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Willems S, Vanden Bussche P, Van Poel E, Collins C, Klemenc-Ketis Z. Moving forward after the COVID-19 pandemic: Lessons learned in primary care from the multi-country PRICOV-19 study. Eur J Gen Pract 2024; 30:2328716. [PMID: 38511848 PMCID: PMC10984223 DOI: 10.1080/13814788.2024.2328716] [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: 06/28/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has accentuated the indispensable role of primary care. Objectives: Recognising this, the PRICOV-19 study investigated how 5,489 GP practices across 38 countries (Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kosovo*, Latvia, Lithuania, Luxembourg, Malta, Republic of Moldova, Netherlands, North Macedonia, Norway, Poland, Portugal, Romania, Serbia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, and United Kingdom) adapted their care delivery during the pandemic. METHODS Based on a series of discussions on the results of the PRICOV-19 study group, eight recommendations to enhance primary care's preparedness for future crises were formulated and endorsed by EQuiP and WONCA Europe. RESULTS The recommendations underscore the importance of recognising and sustaining the substantial strides made in patient safety within GP practices during the pandemic in current daily practices; acknowledging and supporting the pivotal role of GP practices in addressing health inequalities during crises; adopting interprofessional care models to enhance practices' resilience and adaptability to change; supporting training practices; creating healthy working environments; investing in infrastructure that supports adequate and safe care; and increasing funding for research on patient safety and primary care quality to inform evidence-based health policies and fostering international knowledge exchange among healthcare professionals and policymakers. CONCLUSION Policymakers, primary care associations, and the broader healthcare system are urged to collaboratively take responsibility and increase support for GP practices to enhance their resilience, adaptability, and capacity to deliver safe and equitable healthcare during future crises.
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Affiliation(s)
- Sara Willems
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- European Association for Quality and Patient Safety in General Practice/Family Medicine
| | - Pierre Vanden Bussche
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- European Association for Quality and Patient Safety in General Practice/Family Medicine
- Academic Centre for Family Medicine, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Esther Van Poel
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Claire Collins
- Equity Research Group, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Irish College of General Practitioners, Dublin, Ireland
| | - Zalika Klemenc-Ketis
- European Association for Quality and Patient Safety in General Practice/Family Medicine
- Ljubljana Community Health Centre, Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
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Kendir C, van den Berg M, Bloemeke-Cammin J, Groene O, Guanais F, Rochfort A, Valderas JM, Klazinga N. Engaging primary care professionals in OECD's international PaRIS survey: a documentary analysis. Health Res Policy Syst 2024; 22:76. [PMID: 38965544 PMCID: PMC11223287 DOI: 10.1186/s12961-024-01170-2] [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: 01/04/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024] Open
Abstract
Healthcare professionals have first-hand experience with patients in clinical practice and the dynamics in the healthcare system, which can be of great value in the design, implementation, data analysis and dissemination of research study results. Primary care professionals are particularly important as they provide first contact, accessible, coordinated, comprehensive and continuous people-focused care. However, in-depth examination of the engagement of health professionals in health system research and planning activities-how professionals are engaged and how this varies across national contexts- is limited, particularly in international initiatives. There is a need to identify gaps in the planning of engagement activities to inform the design and successful implementation of future international efforts to improve the responsiveness of health systems to the changing needs of patients and professionals. The aim of this study was to explore how primary care professionals were engaged in the design and implementation plans of an international health policy study led by the Organisation for Economic Co-operation and Development (OECD). The OECD's international PaRIS survey measures and disseminates information on patient-reported outcome and experience measures (PROMs and PREMs) of people living with chronic conditions who are managed in primary care. A documentary analysis of 17 written national implementation plans (country roadmaps) was conducted between January and June 2023. Two reviewers independently performed the screening and data abstraction and resolved disagreements by discussion. We reported the intended target primary care professionals, phase of the study, channel of engagement, level of engagement, and purpose of engagement. All 17 countries aimed to engage primary care professionals in the execution plans for the international PaRIS survey. While organisations of primary care professionals, particularly of family doctors, were the most commonly targeted group, variation was found in the timing of engagement activities during the different phases of the study and in the level of engagement, ranging from co-development (half of the countries co-developed the survey together with primary care professionals) to one-off consultations with whom. International guidance facilitated the participation of primary care professionals. Continuous collaborative efforts at the international and national levels can foster a culture of engagement with primary care organisations and individual professionals and enhance meaningful engagement of primary care professionals.
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Affiliation(s)
- Candan Kendir
- Directorate for Employment, Labour and Social Affairs, Organisation for Economic Co-Operation and Development (OECD), Paris, France.
