| BackgroundIt has been an urgent need to improve the prevention and control system for public health emergencies and to improve the capacity in response to major infectious diseases,because of the persistent threat of public health events from serious infectious diseases since the 21st century.COVID-19 spreads rapidly with strong infections.In particular,COVID-19 threatened human health and life safety with a higher mortality rate in its early pandemic.The COVID-19 pandemic situation is severe and complex due to the frequent mutation of SARS-CoV-2,leading to continuous optimization and adjustment of COVID-19 prevention and control strategy in China.The capability of primary care in response to COVID-19 is crucial to the effectiveness of the whole pandemic prevention and control for their vital position at the upstream in the full epidemic prevention and control chain.While in the early period of this pandemic,the foundation of emergency management in primary care was weak,making it easier become a weakness in the epidemic prevention and control chain.It is a practical demand to improve primary care capacity in response to COVID-19.Focusing on the research on primary care emergency response capacity is also a requirement of the national strategy.Developing the emergency response capacity of primary care and carrying out the standardization construction of the emergency response capacity of primary care was clearly proposed in the "Fourteenth Five Year" National Emergency System Plan.Studies on the capacity evaluation of prevention and control in response to major infectious diseases have gradually attracted Chinese scholars’ attention after SARS.However,most scholars focused on the Centers for Disease Prevention and Control,general hospitals or some regions,ignoring primary care institutions.There was still few evaluation research on the prevention and control capacity of primary care institutions in response to COVID epidemic.ObjectivesThis study aimed to deeply explore the significant research question of improving the capacity to prevent and control major infectious diseases in primary care institutions based on the case study of COVID outbreak.Therefore,the general goal of this study was to describe and evaluate the capacity of COVID prevention and control in primary medical and health institutions following the whole process of epidemic prevention and control,with an emphasis on strategies to promote the COVID prevention and control capacity of primary care institutions.1.To precisely position the roles of primary care in response to COVID-19 pandemic defined in policy documents.2.To develop a capacity evaluation indicator system of COVID prevention and control of primary care,and then to modify the indicator system through multiple rounds of Delphi expert consultation,to define the weight of evaluation indicators and finally to measure the capacity of primary care.3.To develop an instrument to quantitatively measure the readiness among medical staff in primary care institutions in response to COVID-19 pandemic,to assess the validity and reliability of this instrument,and then to measure the readiness among medical staff by using this instrument.4.To give some suggestions and strategies to promote the capacity of COVID prevention and control in primary care institutions at multiple levels.ImplicationsThis study further explored the universal research on evaluating the prevention and control capacity of major infectious diseases from the perspective of evaluating a specific infectious disease.The capacity evaluation indicators for the COVID prevention and control of primary medical and health institutions and the COVID Prevention and Control Readiness Assessment Instrument developed in this study have enriched the theoretical achievements of primary care in response to major infectious diseases in China.This study provides more in-depth and cutting-edge application research findings to help primary care institutions better respond to major infectious diseases.The findings of this study call for policy actions and interventions to promote the capacity of COVID prevention and control of primary care and the COVID prevention and control readiness among medical staff in those primary care institutions.Research contents and methodsThis study was divided into three stages:1.In the first stage,we conducted theoretical research.We read through and analyzed the policy documents to precisely position the roles of primary care in response to the COVID-19 pandemic.Moreover,we then conducted a literature review related to the capacity assessment tools of public health emergencies of medical and health institutions in response to infectious diseases.We also carried out another literature review about the Readiness Estimate and Deployability Index(READI)used to measure the readiness for primary care medical staff.We developed the COVID Prevention and Control Readiness Assessment Instrument based on the READI and COVID Prevention and Control.2.In the second stage,we constructed the evaluation indicator system of COVID prevention and control of primary care institutions.Firstly,we extracted primary care capacity evaluation indicators in response to COVID-19 through the previous literature review and health policy analysis,forming an indicator pool for preliminary screening.Next,capacity indicator system and primary care items in response to COVID-19 were rigorously screened based on two rounds of Delphi expert consultation.Then,the final capacity indicator system was formed.We defined