ABSTRACT
BACKGROUND: In March 2020, Qatar started reporting increased numbers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19). National preventive measures were implemented, and a testing plan was developed to respond to the pandemic with the Primary Health Care Corporation (PHCC) as the central element. PHCC is the main public primary healthcare provider in Qatar and it operates in 27 health centers with around 1.4 million registered individuals as of January 1, 2020. The latter population was distributed across four main nationality groups; Middle Eastern and North African (51.5%), Asian (41.2%), African (2.4%), and others (5.1%). At the primary healthcare level in Qatar, this study describes the epidemiological characteristics of individuals registered at PHCC who had contracted COVID-19 in 2020 during the first wave before the vaccination phase and examines the factors associated with the positivity rate. METHODS: Retrospective data analysis was conducted for persons screened for SARS-CoV-2 in primary healthcare health centers in Qatar between March 11 and December 31, 2020. The study analyzed the demographic characteristics of the tested persons and noncommunicable disease burden, positivity rate by month, nationality, and age-group, and the factors associated with the positivity rate. RESULTS: Between March 11 and December 31, 2020, PHCC tested 379,247 persons for SARS-CoV-2, with a median age (IQR) of 32 (21-42) years. Of these, 57.0% were from the Middle East and North Africa, and 32.5% were originally from Asia. Overall, 10.9% had diabetes mellitus and 11.3% had hypertension. The epidemiological curve showed a steep increase in the positivity rate from March till May 2020, at the highest rate of 37.5% in May 2020. The highest positivity rate was observed among Asian males at 15.7%. The positivity rate was the lowest among the age-group aged 60 years and above. It was almost the same among the tested persons for SARS-CoV-2 in the three main age groups (0-18, 19-39, 40-59) at 10.1%, 12.3%, and 12.2%, respectively. In a multi regression model, being a male was associated with a higher risk (OR 1.15; 95% CI 1.13-1.17). Asians were at higher risk than those originally from the Middle East and North Africa (OR 1.29; 95% CI 1.27-1.32). COVID-19 infection was higher among those presenting clinical symptoms than asymptomatic individuals (OR. 4.52; 95% CI 4.42-4.64). CONCLUSION: The epidemic among the PHCC-registered population predominantly affected younger ages and males, namely, coming from Asia. At the primary healthcare level, the COVID-19 infection rate was higher among those who presented with clinical symptoms. The lowest positivity rate among individuals >60 years may reflect the effectiveness of public health measures related to the high-risk group. Scaled-up testing at the primary healthcare level helped to detect more cases during the peak of the first wave and was reflected in a steady increase in the positivity rate flattened later due to the established public health measures.
ABSTRACT
Background: Health care systems worldwide have rapidly responded to manage the COVID-19 pandemic by providing screening tests, contact tracing, treatment, and vaccination. However, the long duration of the pandemic has had an enormous load on the health care systems, which disrupted continuity of the essential non-covid services, long waiting time for appointments, and increase in the utilization of telemedicine services. Primary health care was established as an essential foundation for the global response to the COVID-19. In Qatar, Primary Heath Care Corporation (PHCC), the main primary care services provided played a major role in the response to the pandemic. However, its services were affected and disrupted, and new services were added. Hence, the aim of this analysis is to understand the long-term impact of the COVID-19 on the services provided by PHCC in Qatar in terms of PHCC pandemic response, change in utilization of the core, and preventative services, and the introduction of new alternative services. Methods: A retrospective data analysis was conducted for all the appointments and visits for all the PHCC health centers in the years of 2020 and 2021. The study conducted a comparison of the services utilizations using the utilization figures of PHCC services between 1st of January and 31st of December 2019 as a reference year. The differences in the utilization per service were presented in frequencies and percentages. Results: The in-person services dropped drastically in 2020 at 36% reduction in compassion to 2019. However, the newly introduced virtual consultation services in 2020 reached their highest utilization figures in 2021 at 908,965 virtual visits. The COVID-19 specific related services ranging from the COVID-19 drive-through testing to vaccine administration constituted a total number of 2,836,127 visits corresponding to 44% of the total PHCC services utilization visits in 2021. In 2021, PHCC dental services dropped by 25.2%. The most noticeable utilization drops in 2021 were among the preventative services with 53.2% and 78.9% in colorectal screening and non-communicable diseases (NCDs) risk factors annual screening services, respectively. However, mental health services have witnessed a surge in utilization at 134.1% increase in 2021 in comparison to 2019. Conclusion: The COVID-19 pandemic caused a disruption in the PHCC utilization of core services, namely dental services. Additionally, PHCC preventive services utilizations were affected drastically including cancer and NCDs risk factors annual screening. Nevertheless, PHCC managed to provide alternative virtual services and played a vital role in responding to the pandemic by leading the COVID-19 vaccination campaign in Qatar. However, future research is needed to establish which vulnerable patient groups were most affected by the pandemic, to continue to inform strategies and policies directed at mitigating the impact of future potential pandemics.