- Department of Public and Occupational Health, Amsterdam University Medical Centres (UMC), Amsterdam, Netherlands.
| | - Michael van den Berg
- Directorate for Employment, Labour and Social Affairs, Organisation for Economic Co-Operation and Development (OECD), Paris, France
| | | | - Oliver Groene
- Research & Innovation, OptiMedis, Hamburg, Germany
- Faculty of Management, Economics and Society, University of Witten/Herdecke, Witten, Germany
| | - Frederico Guanais
- Directorate for Employment, Labour and Social Affairs, Organisation for Economic Co-Operation and Development (OECD), Paris, France
| | - Andree Rochfort
- Quality Improvement, Irish College of General Practitioners, Dublin, Ireland
- Department of General Practice and Forensic & Legal Medicine, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jose M Valderas
- Department of Family Medicine, National University Health System, Singapore, Singapore
- Centre for Research in Health Systems Performance (CRiHSP), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam University Medical Centres (UMC), Amsterdam, Netherlands
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Tatsioni A, Groenewegen P, Van Poel E, Vafeidou K, Assenova R, Hoffmann K, Schaubroeck E, Stark S, Tkachenko V, Willems S. Recruitment, data collection, participation rate, and representativeness of the international cross-sectional PRICOV-19 study across 38 countries. BMC PRIMARY CARE 2024; 24:290. [PMID: 38937675 PMCID: PMC11212222 DOI: 10.1186/s12875-024-02438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Recruitment for surveys has been a great challenge, especially in general practice. METHODS Here, we reported recruitment strategies, data collection, participation rates (PR) and representativeness of the PRICOV-19 study, an international comparative, cross-sectional, online survey among general practices (GP practices) in 37 European countries and Israel. RESULTS Nine (24%) countries reported a published invitation; 19 (50%) had direct contact with all GPs/GP practices; 19 (50%) contacted a sample of GPs /GP practices; and 7 (18%) used another invitation strategy. The median participation rate was 22% (IQR = 10%, 28%). Multiple invitation strategies (P-value 0.93) and multiple strategies to increase PR (P-value 0.64) were not correlated with the PR. GP practices in (semi-) rural areas, GP practices serving more than 10,000 patients, and group practices were over-represented (P-value < 0.001). There was no significant correlation between the PR and strength of the primary care (PC) system [Spearman's r 0.13, 95% CI (-0.24, 0.46); P-value 0.49]; the COVID-19 morbidity [Spearman's r 0.19, 95% CI (-0.14, 0.49); P-value 0.24], or COVID-19 mortality [Spearman's r 0.19, 95% CI (-0.02, 0.58); P-value 0.06] during the three months before country-specific study commencement. CONCLUSION Our main contribution here was to describe the survey recruitment and representativeness of PRICOV-19, an important and novel study.
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Affiliation(s)
- Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece.
| | - Peter Groenewegen
- Netherlands Institute for Health Services Research (Nivel), 3500 BN, Utrecht, The Netherlands
- Department of Sociology, Utrecht University, 3584 CS, Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, 3584 CS, Utrecht, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Kyriaki Vafeidou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Radost Assenova
- Department of Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Kathryn Hoffmann
- Unit Health Services Research and Telemedicine in Primary Care, Medical University of Vienna, Vienna, Austria
| | - Emmily Schaubroeck
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054, Erlangen-Nuremberg, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054, Erlangen-Nuremberg, Germany
| | - Victoria Tkachenko
- Department of Family Medicine, Shupyk National Healthcare University of Ukraine, Kiev, Ukraine
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
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Garzón-Orjuela N, Collins C, Willems S, Van Poel E, Vellinga A. Patient safety incidents in Irish general practice during the COVID-19 pandemic: an exploratory practice level analysis. BMC PRIMARY CARE 2024; 24:288. [PMID: 38811900 PMCID: PMC11137878 DOI: 10.1186/s12875-024-02439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Patient safety is defined as the prevention of harm to patients and aims to prevent errors. This analysis explores factors associated with the reported occurrence of patient safety incidents (PSIs) in general practices in Ireland at the start of the COVID-19 pandemic. METHODS The PRICOV-19 was a cross-sectional study to record the (re)organisation of care provided in general practice and changes implemented during the COVID-19 pandemic in 38 countries. Primary outcomes include three potential scenarios of PSIs: delayed care due to practice factors, delayed care due to patient factors, and delayed care due to triage. Exploratory variables included demographic and organisational characteristics, triage, collaboration, and strategies to safeguard staff members' well-being. RESULTS Of the 172 participating Irish general practices, 71% (n = 122) recorded at least one potential PSI. The most frequent incident was delayed care due to patient factors (65%), followed by practice (33%) and triage (30%). Multivariate analysis showed that delayed care due to patient factors was associated with changes in the process of repeat prescriptions (OR 6.7 [CI 95% 2.5 to 19.6]). Delayed care due to practice factors was associated with suburbs/small towns (OR 4.2 [1.1 to 19.8]) and structural changes to the reception (OR 3.5 [1.2 to 11.4]). While delayed care due to patient factors was associated with having a practice population of 6000-7999 patients (OR 4.7 [1.1 to 27.6]) and delayed care due to practice factors was associated with having a practice population of 2000-3999 patients (OR 4.2 [1.2 to 17.1]). No linear associations were observed with higher or lower patient numbers for any factor. Delayed care due to triage was not associated with any exploratory variables. CONCLUSION The COVID-19 pandemic resulted in dramatic changes in the delivery of care through general practices in Ireland. Few factors were associated with the reported occurrence of PSIs, and these did not show consistent patterns. Sustained improvements were made in relation to repeat prescriptions. The lack of consistent patterns, potentially confirms that the autonomous decisions made in general practice in response to the challenges of the COVID-19 pandemic could have benefitted patient safety (See Graphical abstract).
