Role of family physicians in providing primary healthcare during COVID-19 pandemic

ABSTRACT

According to the World Health Organization, over 41 million cases of COVID-19 and 1 million deaths have been reported globally. More than 7 million cases of coronavirus have been reported in India alone. The growing number of cases of coronavirus worldwide poses numerous challenges to the country’s current healthcare delivery system, especially in developing nations such as India. In such a situation, the task of maintaining continuity in the provision of comprehensive primary healthcare services in the community becomes a big challenge. This article discusses how family physicians can help to augment the healthcare system at the time of pandemic by providing easily accessible, holistic healthcare and by use of telemedicine. It also talks about the need to mainstream family medicine into the undergraduate and postgraduate medical curriculum and establish a robust network of family physicians trained in outbreak response and disease preparedness. For this study we looked for all papers with the terms ‘Family physician’, ‘COVID-19’, ‘pandemic’, and ‘Primary health care’. Databases searched include PubMed, Google Scholar and DOAJ, using key words – family physician, family medicine, primary healthcare, COVID-19, and pandemic in different combinations.

Introduction

According to the World Health Organization, over 41 million cases of coronavirus disease 2019 (COVID-19) and 1 million associated deaths have been recorded globally. In India alone more than 7 million cases of corona virus have been reported.[1] The growing number of cases of coronavirus worldwide presents multiple challenges to the global healthcare delivery system, especially in developing nations such as India. The Govt. of India being a signatory to the Alma-Ata Declaration, is committed to achieving the goal of health for all through the primary healthcare approach. In India primary healthcare is being provided in rural areas by subcentres and primary health centres through a team comprising of medical officers, multipurpose health workers, Auxiliary nurse midwives, ASHAs, Anganwadi workers, village health guides, and trained dais. Urban areas are being catered to by urban primary health centres and community centres for the same. Examples of other mechanisms for delivering primary healthcare in cities include establishment of the Aam Aadmi Mohalla Clinics in Delhi and Swasth clinics in Mumbai which aim at providing easily accessible quality health services to the community.[2] In 2017, the National Health Policy envisioned the strengthening of the existing subcentres and primary health centres into Health and Wellness Centres, under the Ayushman Bharat Programme, for providing comprehensive healthcare and providing free essential drugs and diagnostic services.[3]

During the course of the COVID pandemic, the country has witnessed many shortcomings in the primary healthcare delivery system such as the disruption of routine health services due to repurposing of manpower for COVID-related services, inadequate supply of personal protective equipment and drugs, inadequate training of COVID frontline health workers and increased absenteeism from work due to elevated stress and anxiety. It is of paramount importance to train more generalists such as family physicians who can competently treat a wide range of medical conditions, act as a link between different specialities, and help in decreasing the patient load on an already overburdened healthcare delivery system.

Roles and Responsibilities of a Family Physician in Providing Primary Healthcare Services

The concept of family medicine as a specialization came into being due to a felt need amongst the people of the community for a more personalized and comprehensive healthcare in order to counter the culture of rapidly increasing specialization and sub-specialization in the medical field.[4]

Family physicians are devoted to providing healthcare for the individual and family irrespective of age, gender, disease, or affected part of the body. Patients are treated keeping in mind not only the health status of the individual but also the medical history of the entire family, while emphasizing on all aspects of healthcare including disease prevention and health promotion.[5] A family physician is regarded as an expert generalist. Apart from being competent in a wide range of clinical skills, the family doctor is also well known to be a consultant, capacity builder, pioneer of clinical governance, community-oriented primary care advocate, and clinical teacher.[6]

Family physicians are responsible for providing a holistic package of health services to people of all age groups in the community starting from the new born to the elderly. The health services provided include immunization of children, management of common illnesses such as common cold, respiratory tract infections, etc., first aid for injuries, management of chronic illness such as diabetes and hypertension, early detection and management of any emerging conditions such as cancer and provision of referral services. Health education, which is an important aspect of preventive care, is also being imparted by family physicians to patients on relevant health issues such as nutrition in pregnant women and under five children, family planning methods, hand hygiene, use of personal protective equipment (PPE) to prevent COVID-19, etc.

Role of Family Physician in Context of the Ongoing Pandemic

Family physicians being more approachable due to the continued association with patients and their families, are more likely to be preferred for health check-ups over other healthcare providers. They play a key role in providing comprehensive treatment which includes accessible health services either at your doorstep or through virtual consultation, patient triage, health education, counselling, and family-focused behavioral interventions to minimize stigma and anxiety.[7] Patients look for advice and reassurance from their family physicians now more than ever before.[8]

Early screening at the community level by a primary healthcare provider, such as a family physician, will reduce the patient load on secondary and tertiary level health centres which will in turn reduce healthcare costs for the country.[9]

In cases where the patient is detected positive for coronavirus and is isolated at home the family physician can play a pivotal role in alleviating any kind of associated stress or stigma by providing appropriate guidance through telephonic/online consultation. A survey conducted by the College of Family Physicians of Canada showed that a majority (86%) of respondents said they should be able to consult their family doctor at the time of a serious medical emergency.[10]

Virtual consultations will also help to facilitate the management of patients suffering from ailments other than COVID-19 such as non-communicable diseases and common minor illnesses, which may be neglected otherwise. Home visits may be made by family physicians for those patients who complain of moderate/severe COVID-19 symptoms and to provide essential services such as oxygen support and to educate the family regarding home management of the illness. This would also help in reducing the risk of exposure of non-COVID patients to infected patients/staff in a hospital setting by preventing unnecessary exposure.

Challenges in Primary Health Care Delivery Due to COVID-19

Primary healthcare service delivery has suffered several setbacks in the country because of COVID-19. Healthcare utilization also decreased significantly due to stigmatization of the disease and rampant spread of misleading information on news and social media. Easily accessible healthcare was unavailable due to creation of dedicated COVID facilities and suspension of routine OPD services in the country.

Family medicine as a subject has not yet been introduced into the undergraduate MBBS curriculum all over India and currently only a handful of medical colleges have been recognized to offer the course of MD Family Medicine for postgraduation. The first institute to start the MD family medicine program in India was the Government Medical College in Calicut, Kerala in 2011. Thus, there is an insufficient number of medical doctors opting for this stream after graduation. This necessitates the need for the reorientation of the MBBS curriculum so that medical graduates are competent in the core skills of Family medicine branch.

The National Medical Commission (NMC) Act 2019 requires the NMC to facilitate training at both undergraduate and postgraduate levels in family medicine.[11]

In order to strengthen our disease surveillance system and detect outbreaks due to diseases such as COVID-19 in the future, we need to focus on integrating the networks of family physicians with our three tiered health system. Also, they should be involved in frontline training on outbreak response so that family physicians can contribute effectively at the time of emergency.

Conclusion

The family physicians being skilled generalists are not only capable of providing comprehensive primary healthcare but also have the key advantage of being closely connected to the families they cater to. In order to provide the community with primary health services and sustain the healthcare delivery system at a time of crisis, a strong primary care network of family doctors is of paramount importance. As a country, if we are to be better equipped to face such similar public health emergencies in the future, we need our government health systems to work harmoniously with family physicians and other general practitioners in the private sector. Family medicine needs to be focused upon as a core medicine branch in undergraduate teaching and students need more support and encouragement to take up this field as a career. This will go a long way towards improving the country’s overall health situation and in overcoming the pitfalls in the current healthcare delivery system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.