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Gómez-Bravo R, Ares-Blanco S, Gefaell Larrondo I, Ramos Del Rio L, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Divjak AĆ, Peña MD, Domeyer PR, Feldmane S, Fitzgerald L, Gjorgjievski D, Gómez-Johansson M, Hanževački M, Ilkov O, Ivanna S, Jandrić-Kočić M, Karathanos VT, Ücüncü E, Kirkovski A, Knežević S, Korkmaz BÇ, Kostić M, Krztoń-Królewiecka A, Kozlovska L, Lingner H, Murauskienė L, Nessler K, Parodi López N, Perjés Á, Petek D, Petrazzuoli F, Petricek G, Sattler M, Seifert B, Serafini A, Sentker T, Ticmane G, Tiili P, Torzsa P, Valtonen K, Vaes B, Vinker S, Neves AL, Guisado-Clavero M, Astier-Peña MP, Hoffmann K. The Use of COVID-19 Mobile Apps in Connecting Patients with Primary Healthcare in 30 Countries: Eurodata Study. Healthcare (Basel) 2024; 12:1420. [PMID: 39057562 PMCID: PMC11275920 DOI: 10.3390/healthcare12141420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. OBJECTIVE To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. METHODOLOGY Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. MAIN OUTCOME MEASURES Patient's first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. RESULTS Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania's apps considered social needs. CONCLUSIONS COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases.
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Affiliation(s)
- Raquel Gómez-Bravo
- Centre Hospitalier Neuro-Psychiatrique, CHNP, 43, Avenue des Alliés, L-9012 Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Campus Belval, Maison des Sciences Humaines 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Avenida de la Albufera, 285, 28038 Madrid, Spain
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Avda. de Atenas, s/n., 28922 Alcorcón, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, calle del Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Ileana Gefaell Larrondo
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria (FIIBAP), 28003 Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion-RICAPPS-(RICORS), 28029 Madrid, Spain
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Avenida de la Albufera, 285, 28038 Madrid, Spain
| | - Limor Adler
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (S.V.)
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, 451 10 Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, Faculté de Médicine Henri Warembourg, University of Lille, 59045 Lille, CEDEX 1, France
| | | | - Iliana-Carmen Busneag
- Kinetic Therapy and Special Motricity, Faculty of Physical Education and Sport, “Spiru Haret” University, 030045 Bucharest, Romania
| | | | - Maryher Delphin Peña
- Department of Geriatric Medicine, Hôpitaux Robert Schuman, L-1130 Luxembourg, Luxembourg
| | | | - Sabine Feldmane
- Department of Family Medicine, Faculty of Medicine, Rīga Stradins University, LV-1007 Riga, Latvia
| | - Louise Fitzgerald
- Irish College of General Practice (MICGP), Royal College of Physician (MRCSI), D02 YN77 Dublin, Ireland
| | - Dragan Gjorgjievski
- Center for Family Medicine, Medical Faculty Skopje, 1000 Skopje, North Macedonia
| | | | - Miroslav Hanževački
- Department of Family Medicine, “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb West, 10000 Zagreb, Croatia
| | - Oksana Ilkov
- Department of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Narodna Square, 3, 88000 Uzhhorod, Transcarpathian Region, Ukraine (S.I.)
| | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Narodna Square, 3, 88000 Uzhhorod, Transcarpathian Region, Ukraine (S.I.)
| | | | - Vasilis Trifon Karathanos
- Medical Education Unit, Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
- General Health System (GHS) Cyprus, 6037 Larnaca, Cyprus
| | - Erva Ücüncü
- Department of Family Medicine, Prof. Dr. Cemil Tascioglu City Hospital, 34384 Istanbul, Turkey
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Snežana Knežević
- Department of Medical Sciences, Academy of Applied Studies Polytechnic, 11000 Belgrade, Serbia;
| | | | - Milena Kostić
- Health Center “Dr. Đorđe Kovačević”, 11550 Lazarevac, Serbia
| | - Anna Krztoń-Królewiecka
- Department of Family Medicine, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
| | - Liga Kozlovska
- Department of Family Medicine, Riga Stradins University, LV-1007 Riga, Latvia (G.T.)