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Affiliation(s)
- Nathaly Garzón-Orjuela
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- CARA Network, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Claire Collins
- Irish College of General Practitioners, Dublin, Ireland.
- Department of Public Health and Primary Care, Ghent University, Ghent, 9000, Belgium.
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, 9000, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, 9000, Belgium
| | - Akke Vellinga
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- CARA Network, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Kuhlmann E, Falkenbach M, Brînzac MG, Correia T, Panagioti M, Ungureanu MI. The mental health needs of healthcare workers: When evidence does not guide policy. A comparative assessment of selected European countries. Int J Health Plann Manage 2024; 39:614-636. [PMID: 38193752 DOI: 10.1002/hpm.3752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The healthcare workforce (HCWF) globally is facing high stress levels and deteriorating mental health due to workplace, labour market and policy deficiencies that further exacerbate the existing crisis. However, comprehensive and effective action is missing. AIMS We adopt a health system and governance perspective to address the mental health needs of healthcare workers (HCWs), considering the nature of interventions and the levels and actors involved in governance. The aim is to move the debate forward by identifying governance gaps hampering the implementation of health workforce policies and exploring strategies to effectively increase mental health support. MATERIAL AND METHODS A qualitative comparative methodology is applied based on a case study design utilising a multi-level intersectoral governance matrix. We conducted a rapid assessment of HCWF developments in the European context (Germany, Portugal, Romania, Switzerland and the United Kingdom), drawing on secondary sources and country experts. RESULTS AND DISCUSSION Awareness of mental health threats among HCWs increased, but policy discourse is driven by service delivery and labour market demands. The attention to HCWs' needs is stronger on the international level and weakest at national/regional levels. Although organisations and professions demonstrate varying degrees of activity, their efforts are scattered and lack sustainability. Similar challenges were identified across healthcare systems, including limited action, disconnected actors, missing coordination, and a lack of attention to governance gaps and system weaknesses. CONCLUSION Adopting a health system approach is important but not sufficient. Successful mental health policy implementation needs multi-level governance and coherent coordination mechanisms.
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Affiliation(s)
- Ellen Kuhlmann
- Institute for Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Michelle Falkenbach
- European Observatory on Health Systems and Policies, Brussels, Belgium
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Monica-Georgiana Brînzac
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Faculty of Political, Administrative and Communication Sciences, Center for Health Workforce Research and Policy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Tiago Correia
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Marius-Ionut Ungureanu
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Faculty of Political, Administrative and Communication Sciences, Center for Health Workforce Research and Policy, Babeș-Bolyai University, Cluj-Napoca, Romania
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Kirkove D, Willems S, Van Poel E, Dardenne N, Donneau AF, Perrin E, Ponsar C, Mallen C, Stylianou N, Collins C, Gagnayre R, Pétré B. Characteristics of primary care practices associated with patient education during COVID-19: results of the cross-sectional PRICOV-19 study in 38 countries. BMC PRIMARY CARE 2024; 24:285. [PMID: 38637765 PMCID: PMC11027213 DOI: 10.1186/s12875-024-02348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND In response to the COVID-19 pandemic, the World Health Organization established a number of key recommendations such as educational activities especially within primary care practices (PCPs) which are a key component of this strategy. This paper aims to examine the educational activities of PCPs during COVID-19 pandemic and to identify the factors associated with these practices across 38 countries. METHODS A "Patient Education (PE)" score was created based on responses to six items from the self-reported questionnaire among PCPs (n = 3638) compiled by the PRICOV-19 study. Statistical analyses were performed on 3638 cases, with PCPs with missing PE score values were excluded. RESULTS The PE score features a mean of 2.55 (SD = 0.68) and a median of 2.50 (2.16 - 3.00), with a maximum of 4.00, and varies quite widely between countries. Among all PCPs characteristics, these factors significantly increase the PE score: the payment system type (with a capitation payment system or another system compared to the fee for service), the perception of average PCP with patients with chronic conditions and the perception of adequate governmental support. CONCLUSION The model presented in this article is still incomplete and requires further investigation to identify other configuration elements favorable to educational activities. However, the results already highlight certain levers that will enable the development of this educational approach appropriate to primary care.
