The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland

Allocation of Financial Resources to Primary Healthcare: A Scoping Review Protocol

Background

Countries possessing robust primary healthcare (PHC) systems typically yield superior health outcomes, reduced inequality, and diminished healthcare expenses for their citizens. Moreover, PHC demonstrates a direct correlation with the efficient utilization of resources. However, the allocation of financial resources dedicated to PHC varies significantly among countries and lacks explicit clarity. Therefore, this paper aims to conduct a review of published literature to ascertain the extent of resource allocation to PHC across diverse nations. In addition, it aims to explore associated factors, challenges, and mechanisms influencing this allocation.

Methods

This scoping review protocol will adopt the Joanna Briggs Institute's scoping review methodology, which was updated in 2020. It will leverage library studies and refer to reputable databases. The inclusion criteria will include studies conducted between January 2000 and December 2023, focusing on criteria, amounts, mechanisms, and challenges associated with financial resource allocation to PHC globally. In addition, studies must be published in either English and Persian. Studies lacking full-text availability will be excluded from the review. Mendeley software will be utilized to organize and manage the collected studies. The study selection process will be visually depicted using the PRISMA-SCR diagram. Conventional content analysis will be employed to analyze the studies.

Conclusions

Considering the position and role of primary health care in promoting the health of society, by implementing this protocol, the data obtained from the proposed scoping review will enable the managers and officials of the health system to follow the experiences of different countries in the field of scientific and fair allocation of financial resources to PHC, reinforcing Universal Health Coverage (UHC).

Predictive Factors of Physicians' Satisfaction and Quality of Work Under Teleconsultation Conditions: Structural Equation Analysis

BACKGROUND

The COVID-19 pandemic contributed to an increase in teleconsultation adoption in the Polish primary health care system. It is expected that in the long run, teleconsultations will successfully replace a significant part of face-to-face visits. Therefore, a significant challenge facing primary health care facilities (PHCs) is the acceptance of teleconsultations by their users, especially physicians.

OBJECTIVE

This study aimed to explore physicians' acceptance of teleconsultations during the COVID-19 pandemic in Poland.

METHODS

A representative survey was conducted among 361 physicians of PHCs across Poland in 2021. For the purposes of the study, we developed a modified Technology Acceptance Model (TAM) model. Based on the modified TAM, we analyzed the impact of perceived usefulness (PU), perceived ease of use (PEU), and intention to use teleconsultation (INT) on physicians' satisfaction (SAT) and quality of work (Q). The psychometric properties of the research instrument were examined using exploratory factor analysis. Finally, structural equation modeling was used for data analysis.

RESULTS

The results indicated a generally high level of PU (mean 3.85-4.36, SD 0.87-1.18), PEU (mean 3.81-4.60, SD 0.60-1.42), INT (mean 3.87-4.22, SD 0.89-1.12), and SAT (mean 3.55-4.13, SD 0.88-1.16); the lowest rated dimension in TAM was Q (mean 3.28-3.73, SD 1.06-1.26). The most important independent variable was PU. The influence of PU on INT (estimate=0.63, critical ratio [CR]=15.84, P<.001) and of PU on SAT (estimate=0.44, CR= 9.53, P<.001) was strong. INT was also a key factor influencing SAT (estimate=0.4, CR=8.57, P<.001). A weaker relationship was noted in the effect of PEU on INT (estimate=0.17, CR=4.31, P<.001). In turn, Q was positively influenced by INT (estimate=0.179, CR=3.64, P<.001), PU (estimate=0.246, CR=4.79, P<.001), PEU (estimate=0.18, CR=4.93, P<.001), and SAT (estimate=0.357, CR=6.97, P<.001). All paths between the constructs (PU, PEU, INT, SAT, and Q) were statistically significant, which highlights the multifaceted nature of the adoption of teleconsultations among physicians.