- Rural Family Doctors’ Association of Latvia, LV-4501 Balvi, Latvia
| | - Heidrun Lingner
- Center for Public Health and Healthcare, Department of Medical Psychologie OE5430, Hannover Medical School, 30625 Hannover, Germany
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Katarzyna Nessler
- Department of Family Medicine, Uniwersytet Jagielloński—Collegium Medicum (UJCM), 31-061 Krakow, Poland
| | - Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary (P.T.)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, 221 00 Malmö, Sweden;
| | - Goranka Petricek
- Department of Family Medicine, “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Bohumil Seifert
- Institute of General Practice, First Faculty of Medicine, Charles University, Albertov 7, 110 00 Prague, Czech Republic
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena, Laboratorio EduCare, University of Modena and Reggio Emilia, 41121 Reggio Emilia, Italy
| | - Theresa Sentker
- Center for Public Health and Healthcare, Department of Medical Psychologie OE5430, Hannover Medical School, 30625 Hannover, Germany
| | - Gunta Ticmane
- Department of Family Medicine, Riga Stradins University, LV-1007 Riga, Latvia (G.T.)
- Rural Family Doctors’ Association of Latvia, LV-4501 Balvi, Latvia
| | - Paula Tiili
- Communicable Diseases and Infection Control Unit, Wellbeing Services, County of Vantaa and Kerava, P.O. Box 341, 01301 Vantaa, Finland
- Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary (P.T.)
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, Wellbeing Services, County of Vantaa and Kerava, P.O. Box 341, 01301 Vantaa, Finland
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium;
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (S.V.)
| | - Ana Luisa Neves
- Department of Primary Care and Public Health, Imperial College London, London SW7 2AZ, UK;
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, 28035 Madrid, Spain;
| | - María Pilar Astier-Peña
- Universitas Health Centre, SALUD (Servicio Aragonés de Salud), University of Zaragoza, Andres Vicente 42, 50009 Zaragoza, Spain
| | - Kathryn Hoffmann
- Department of Primary Care Medicine, Medical University of Vienna, 1090 Vienna, Austria
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Genova A, Lombardini S. General practitioners in front of COVID-19: Italy in European comparative perspective. FRONTIERS IN SOCIOLOGY 2024; 9:1365517. [PMID: 38846342 PMCID: PMC11153776 DOI: 10.3389/fsoc.2024.1365517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
COVID-19 has highlighted strengths and weaknesses in healthcare systems all over the word. Despite the differences in primary care models in Europe, this study investigates the state-of-the-art of general practitioners (GPs) before the COVID-19 pandemic spread as a result of the reform process of the previous two decades. The GPs numbers over 100,000 inhabitants has been considered as a proxy of public health investment in GPs. Is the number of GPs increased or decreased in the last 20 years of reform processes in European countries? The main hypothesis is that European healthcare systems would have increased the number of GPs coherently with WHO recommendations. Comparative data on the number of GPs per 100,000 inhabitants in 21 European countries are investigated between 1995 and 2014 (the last available data). Data show that the number of family doctors over 100,000 inhabitants in European countries has increased over the last 20 years, except for Italy, where it has strongly reduced. Primary care has had a crucial role in managing the pandemic. Results of this study suggest that a country such as Italy, which has not invested in family doctors in the last two decades, would have been less equipped to manage the COVID-19 pandemic.