the indicators’ weight through the Analytic Hierarchy Process(AHP)method by comparing the importance of mean value difference.Yaahp 10.1 software was used to construct the judgment matrix.Lastly,the scientific verification was carried out for the COVID Prevention and Control Readiness Assessment Instrument,which measured the readiness included in the total capacity indicator system.Item analysis,Exploratory factor analysis(EFA),Confirmatory factor analysis(CFA)and reliability test validity test were used to develop and validate the COVID Prevention and Control Readiness Assessment Instrument.3.In the third stage,we implemented empirical research to describe and analyze the capacity of primary care institutions in response to COVID.We recruited 50 primary care institutions and 1019 medical staff by cluster sampling method in Jinan,Shandong Province.The 699 participants remained after removing invalid samples.We described and analyzed the COVID prevention and control capacity of these fifty primary care institutions by calculating the comprehensive score and each indicator’s score.Finally,a multilevel linear regression model was used to examine the relationship between the institution,individual characteristics and COVID prevention and control readiness.SPSS 26.0 software was used for item analysis,EFA and statistical description.AMOS 24.0 software was used for CFA,urban-rural equivalence test,discrimination validity and convergence validity test.Stata 17.0 software was used for exploring the influencing factors and Excel 2021 software was used to sort out the analysis results.Results1.Roles of primary care in response to the COVID-19 pandemic defined in policy documentsThe functions of primary care mainly consisted of the following eight aspects:early detection and reporting COVID-19 cases;strengthening professional knowledge of infectious prevention;training and organizing emergency drills;infection control and personal protection;cooperating with the community;implementing health education;health management of priority population;COVID sampling and testing and the vaccination.2.Capacity evaluation indicator system development process research resultsThree dimensions,eleven first-level indicators,twenty-five second-level indicators and one hundred and four specific items of the capacity evaluation indicator system of primary care institutions in response to COVID-19 have been preliminarily formed through policy analysis and literature review.The evaluation indicators were further screened and determined through two rounds Delphi expert consultation.The positive coefficients of the two rounds of Delphi expert consultation were 86.4%and 94.7%respectively.Furthermore,the authoritative coefficients of the two rounds of Delphi expert consultation were both 0.91.The capacity evaluation indicator system of primary care institutions in response to COVID-19 finally included three dimensions,eleven first-level indicators,thirty second-level indicators and one hundred and eight specific items.Three dimensions comprised the organizational framework dimension,COVID prevention and control process dimension and output dimension.Eleven first-level indicators comprised personnel indicators,organization construction,logistics support,setting of prevention and control sites,systematic monitoring,personal screening,health management of high-risk individuals,COVID-19 vaccination,health education of epidemic prevention,hospital infection and prevention,and readiness of COVID prevention and control.The indicators’ weight was defined through the AHP method by comparing the importance mean value difference.3.COVID Prevention and Control Readiness Assessment Instrument development and validation research resultsThe research results of constructing and validating the COVID Prevention and Control Readiness Assessment Instrument among medical staff in primary care institutions,took high risk areas as an example.We divided the data of samples into two separate parts,one data for item analysis and EFA,and another one for CFA,urban-rural equivalence test,reliability test and validity test.Each item had good discrimination in item analysis.The correlation coefficient method indicated that most items had a good correlation with the total score,and some items had a strong correlation(≥0.7,P<0.001).Cronbach’a coefficient method indicated that the correlation coefficients of all the items were all more than 0.40 after correction.No items should be dropped after the item analysis.In exploratory factor analysis,the suitability of the data for factoring was assessed before performing the factor analysis.The Kaiser-Meyer-Olkin value was 0.913(P<0.001),supporting the factorability of the items.Three factors were clearly identified through EFA,explaining 61%of the variance.The 17-item COVID Prevention and Control Readiness Assessment Instrument was developed.The results of CFA showed that the COVID Prevention and Control Readiness Assessment Instrument had a good structural validity,the loading of each factor ranged from 0.50 to 0.91,the two-level modified model fitting index was ideal(RMSEA=0.06,SRMR=0.04,GFI=0.94,CFI=0.97)and passed the urban-rural equivalence test.The Cronbach’s α coefficient of the total score and each factor scores ranged from 0.88 to 0.94.The split-half reliability of the scale and its factors ranged from 0.78 to 0.93.The COVID Prevention and Control Readiness Assessment Instrument had good convergence and discrimination validity.The 17-item COVID Prevention and Control Readiness Assessment