CONCLUSIONS

Our findings provide strong empirical support for the hypothesized relationships in TAM. The findings suggest that the PU and PEU of teleconsultation have a significant impact on the intention of physicians to adopt teleconsultation. This results in an improvement in the satisfaction of Polish physicians with the use of teleconsultation and an increase in Q. The study contributes to both theory and practice by identifying important prognostic factors affecting physicians' acceptance of teleconsultation systems.

Quality of care in Belgian general practices during the COVID-19 pandemic: results of the cross-sectional PRICOV-19 study

BACKGROUND

The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries.

METHODS

The data collected from 479 Belgian practices during 2020-2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed.  Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system.

RESULTS

Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries.

CONCLUSIONS

Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care.

Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic

OBJECTIVES

The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices.

METHODS

We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology.

RESULTS

We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs).

CONCLUSIONS

Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.

How COVID-19 has changed the utilization of different health care services in Poland

BACKGROUND

The COVID-19 pandemic has affected health care systems in many ways, including access to and the use of non-COVID services. The aim of the study was to assess the impact of the pandemic on the utilization of different public health care services in Poland.

METHODS

The aggregated data on health care users and provided services for the years 2015/2016-2021 were used to analyse the changes in health care utilization during the pandemic and deviations from pre-pandemic utilization trends. Quantitative analysis was complemented with qualitative descriptions of the changes in principles of health care provision during the pandemic.

RESULTS

The results show a considerable drop in the provision of most health care services in 2020 that in some cases disturbed pre-pandemic utilization trends and was not made up for in 2021. The most significant decrease has been observed in the field of preventive and public health services, as well as rehabilitation. The provision of these services was put on hold during the pandemic.

CONCLUSIONS

The accumulated COVID-19-related "health debt" urgently calls for government actions to strengthen disease prevention and health promotion in Poland.

Outpatient Spine Surgery in Poland: A Survey on Popularity, Challenges, and Future Perspectives

Objective

This study aimed to investigate the popularity of outpatient spine surgery in Poland, identify factors influencing its adoption, and assess its benefits, challenges, and impact on patient outcomes and healthcare costs. Additionally, the study proposes strategies to improve outpatient spine surgery adoption and ensure its safe implementation in Poland.

Materials and Methods

An electronic survey was distributed to members of the Polish Spine Surgery Society and the Polish Neurosurgery Society. Data were analyzed using Matlab R2020b statistical software, employing descriptive statistics to summarize the responses.

Results

The survey indicated that 67% of respondents provide spinal procedures commercially, with 58% performing them on an outpatient basis, showing the growing role of the private sector in providing spinal surgery services in Poland. Root nerve blocks and joint blocks were the most common outpatient procedures, followed by microdiscectomy, endoscopic discectomy, and L-S spinal fusion. The public NHF was the most common payer for outpatient procedures.

Conclusion

Outpatient spine surgery in Poland is not yet widespread, but improvements can be made to reduce hospital stays and enhance recovery. Changes in reimbursement systems to cover outpatient procedures and addressing physicians' liability concerns, particularly by emphasizing the NO-fault system, are essential. With proper support, outpatient spine surgery could become a valuable addition to Poland's healthcare system.

Classification of reviews of e-healthcare services to improve patient satisfaction: Insights from an emerging economy

The COVID-19 pandemic has brought in many unique challenges and opportunities for patient care, and one is online healthcare practices. Patient satisfaction with online consultation is primary importance as online healthcare practices are evolving with time. Although previous research has examined how patient satisfaction with online doctor services can be further improved, there has been scant research on the satisfaction with online doctor services concerning Indian patients. Within the framework of service science theories, this study examines satisfaction and sentiments of Indian patients with online doctor services from multiple perspectives. A total of 38019 patient online feedback for 343 doctors was used for understanding patient sentiments. The sentiment analysis classified the reviews of the patients on online doctor consultation services. The finding suggests that healthcare service providers consider a systemic approach that includes core health services along with technical and marketing factors to proactively improve online patient satisfaction.