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Affiliation(s)
- Angela Genova
- Department of Economics, Society, Politics, University of Urbino, Urbino, Italy
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Ares-Blanco S, Guisado-Clavero M, Del Rio LR, Larrondo IG, Fitzgerald L, Murauskienė L, López NP, Perjés Á, Petek D, Petrazzuoli F, Petricek G, Sattler M, Saurek-Aleksandrovska N, Senn O, Seifert B, Serafini A, Sentker T, Ticmane G, Tiili P, Torzsa P, Valtonen K, Vaes B, Vinker S, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Divjak AĆ, Peña MD, Díaz E, Domeyer PR, Feldmane S, Gjorgjievski D, Gómez-Johansson M, de la Fuente ÁG, Hanževački M, Hoffmann K, Ільков О, Ivanna S, Jandrić-Kočić M, Karathanos VT, Üçüncü EK, Kirkovski A, Knežević S, Korkmaz BÇ, Kostić M, Krztoń-Królewiecka A, Kozlovska L, Nessler K, Gómez-Bravo R, Peña MPA, Lingner H. Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study. Eur J Public Health 2024; 34:402-410. [PMID: 38326993 PMCID: PMC10990533 DOI: 10.1093/eurpub/ckad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary care and Community North Area of Madrid, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Ileana Gefaell Larrondo
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Louise Fitzgerald
- Member of Irish College of General Practice (MICGP), Member of Royal College of Physician (MRCSI), Dublin, Ireland
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden; Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine at the University of Semmelweis, Budapest, Hungary
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Goranka Petricek
- Department of Family Medicine “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, Croatia; Health Centre Zagreb West, Croatia
| | | | | | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Bohumil Seifert
- Charles University, First Faculty of Medicine, Institute of General Practice, Prague, Czech Republic
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena, Laboratorio EduCare, University of Modena and Reggio Emilia, Modena, Italy
| | - Theresa Sentker
- Center for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
| | - Gunta Ticmane
- Department of Family Medicine at Riga Stradiņš University, Riga, Latvia; Member of the board of the Rural Family Doctors’ Association of Latvia, Latvia
| | - Paula Tiili
- Communicable Diseases and Infection Control Unit, City of Vantaa, Vantaa. University of Helsinki, Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine at the University of Semmelweis, Budapest, Hungary
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, City of Vantaa, Vantaa, Finland
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. WONCA Europe President, Israel
| | - Limor Adler
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France
| | | | | | | | - Maryher Delphin Peña
- Department of Geriatric Medicine, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Esperanza Díaz
- Pandemic Center, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway; Norwegian National Institute of Public Health, Bergen, Norway
| | | | - Sabine Feldmane
- Department of Family Medicine, Rīga Stradins University, Riga, Latvia
| | | | | | | | - Miroslav Hanževački
- Department of Family Medicine “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, Croatia; Health Centre Zagreb West, Croatia
| | - Kathryn Hoffmann
- Department of General Practice and Primary Care, Med. University of Vienna, Vienna, Austria
| | - Оксана Ільков
- Department of Family Medicine and Outpatient Care, Medical Faculty 2, Uzhhorod National University, Uzhhorod, Ukraine
| | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care, Medical Faculty 2, Uzhhorod National University, Uzhhorod, Ukraine
| | | | - Vasilis Trifon Karathanos
- Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of Health Sciences, University of Ioannina- Greece; GHS, Larnaca, Cyprus
| | - Erva Kirkoç Üçüncü
- Department of Family Medicine, Prof. Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | | | - Milena Kostić
- Health Center “Dr Đorđe Kovačević”, Lazarevac, Belgrade, Serbia
| | | | - Liga Kozlovska
- Department of Family Medicine of Riga Stradins University, Riga, Latvia; President of the Rural Family Doctors' Association of Latvia
| | - Katarzyna Nessler
- Department of Family Medicine UJCM at Uniwersytet Jagielloński - Collegium Medicum, Kraków, Poland
| | - Raquel Gómez-Bravo
- CHNP, Rehaklinik, Ettelbruck, Luxembourg; Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education, and Social Sciences, Luxembourg University, Luxembourg, Luxembourg
| | - María Pilar Astier Peña
- Technical Advisor for Quality and Safety, Territorial Healthcare Quality Unit, Territorial Healthcare Direction of Camp de Tarragona, Healthcare Institut of Catalonia, Health Departament, Generalitat de Catalunya GIBA-IIS-Aragón, Catalunya, Spain; Chair of Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine) and Quality and Safety in Family Medicine of WONCA World (Global Family Doctors), Board Member of WONCA World and SECA (Spanish Society for Healthcare Quality), Spain
| | - Heidrun Lingner
- Center for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
