Addressing Hospital Overwhelm During the COVID-19 Pandemic by Using a Primary Health Care-Based Integrated Health...

Area of Science:

• Public Health
• Health Systems Research
• Epidemiology

Background:

• Global health systems faced unprecedented strain following the easing of COVID-19 restrictions.
• Primary health care (PHC) has been overlooked in discussions on pandemic preparedness.
• Strengthening PHC is crucial for enhancing response to public health emergencies.

Purpose of the Study:

• To investigate combined policies for primary health care (PHC) to bolster health system resilience.
• To explore a bottom-up approach for PHC integration in public health emergency response.

Main Methods:

• A system dynamics model was developed to simulate Shanghai's post-restriction COVID-19 response.
• Simulations tested three interventions within an integrated PHC model: telemedicine for initial contact, optimized secondary care referrals, and PHC-based recovery.
• The model evaluated the impact of these interventions on hospital capacity and mortality.

Main Results:

• Individual interventions showed benefits: increased telemedicine first contact improved bed availability (6-12%) and reduced deaths (35%).
• Optimized return-to-PHC rates (20%) enhanced bed availability (6-16%) and cut deaths (46%).
• Combining all three interventions yielded a synergistic effect, increasing bed availability by 683% and reducing deaths by 75%.

Conclusions:

• An optimal PHC-integrated strategy involves 60% first contact via telemedicine, a 110% recommendation rate, and 20% return-to-PHC rate.
• This integrated PHC approach significantly enhances health system resilience during public health emergencies.
• Shifting focus from secondary care resource allocation to PHC integration is key for preparedness.