The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries

The COVID-19 pandemic disproportionately affected vulnerable populations' access to health care. By proactively reaching out to them, general practices attempted to prevent the underutilization of their services. This paper examined the association between practice and country characteristics and the organization of outreach work in general practices during COVID-19. Linear mixed model analyses with practices nested in countries were performed on the data of 4982 practices from 38 countries. A 4-item scale on outreach work was constructed as the outcome variable with a reliability of 0.77 and 0.97 at the practice and country level. The results showed that many practices set up outreach work, including extracting at least one list of patients with chronic conditions from their electronic medical record (30.1%); and performing telephone outreach to patients with chronic conditions (62.8%), a psychological vulnerability (35.6%), or possible situation of domestic violence or a child-rearing situation (17.2%). Outreach work was positively related to the availability of an administrative assistant or practice manager (p < 0.05) or paramedical support staff (p < 0.01). Other practice and country characteristics were not significantly associated with undertaking outreach work. Policy and financial interventions supporting general practices to organize outreach work should focus on the range of personnel available to support such practice activities.

Medical Staff Shortages and the Performance of Outpatient Clinics in Poland during the COVID-19 Pandemic

Unlike many industries, healthcare was simultaneously affected by the COVID-19 pandemic in two opposite ways. On the one hand, the industry faced shortages and overload of many medical representatives such as nurses and infectious disease professionals, but on the other, many medical professionals such as dentists were left with considerably reduced demand. The objective of this paper is to study the efficiency of medical staff allocation and the performance of small and medium sized outpatient clinics in Poland during the COVID-19 pandemic. Owing to the contemporaneity of this problem, we have employed a multiple case study approach. Our sample comprises 5 small and medium-sized outpatient clinics located in Poland in the 3-year period 2019-2021. The results indicate a considerable percentage of medical staff employed in small and medium-sized outpatient clinics remained outside the pandemic, despite their potential provision of healthcare services. Four of the five clinics studied remained passive towards the pandemic. In view of future pandemics, the indications we provide have practical implications for outpatient clinics executives and public health policymakers.

Impact of Socioeconomic Status on the Perception of Accessibility to and Quality of Healthcare Services during the COVID-19 Pandemic among Poles—Pilot Study

This pilot study was conducted on the reported hypothesis that the COVID-19 pandemic outbreak had an impact on the accessibility and quality of healthcare services and exacerbated socioeconomic inequalities. The aim was to determine whether economic status and education had an impact on the perception of access and quality to healthcare services during the COVID-19 pandemic and whether, according to patients, accessibility and quality had changed significantly compared to the pre-pandemic period in Poland. The study was based on the authors’ questionnaire and the results were statistically analyzed. Two hundred forty-seven feedback responses were received with a responsiveness rate of 93 percent. Statistically significant differences were found when comparing education level and utilization of healthcare services during the COVID-19 pandemic. A comparison of gender and economic situation, and average monthly income found no statistically significant differences. The outbreak of the COVID-19 pandemic has undoubtedly affected the provision of health services in many countries around the world. One result of the pandemic crisis has been widening socioeconomic inequalities among patients.

How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries

BACKGROUND

General practitioners (GPs) play a crucial role in the fight against the COVID-19 pandemic as the first point of contact for possibly infected patients and are responsible for short and long-term follow-up care of the majority of COVID-19 patients. Nonetheless, they experience many barriers to fulfilling this role. The PRICOV-19 study investigates how GP practices in 38 countries are organized during the COVID-19 pandemic to guarantee safe, effective, patient-centered, and equitable care. Also, the shift in roles and tasks and the wellbeing of staff members is researched. Finally, PRICOV-19 aims to study the association with practice- and health care system characteristics. It is expected that both characteristics of the GP practice and health care system features are associated with how GP practices can cope with these challenges. This paper describes the protocol of the study.

METHODS

Using a cross-sectional design, data are collected through an online questionnaire sent to GP practices in 37 European countries and Israel. The questionnaire is developed in multiple phases, including a pilot study in Belgium. The final version includes 53 items divided into six sections: patient flow (including appointments, triage, and management for routine care); infection prevention; information processing; communication; collaboration and self-care; and practice and participant characteristics. In the countries where data collection is already finished, between 13 and 636 GP practices per country participated in the study. Questionnaire data are linked with OECD and HSMR data regarding national policy responses to the pandemic and analyzed using multilevel models considering the system- and practice-level.