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Vinker S, Windak A, Stoffers J. A 'special issue on COVID-19'. Fourteen primary care publications with implications for practice, teaching, and research. Eur J Gen Pract 2023; 29:2213518. [PMID: 37283027 PMCID: PMC10249446 DOI: 10.1080/13814788.2023.2213518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- Shlomo Vinker
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Branch, Leumit Health Services, Tel Aviv, Israel
- The WONCA Europe Executive Board
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
- WONCA Europe Executive Board member at large (EURACT)
| | - Jelle Stoffers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, the Netherlands
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van der Velden AW, Shanyinde M, Bongard E, Böhmer F, Chlabicz S, Colliers A, García-Sangenís A, Malania L, Pauer J, Tomacinschii A, Yu LM, Loens K, Ieven M, Verheij TJ, Goossens H, Vellinga A, Butler CC. Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic. Eur J Gen Pract 2023; 29:2270707. [PMID: 37870070 PMCID: PMC10990254 DOI: 10.1080/13814788.2023.2270707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 10/04/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, GPs had to distinguish SARS-CoV-2 from other aetiologies in patients presenting with respiratory tract infection (RTI) symptoms on clinical grounds and adapt management accordingly. OBJECTIVES To test the diagnostic accuracy of GPs' clinical diagnosis of a SARS-CoV-2 infection in a period when COVID-19 was a new disease. To describe GPs' management of patients presenting with RTI for whom no confirmed diagnosis was available. To investigate associations between patient and clinical features with a SARS-CoV-2 infection. METHODS In April 2020-March 2021, 876 patients (9 countries) were recruited when they contacted their GP with symptoms of an RTI of unknown aetiology. A swab was taken at baseline for later analysis. Aetiology (PCR), diagnostic accuracy of GPs' clinical SARS-CoV-2 diagnosis, and patient management were explored. Factors related to SARS-CoV-2 infection were determined by logistic regression modelling. RESULTS GPs suspected SARS-CoV-2 in 53% of patients whereas 27% of patients tested positive for SARS-CoV-2. True-positive patients (23%) were more intensively managed for follow-up, antiviral prescribing and advice than true-negatives (42%). False negatives (5%) were under-advised, particularly for social distancing and isolation. Older age (OR: 1.02 (1.01-1.03)), male sex (OR: 1.68 (1.16-2.41)), loss of taste/smell (OR: 5.8 (3.7-9)), fever (OR: 1.9 (1.3-2.8)), muscle aches (OR: 2.1 (1.5-3)), and a known risk factor for COVID-19 (travel, health care worker, contact with proven case; OR: 2.7 (1.8-4)) were predictive of SARS-CoV-2 infection. Absence of loss of taste/smell, fever, muscle aches and a known risk factor for COVID-19 correctly excluded SARS-CoV-2 in 92.3% of patients, whereas presence of 3, or 4 of these variables correctly classified SARS-CoV-2 in 57.7% and 87.1%. CONCLUSION Correct clinical diagnosis of SARS-CoV-2 infection, without POC-testing available, appeared to be complicated.
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Affiliation(s)
- Alike W. van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Milensu Shanyinde
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily Bongard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Femke Böhmer
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - Slawomir Chlabicz
- Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Annelies Colliers
- Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium
| | - Ana García-Sangenís
- Institut Universitari d‘Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Lile Malania
- National Center for Disease Control and Public Health, Tbilisi and Arner Science Management LLC, Tbilisi, Georgia
| | | | - Angela Tomacinschii
- University Clinic of Primary Medical Assistance of State University of Medicine and Pharmacy “N. Testemițanu”, Chişinǎu, The Republic of Moldova
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katherine Loens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Theo J. Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Akke Vellinga
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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6
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Boeijen JA, van de Pol AC, van Uum RT, Smit K, Ahmad A, van Rijswijk E, van Apeldoorn MJ, van Thiel E, de Graaf N, Menkveld RM, Mantingh MR, Geertman S, Couzijn N, van Groenendael L, Schers H, Bont J, Bonten TN, Rutten FH, Zwart DLM. Home-based initiatives for acute management of COVID-19 patients needing oxygen: differences across The Netherlands. BMC Health Serv Res 2023; 23:1257. [PMID: 37968634 PMCID: PMC10652550 DOI: 10.1186/s12913-023-10191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/20/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. METHODS Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. RESULTS Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. CONCLUSIONS We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care.
