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      The next three epochs: Health system challenges amidst and beyond the COVID‐19 era


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          The COVID‐19 pandemic has brought to light tremendous gaps and issues faced by health systems globally. Commendable effort has been made to retain continuity of care for non‐COVID‐19 patients amidst the pandemic, particularly using technology‐enhanced models of care. However, these efforts are not sufficient to tackle the impending challenges that health systems around the world will face next: (1) vaccine uptake and hesitancy; (2) a mental health crisis; and (3) post‐COVID‐19 migration. In this letter to the editor, explanation of why each of these issues is concerning and how each subsequent issue grows in severity is provided. Particular focus on the issue of post‐COVID‐19 migration is made, as this challenge is quite pressing to health systems but has yet to be explored thoroughly in the literature. Possible strategies for health system planners to consider are provided in this letter. Strategies include involving stakeholders such as patients and clinicians in deliberations and deployment of interventions, focussing efforts on adapting primary health systems, and building on technology‐enhanced models of care where possible. By adhering to the recommendations made in this letter, health systems may be able to proactively deal with the identified challenges before they become crises of their own, post COVID‐19.

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          Mental Health During the COVID-19 Pandemic: Effects of Stay-at-Home Policies, Social Distancing Behavior, and Social Resources

          Highlights • Studied the role of social distancing in mental health during the COVID-19 pandemic • Stay-at-home orders associated with depression, GAD, insomnia, and acute stress • Distancing behavior associated with depression, GAD, intrusive thoughts, and stress • Depression and GAD symptoms increased between February and March 2020 • Symptom increases were associated with individuals’ social distancing behavior
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            Is Open Access

            Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study

            Background To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. Aim To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. Design and setting Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. Method Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices’ experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. Results There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. Conclusion The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
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              COVID-19 and mental health deterioration by ethnicity and gender in the UK

              We use the UK Household Longitudinal Study and compare pre-COVID-19 pandemic (2017-2019) and during-COVID-19 pandemic data (April 2020) for the same group of individuals to assess and quantify changes in mental health as measured by changes in the GHQ-12 (General Health Questionnaire), among ethnic groups in the UK. We confirm the previously documented average deterioration in mental health for the whole sample of individuals interviewed before and during the COVID-19 pandemic. In addition, we find that the average increase in mental distress varies by ethnicity and gender. Both women –regardless of their ethnicity– and Black, Asian, and minority ethnic (BAME) men experienced a higher average increase in mental distress than White British men, so that the gender gap in mental health increases only among White British individuals. These ethnic-gender specific changes in mental health persist after controlling for demographic and socioeconomic characteristics. Finally, we find some evidence that, among men, Bangladeshi, Indian and Pakistani individuals have experienced the highest average increase in mental distress with respect to White British men.

                Author and article information

                Int J Health Plann Manage
                Int J Health Plann Manage
                The International Journal of Health Planning and Management
                John Wiley and Sons Inc. (Hoboken )
                17 April 2021
                [ 1 ] Department of Family Medicine Faculty of Medicine & Health Sciences, McGill University Montréal Québec Canada
                [ 2 ] Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre Montréal Québec Canada
                [ 3 ] Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre Montréal Québec Canada
                Author notes
                [*] [* ] Correspondence

                Anish K. Arora, Department of Family Medicine, McGill University, 5858 Chemin de la Côte‐des‐Neiges, Suite 300, Montréal QC, Canada, H3S 1Z1.

                Email: Anish.arora@ 123456mail.mcgill.ca

                © 2021 John Wiley & Sons Ltd.

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                Page count
                Figures: 0, Tables: 0, Pages: 4, Words: 1627
                Funded by: Doctoral Scholarship
                Award ID: Fonds de la recherche en santé du Québec in partnership with Unité de Soutien SRAP du Québec
                Letter to the Editor
                Letter to the Editor
                Custom metadata
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:02.07.2021

                Economics of health & social care
                health systems,health policy,primary care,covid‐19,vaccine hesitancy,mental health,migrants


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