DISCUSSION

To the best of our knowledge, the PRICOV-19 study is the largest and most comprehensive study that examines how GP practices function during the COVID-19 pandemic. Its results can significantly contribute to better preparedness of primary health care systems across Europe for future major outbreaks of infectious diseases.

The Quality of Medical Care in the Conditions of the COVID-19 Pandemic, with Particular Emphasis on the Access to Primary Healthcare and the Effectiveness of Treatment in Poland

Health has a significant influence on the quality of life of a society. The COVID-19 pandemic has forced many countries to implement restrictive measures to prevent its wider spread, including, inter alia, the introduction of remote healthcare in the form of teleconsultations. Therefore, there is the question of how such a change affects the quality of treatment and the primary healthcare of patients during the COVID-19 pandemic. The article aims to examine patient satisfaction with the access to primary healthcare and the effectiveness of treatment in a condition of remote medical care caused by the COVID-19 pandemic. We also analyse the impact of access to primary healthcare on the treatment effectiveness. Patient satisfaction was measured using a questionnaire assessing the quality of primary medical care. Of the 36 items studied, seven were related to the accessibility dimension and four were related to the treatment effectiveness dimension. Our results suggest that the treatment effectiveness and the access to primary healthcare services during the COVID-19 pandemic through telemedicine are quite highly rated by patients. Hence, further implementation of telemedicine in primary healthcare should improve the quality of lives of the wide society. We have also identified the access to primary healthcare has a considerable impact on the treatment effectiveness. Therefore, we recommend increasing the contact between patients and GPs via telemedicine under lockdown conditions.

The Research on Patient Satisfaction with Remote Healthcare Prior to and during the COVID-19 Pandemic

The issue of research on patient satisfaction with healthcare services took on a completely new dimension due to the COVID-19 pandemic and the developing telehealth services. This results from the fact that during the pandemic, remote healthcare was often the only possible form of care provision to the patient. The COVID-19 pandemic has substantially accelerated the implementation of remote healthcare in healthcare institutions and made it an essential tool for providing healthcare services. The objective of the literature review was to study the research on patient satisfaction with remote healthcare services prior to and during the pandemic. The study featured a literature review of electronic databases, such as: Medline, ProQuest, PubMED, Ebsco, Google Scholar, WoS. The identified empirical papers were classified in two groups concerning the research on patient satisfaction prior to and during the COVID-19 pandemic, and were divided and descriptively synthesised. Certain limitations to the methodical quality of the research were demonstrated as result of the conducted analyses. It was also ascertained that researchers lack clarity on the method of defining and measuring satisfaction prior to and during the COVID-19 pandemic.

The Impact of the SARS-CoV-19 Pandemic on the Global Gross Domestic Product

The rapid, unexpected, and large-scale expansion of the SARS-CoV-19 pandemic has led to a global health and economy crisis. However, although the crisis itself is a worldwide phenomenon, there have been considerable differences between respective countries in terms of SARS-CoV-19 morbidities and fatalities as well as the GDP impact. The object of this paper was to study the influence of the SARS-CoV-19 pandemic on global gross domestic product. We analyzed data relating to 176 countries in the 11-month period from February 2020 to December 2020. We employed SARS-CoV-19 morbidity and fatality rates reported by different countries as proxies for the development of the pandemic. The analysis employed in our study was based on moving median and quartiles, Kendall tau-b coefficients, and multi-segment piecewise-linear approximation with Theil-Sen trend lines. In the study, we empirically confirmed and measured the negative impact of the SARS-CoV-19 pandemic on the respective national economies. The relationship between the pandemic and the economy is not uniform and depends on the extent of the pandemic's development. The more intense the pandemic, the more adaptive the economies of specific countries become.