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Affiliation(s)
- Josi A Boeijen
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - Alma C van de Pol
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Rick T van Uum
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Karin Smit
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Abeer Ahmad
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
- Department of General Practice, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Eric van Rijswijk
- Primary Care Network Jeroen Bosch Huisartsen, Nieuwe Linie 231-232, Vught, 5264PJ, The Netherlands
| | - Marjan J van Apeldoorn
- Department of Internal Medicine, Jeroen Bosch Hospital, Postbus 90153, 's-Hertogenbosch, 5200 ME, The Netherlands
| | - Eric van Thiel
- Department of Pulmonology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, 3318 AT, The Netherlands
| | - Netty de Graaf
- Department of Pulmonology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, 3318 AT, The Netherlands
| | - R Michiel Menkveld
- Wilhelmina Hospital Assen, Europaweg-Zuid 1, Postbus 30001, Assen, 9400 RA, The Netherlands
| | - Martijn R Mantingh
- Regional Organization for General Practice Drenthe, Dokter Drenthe, Stationsstraat 44, Assen, 9401 KX, The Netherlands
| | - Silke Geertman
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Nicolette Couzijn
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Leon van Groenendael
- Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein 21, Nijmegen, 6525 EZ, The Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein 21, Nijmegen, 6525 EZ, The Netherlands
| | - Jettie Bont
- Department of General Practice, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Tobias N Bonten
- Public Health & Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Frans H Rutten
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Dorien L M Zwart
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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7
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Guisado-Clavero M, Ares-Blanco S, Serafini A, Del Rio LR, Larrondo IG, Fitzgerald L, Vinker S, van Pottebergh G, Valtonen K, Vaes B, Yilmaz CT, Torzsa P, Tilli P, Sentker T, Seifert B, Saurek-Aleksandrovska N, Sattler M, Petricek G, Petrazzuoli F, Petek D, Perjés Á, López NP, Neves AL, Murauskienė L, Lingner H, Nessler K, Heleno B, Krztoń-Królewiecka A, Kostić M, Korkmaz BÇ, Knežević S, Kirkovski A, Karathanos VT, Jandrić-Kočić M, Ivanna S, Ільков О, Hoffmann K, Hanževački M, Gómez-Johansson M, Gjorgjievski D, Domeyer PRJ, Peña MD, Divjak AĆ, Busneag IC, Brutskaya-Stempkovskaya E, Bayen S, Bakola M, Adler L, Assenova R, Astier-Peña MP, Gómez Bravo R. The role of primary health care in long-term care facilities during the COVID-19 pandemic in 30 European countries: a retrospective descriptive study (Eurodata study). Prim Health Care Res Dev 2023; 24:e60. [PMID: 37873623 PMCID: PMC10594530 DOI: 10.1017/s1463423623000312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/31/2022] [Accepted: 05/25/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND AIM Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic. METHODS Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care. RESULTS Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom's follow-up was performed mainly by PHC. CONCLUSION PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.
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Affiliation(s)
- Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Health Care and
Community North Area of Madrid, Madrid,
Spain
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain; Instituto de Investigación Sanitaria Gregorio
Marañón, Madrid, Spain
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena; Laboratorio EduCare,
University of Modena and Reggio Emilia,
Italy
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain
| | - Ileana Gefaell Larrondo
- Federica Montseny Health Centre, Gerencia Asistencial de
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain
| | - Louise Fitzgerald
- Member of Irish College of General Practice (MICGP), Member
of Royal College of Physician (MRCSI), Ireland
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv,
Israel; WONCA Europe President
| | - Gijs van Pottebergh
- Department of Public Health and Primary Health Care, KU
Leuven, Leuven, Belgium
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, City of
Vantaa and University of Helsinki, Helsinki,
Finland
| | - Bert Vaes
- Department of Public Health and Primary Health Care, KU
Leuven, Leuven, Belgium
| | - Canan Tuz Yilmaz
- Lecturer, Bursa Uludağ University, Family
Medicine Department, Turkey
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis
University, Hungary
| | - Paula Tilli
- Communicable Diseases and Infection Control Unit, City of
Vantaa and University of Helsinki, Helsinki,
Finland
| | | | - Bohumil Seifert
- Charles University, First Faculty of Medicine, Institute of
General Practice, Czech Republic
| | | | | | - Goranka Petricek
- Department of Family Medicine “Andrija Stampar” School of Public Health,
School of Medicine, University of Zagreb,
Croatia; Health Centre Zagreb West, Croatia
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care
Research, Lund University, Malmö,
Sweden
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine,
University of Ljubljana, Slovenia;
Chairperson of EGPRN
| | - Ábel Perjés
- Department of Family Medicine, University of
Semmelweis, Budapest, Hungary
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg,
Sweden; Department of Pharmacology, Sahlgrenska Academy,