Instrument includes the professional ability(6 items),selfprotection ability(4 items)and sense of identification related to readiness(7 items).4.Quantitative research resultsThe empirical research findings showed that primary care institutions had undertaken much work in response to COVID-19 pandemic in the first half of 2022.24%of primary care institutions had a strong capacity to prevent and control COVID-19 pandemic,52%with a medium capacity and 24%with weak capacity.Among the capacity indicators of COVID prevention and control,primary care institutions had the strongest capacity to carry out hospital protection and set up prevention and control sites,while the capacity to carry out health care management for high-risk groups was relatively weak.Primary medical staff had a medium to the high level of COVID prevention and control readiness in those primary care institutions.COVID prevention and control readiness of medical staff was influenced by both institutional and individual factors,such as marital status,jobs,whether the pressure was relieved by exercise,children status of medical staff,county,whether the institution has carried out epidemic prevention health education activities,and the number of public health staff in primary care institution.ConclusionsThe main findings of this study were as follows:1.The capacity evaluation indicator system of primary care institutions in response to COVID-19 finally included three dimensions and eleven first-level indicators.Three dimensions were composed of organizational framework dimension,COVID prevention and control process dimension and output dimension.Eleven first level indicators comprised personnel indicators,organization construction,logistics support,setting of prevention and control sites,systematic monitoring,personal screening,health management of high-risk individuals,COVID-19 vaccination,health education of epidemic prevention,hospital infection and prevention,and readiness of COVID prevention and control.2.The 17-item COVID Prevention and Control Readiness Assessment Instrument includes professional ability dimension,self-protection ability dimension and sense of identification related to readiness dimension.This Instrument can reflect the specificity of medical staff in primary care institutions with good reliability,validity and feasibility.3.Primary care institutions had undertaken plenty of work in response to COVID-19 pandemic with a medium to high capacity of COVID prevention and control.Primary care institutions had the strongest capacity to protect hospitals and set up prevention and control sites.In contrast,the capacity to carry out health-care management for high-risk groups was relatively weak.Medical staff had a medium to high level of COVID prevention and control readiness which was influenced by both institution and personal characteristics.Policy suggestionsThere were some policy suggestions for primary care managers and policy makers.(1)Use the capacity evaluation indicator system and the 17-item COVID Prevention and Control Readiness Assessment Instrument to measure the capacity of primary care to find out the weakness.(2)Formulate targeted training programs for COVID prevention and control,and focus on improving the readiness of medical staff.(3)Our government should afford material and non-material rewards to primary care institutions and medical staff who charge at the front line in response to COVID.(4)Continuously optimized and adjusted the COVID-19 prevention and control strategy in primary care.(5)Make full use of Internet technology in primary care’s COVID-19 prevention and control strategy.Strengths and limitationsFrom the perspective of the pandemic prevention and control process,this study constructed the capacity evaluation system from the input resources of COVID prevention and control,the implementation of measures to the output,which comprehensively covered the whole process of primary care in response to COVID-19.This study contributes to enriching the research content in primary care,and making up the blank of capacity assessment tools in response to COVID pandemic of primary care institutions.The proxy indicator(COVID prevention and control readiness indicator)close to direct indicators was used to represent the pandemic prevention and control outcome in this study.The proxy measures method is a new research method for similar public health emergency research when direct result indicators cannot be obtained.The 17-item COVID Prevention and Control Readiness Assessment Instrument was constructed and assessed to measure the readiness of primary medical staff,which expanded the application scope of the initial version of READI in this study.There were also some potential limitations in this study.We failed to include other important outcome indicators,such as infection rate,incidence rate,case fatality rate,epidemic coverage,epidemic duration and other variables.Primary care cannot participate in diagnosing and treating COVID-19 cases due to the various work attributes of medical institution during this study.In addition,the study design cannot completely cover the full process of transforming of COVID-19 prevention and control strategies limited by the dynamic pandemic situation in China.There may be a certain systematic bias between the research findings with the fact that the medical staff may report a higher COVID prevention and control readiness than fact on account of the form of data collection by the administrative way. |
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