ABSTRACT
Background: In March 2020, Qatar started reporting increased numbers of COVID-19 cases. At that stage, containment measures were put in place. The health authority in Qatar developed an emergency action plan to respond to the outbreak with the Primary Health Care as the main component of that response and suspended all non-urgent services including preventive health services. The aim of the retrospective analysis to measure the Impact of COVID-19 on the preventive services provided in Qatar. Methods: A retrospective data analysis was conducted for all the preventive services utilization volume across the 27 PHCC health centres from the 1st of January 2017 to the 31st of July 2020. Results: With 17,012 no-show appointments, well-baby and Immunization services utilization demonstrated a reduction of 40% in May and started to come back to volumes higher than expected in June. The breast cancer and colorectal cancer screening programmes expected volumes demand has dropped by 100% in comparison to 2017 demand due to their respective appointments' cancelation. Wellness services only met 20% of its projected utilization in April, however, the services picked up in June. Conclusion: These findings will guide the public health policymakers to understand the effects COVID-19 on preventive services and the risk of having an increased number of outbreaks for childhood communicable disease, cancer cases with delayed diagnosis due to the screening services suspension. In addition, the plan will address the increased number of sedately behaviour due to the service's reduced utilization of wellness services.
ABSTRACT
AIMS AND OBJECTIVES: To assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to improve the quality of life and reduce psychological and spiritual distress in older people with early stage dementia. BACKGROUND: Dementia is a syndrome with several causes that leads to a progressive decline in multiple areas of functioning. The maintenance of dignity and enhancement of quality of life are key elements of care. Meaningful communication may become more difficult with condition progression. Improvements in communication may have positive effects on the person's quality of life. Dignity Therapy is a short psychotherapeutic intervention that uses a trained therapist to take the person with dementia through a guided interview process, producing a 'generativity' document that creates a lasting, written legacy during a time when they are still able to communicate well. DESIGN AND METHOD: This was a feasibility mixed method study. Dignity Therapy was undertaken with patients diagnosed as having early stage dementia. Data were gathe-red from pre- and post-Dignity Therapy interviews, a focus group, interviews with key stakeholders, and three outcome measures: The Herth Hope Index; The Patient Dignity Inventory; Perceived Quality of Life/Satisfaction with Quality Life Ratings. FINDINGS: This study demonstrated that Dignity Therapy is feasible, acceptable and potentially effective for older people with dementia. Three overarching themes emerged: A life in context, A key to connect and Personal legacy. CONCLUSIONS: We recommend that this feasibility study forms the basis for further study, advocating the prospective benefits to patients with dementia, families and nursing practice. IMPLICATIONS FOR PRACTICE: Dignity Therapy, as a psychosocial intervention, has the potential to improve the quality of life and enhance person centred care for people with dementia.
