JMIR Publications

ABSTRACT

Background:

After strict COVID-19-related restrictions were lifted, health systems globally were overwhelmed. Much has been discussed about how health systems could better prepare for future pandemics; however, primary healthcare (PHC) has been largely ignored.

Objective:

To investigate what combined policies PHC would apply to strengthen the healthcare system from bottom up so as to better respond to a public health emergency.

Methods:

We developed a system dynamics model to replicate Shanghai's response when COVID-related restrictions were lifted. We then simulated an alternative PHC-based integrated health system, and tested three interventions: first contact in PHC with telemedicine services, recommendation to secondary care, and return to PHC for recovery.

Results:

Simulation results showed that each selected intervention could alleviate hospital overwhelm. Increased first contacts in PHC with telemedicine increased hospital bed availability by 6%–12% and reduced the cumulative number of deaths by 35%. More precise recommendations had a limited impact on hospital overwhelm (<1%), but under-recommendation (rate, 80%) would lead to a 19% increase in cumulative deaths. An increased return to PHC of 5%–20% could improve hospital bed availability by 6%–16% and reduce cumulative deaths by 46%. Moreover, combining all three interventions had a multiplier effect: bed availability increased by 683%, and the cumulative number of deaths dropped by 75%.

Conclusions:

Compared with the allocation of medical resources in secondary care, we identified an optimal PHC-based integrated strategy with a 60% rate of first contact in PHC, 110% recommendation rate, and 20% rate of return to PHC, which could increase health system resilience during public health emergencies.