why place matters: a rurally-orientated analysis of COVID-19’s differential impacts.Crossref | GoogleScholarGoogle Scholar |
McGowan M (2020) Temporary border closure to better protect Western Australians. Government of Western Australia. Available at https://www.mediastatements.wa.gov.au/Pages/McGowan/2020/04/Temporary-border-closure-to-better-protect-Western-Australians.aspx
McGowan M, Cook R (2021a) Western Australia enters five-day lockdown from 6pm tonight. Western Australian Government. Available at https://www.mediastatements.wa.gov.au/Pages/McGowan/2021/01/Western-Australia-enters-five-day-lockdown-from-6pm-tonight.aspx
McGowan M, Cook R (2021b) WA’s safe transition plan to provide a soft landing out of pandemic. Government of Western Australia. Available at https://www.mediastatements.wa.gov.au/Pages/McGowan/2021/11/WAs-Safe-Transition-Plan-to-provide-a-soft-landing-out-of-pandemic.aspx
McGowan M, Sanderson A-J (2022a) ServiceWA app launches to help keep WA safe. Government of Western Australia. Available at https://www.mediastatements.wa.gov.au/Pages/McGowan/2022/01/ServiceWA-app-launches-to-help-keep-WA-safe.aspx
McGowan M, Sanderson A-J (2022b) Proof of vaccination to be expanded State-wide from January 31. Government of Western Australia. Available at https://www.mediastatements.wa.gov.au/Pages/McGowan/2022/01/Proof-of-vaccination-to-be-expanded-State-wide-from-January-31.aspx
McGowan M, Cook R, Papalia P (2020) Maintaining contact registers, a requirement to keep WA safe. Government of Western Australia. Available at https://www.mediastatements.wa.gov.au/Pages/McGowan/2020/11/Maintaining-contact-registers-a-requirement-to-keep-WA-safe.aspx
Mughal F, Khunti K, Mallen CD (2021) The impact of COVID-19 on primary care: insights from the National Health Service (NHS) and future recommendations. Journal of Family Medicine and Primary Care 10, 4345–4349.
| The impact of COVID-19 on primary care: insights from the National Health Service (NHS) and future recommendations.Crossref | GoogleScholarGoogle Scholar |
Murton S (2021) General practice and COVID-19: the journey to get vaccination experts involved. Journal of Primary Health Care 13, 198–200.
| General practice and COVID-19: the journey to get vaccination experts involved.Crossref | GoogleScholarGoogle Scholar |
O’Sullivan B, Leader J, Couch D, Purnell J (2020) Rural pandemic preparedness: the risk, resilience and response required of primary healthcare. Risk Management and Healthcare Policy 13, 1187–1194.
| Rural pandemic preparedness: the risk, resilience and response required of primary healthcare.Crossref | GoogleScholarGoogle Scholar |
Royal Australian College of General Practice (2022) General practice health of the nation 2022. Available at https://www.racgp.org.au/general-practice-health-of-the-nation-2022 [Accessed 10 October 2022]
Shaw KA, Chilcott A, Hansen E, Winzenberg T (2006) The GP’s response to pandemic influenza: a qualitative study. Family Practice 23, 267–272.
| The GP’s response to pandemic influenza: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
Tomizuka T, Kanatani Y, Kawahara K (2013) Insufficient preparedness of primary care practices for pandemic influenza and the effect of a preparedness plan in Japan: a prefecture-wide cross-sectional study. BMC Family Practice 14, 174
| Insufficient preparedness of primary care practices for pandemic influenza and the effect of a preparedness plan in Japan: a prefecture-wide cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
Walter M (2013) ‘Social research methods.’ (Oxford University Press: South Melbourne, Victoria)
World Health Organisation (2022) WHO coronavirus (COVID-19) dashboard. Available at https://covid19.who.int/