University of Gothenburg, Gothenburg,
Sweden
| | - Ana Luisa Neves
- Imperial College London, United Kingdom;
Faculty of Medicine, University of Porto,
Portugal
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of
Medicine, Vilnius University, Lithuania
| | - Heidrun Lingner
- Medizinische Hochschule Hannover, OE 5430, Carl Neuberg Str. 1,
30625Hannover, Germany
| | - Katarzyna Nessler
- Department of Family Medicine, UJCM at Uniwersytet
Jagielloński – Collegium Medicum, Poland
| | - Bruno Heleno
- Comprehensive Health Research Center, NOVA Medical School,
Universidade Nova de Lisboa; USF das Conchas,
Regional Health Administration Lisbon and Tagus Valley, Lisbon,
Portugal
| | | | - Milena Kostić
- Health Center “Dr Đorđe Kovačević”, Lazarevac,
Belgrade, Serbia
| | | | | | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius
University, Skopje, North Macedonia
| | - Vasilis Trifon Karathanos
- Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of
Health Sciences, University of Ioannina-Greece; Family Doctor,
GHS, Larnaca, Cyprus
| | | | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care,
UZHNU, Medical Faculty 2, Ukraine
| | - Оксана Ільков
- Department of Family Medicine and Outpatient Care, Medical Faculty 2,
Uzhhorod National University, Ukraine
| | - Kathryn Hoffmann
- Associate Professor and Medical Doctor for General Practice and Primary
Care, Medical University of Vienna, Austria
| | - Miroslav Hanževački
- Department of Family Medicine “Andrija Stampar” School of Public Health,
School of Medicine, University of Zagreb,
Croatia; Health Centre Zagreb West, Croatia
| | | | | | | | | | | | - Iliana-Carmen Busneag
- “Spiru Haret” University, Practising Family Doctor, Occupational
Health Expert, Bucharest, Romania
| | | | - Sabine Bayen
- Department of General Practice, University of Lille,
UFR3S, France
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of
Medicine, School of Health Science, University of Ioannina,
Ioannina, Greece
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv,
Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine,
Medical University of Plovdiv, Bulgaria
| | - María Pilar Astier-Peña
- Healthcare Quality Technical Assistant, Territorial Quality Unit, Camp de
Tarragona Healthcare Directorate, Catalan Institute of Health,
Catalonia Government, Spain; Semfyc, Wonca World Executive Board,
University of Zaragoza, GIBA IIS Aragon,
Spain
| | - Raquel Gómez Bravo
- Centre Hospitalier Neuro-Psychiatrique, CHNP,
Rehaklinik, Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health; Institute for Health and
Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities,
Education, and Social Sciences, Luxembourg University,
Luxembourg
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8
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Milani C, Buscemi P, Velpini B, Naldini G, Cosma C, Giannuzzi F, Ionita G, Monaci P, Landi R, Pontalti I, Baggiani L, Nerattini M, Lorini C, Bonaccorsi G. The Activity of Special Continuity Care Units in the City of Florence During the COVID-19 Pandemic. Int J Public Health 2023; 68:1606338. [PMID: 37867562 PMCID: PMC10587394 DOI: 10.3389/ijph.2023.1606338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives: Worldwide, countries adopted different strategies in primary care (PC) to cope with the COVID-19 pandemic. This study aims to describe and evaluate the functions and activity load of a specific PC organizational model called "Special Continuity Care Units" (SCCU) in Florence, Italy, and to investigate the characteristics of the COVID-19 patients assisted by the service. Methods: The retrospective cross-sectional design used daily updated reports by SCCU team members to evaluate the activity load. The retrospective cohort study analyzed data of the demographics, clinical characteristics, and process outcomes of patients assisted during the second pandemic wave. Results: The analysis shows how the service activity load changed along with the epidemiological trend. Regarding people assisted by the SCCU, the median follow-up duration of symptoms was 6 days; male gender and being symptomatic were predictors of hospitalization. Conclusion: Some key characteristics can be described as indispensable in PC services facing health emergencies: model flexibility, the availability of resources, networking among services to enhance coordination and resource optimization, and close collaboration with general practitioners.
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Affiliation(s)
- Chiara Milani
- Department of Health Science, University of Florence, Florence, Italy
| | - Primo Buscemi
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Beatrice Velpini
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Giulia Naldini
- Department of District Health Care Network, Azienda USL Toscana Centro, Florence, Italy
| | - Claudia Cosma
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Francesco Giannuzzi
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Giulia Ionita
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Pietro Monaci
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Ruggero Landi
- Ex-Special Continuity Care Units, Azienda USL Toscana Centro, Florence, Italy
| | - Irene Pontalti
- Ex-Special Continuity Care Units, Azienda USL Toscana Centro, Florence, Italy
| | - Lorenzo Baggiani
- Department of District Health Care Network, Azienda USL Toscana Centro, Florence, Italy
| | | | - Chiara Lorini
- Department of Health Science, University of Florence, Florence, Italy
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