Factors influencing the willingness of primary care physicians to provide care during the coronavirus disease pandemic: a nationwide survey in Taiwan.

OBJECTIVES: The COVID-19 pandemic continues to advance worldwide with tremendous impact on public health, economy and society. Primary healthcare is crucial in every country during the pandemic for an integrated and coordinated healthcare delivery system; hence, it is of paramount importance to maintain a sufficient frontline workforce. This study aimed to identify factors influencing the willingness of primary care physicians to provide care during the COVID-19 pandemic. DESIGN: Cross sectional study. SETTING: Nationwide survey PARTICIPANTS: Primary care physicians working in the community in Taiwan were selected using a cluster sampling method based on practice region from May to June 2020. OUTCOME MEASURES: The willingness of primary care physicians to provide care during the COVID-19 pandemic. RESULTS: This study surveyed 1000 primary care physicians nationwide, and 625 valid questionnaires were received and included in the final analysis, with an effective response rate of 62.5%. Factors significantly associated with physicians willingness to provide care during COVID-19 were 'joining the Community Healthcare Group (CHCG)' (p<0.001), 'perceived more overall benefits for providing care' (p<0.001) 'perceived less overall barriers to providing care' (p<0.001), 'higher knowledge scores about COVID-19' (p=0.049) and 'physician's major specialties' (p=0.009) in the multivariate logistic regression model. CONCLUSIONS: Building a comprehensive primary care system such as Taiwan's CHCG, training of more family physicians or general practitioners, and protecting and supporting primary care physicians were important in response to infectious disease pandemics. The findings of this study inform the development of guidelines to support and maintain the primary healthcare workforces during the COVID-19 pandemic and for future events.

Impact of team-based community healthcare on preventable hospitalisation: a population-based cohort study in Taiwan.

OBJECTIVES: The objective of this study was to explore the impact of Taiwan's Family Practice Integrated Care Project (FPICP) on hospitalisation. DESIGN: A population-based cohort study compared the hospitalisation rates for ambulatory care sensitive conditions (ACSCs) among FPICP participating and non-participating patients during 2011-2015. SETTING: The study accessed the FPICP reimbursement database of Taiwan's National Health Insurance (NHI) administration containing all NHI administration-selected patients for FPICP enrolment. PARTICIPANTS: The NHI administration-selected candidates from 2011 to 2015 became FPICP participants if their primary care physicians joined the project, otherwise they became non-participants. INTERVENTIONS: The intervention of interest was enrolment in the FPICP or not. The follow-up time interval for calculating the rate of hospitalisation was the year in which the patient was selected for FPICP enrolment or not. PRIMARY OUTCOME MEASURES: The study's primary outcome measures were hospitalisation rates for ACSC, including asthma/chronic obstructive pulmonary disease (COPD), diabetes or its complications and heart failure. Logistic regression was used to calculate the ORs concerning the influence of FPICP participation on the rate of hospitalisation for ACSC. RESULTS: The enrolled population for data analysis was between 3.94 and 5.34 million from 2011 to 2015. Compared to non-participants, FPICP participants had lower hospitalisation for COPD/asthma (28.6‰-35.9‰ vs 37.9‰-42.3‰) and for diabetes or its complications (10.8‰-14.9‰ vs 12.7‰-18.1‰) but not for congestive heart failure. After adjusting for age, sex and level of comorbidities by logistic regression, participation in the FPICP was associated with lower hospitalisation for COPD/asthma (OR 0.91, 95% CI 0.87 to 0.94 in 2015) and for diabetes or its complications (OR 0.87, 95% CI 0.83 to 0.92 in 2015). CONCLUSION: Participation in the FPICP is an independent protective factor for preventable ACSC hospitalisation. Team-based community healthcare programs such as the FPICP can strengthen primary healthcare capacity.