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Affiliation(s)
- Delphine Kirkove
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium.
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Nadia Dardenne
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium
- Biostatistics and Research Method Center, University of Liege, Liege, Belgium
| | - Anne-Françoise Donneau
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium
- Biostatistics and Research Method Center, University of Liege, Liege, Belgium
| | - Elodie Perrin
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium
| | - Cécile Ponsar
- Institute of Health and Society, Louvain University, Louvain, Belgium
| | | | - Neophytos Stylianou
- International Institute for Compassionate Care, Nicosia, Cyprus
- NS Intelligence Solutions Ltd, Nicosia, Cyprus
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Centre, Irish College of General Practitioners, Dublin, D02XR68, Ireland
| | - Rémi Gagnayre
- Education and Health Practices Laboratory (LEPS), (UR 3412), UFR SMBH, Sorbonne Paris-Nord University, Bobigny, France
| | - Benoit Pétré
- Department of Public Health Sciences, University of Liege, B23 / Avenue Hippocrate, n°13, 4000, Liège, Belgium
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Cholewa J, Ponsar C, de Rouffignac S, Pétré B, Van Poel E, Willems S, De Jonghe M. General practitioners' well-being in Belgium: results from the cross-sectional PRICOV-19 study. BMC PRIMARY CARE 2024; 24:284. [PMID: 38594628 PMCID: PMC11005122 DOI: 10.1186/s12875-024-02341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The mental health and well-being of GPs is a critical issue as they play a vital role in providing healthcare services to individuals and communities. Research has shown that GPs often face high levels of stress, burnout, and mental health problems due to their demanding work environment. During the COVID-19 pandemic, GPs faced additional challenges which further impacted their mental health and well-being. This study aims to investigate the impact of systemic work-related stressors on the level of well-being of GPs in Belgium during the pandemic, with a particular emphasis on identifying regional variations between Flanders, Wallonia, and Brussels-Capital. METHODS Data were collected with a self-reported online questionnaire from 479 GPs Belgian practices between December 2020 and August 2021 as part of the international PRICOV-19 study that explored the organization of general practices during COVID-19 in 38 countries to guarantee safe, effective, patient-centered, and equitable care. Well-being was evaluated by the Mayo Clinic's expanded 9-item well-being index. RESULTS The findings of this study reveal notable regional discrepancies in the degree of well-being experienced by Belgian GPs, with the Walloon region displaying the lowest level of well-being (37%) in a population highly susceptible to professional distress (57%). Among the key stressors contributing to such distress, financial difficulties among patients (p < 0.011), the fee-for-service payment system (p = 0.013), a lack of work-related purpose (p = 0.047), and inadequate work-life balance (p < 0.001) were identified as significant factors. When examining the influence of regional disparities, it was found that the sole significant interaction between work-related stressors and region regarding the probability of experiencing distress was related to the possibility of workload sharing among practice personnel. CONCLUSION The findings from this study underscore the imperative for more comprehensive research aimed at scrutinizing the differences in well-being across the three regions in Belgium and identifying the systemic factors that influence the practice environment, as opposed to exclusively concentrating on enhancing individual resilience.
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Affiliation(s)
- Joanna Cholewa
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
| | - Cecile Ponsar
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium.
| | - Ségolène de Rouffignac
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
| | - Benoit Pétré
- Department of Public Health Sciences, Liège University, Liège, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Michel De Jonghe
- Academic Center of General Medicine, Faculty of Medicine and Dentistry, UCLouvain, Brussels, Belgium
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Vanden Bossche D, Van Poel E, Vanden Bussche P, Petré B, Ponsar C, Decat P, Willems S. Outreach work in Belgian primary care practices during COVID-19: results from the cross-sectional PRICOV-19 study. BMC PRIMARY CARE 2024; 24:283. [PMID: 38570775 PMCID: PMC10988793 DOI: 10.1186/s12875-024-02323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND General practitioners (GPs) have a vital role in reaching out to vulnerable populations during and after the COVID-19 pandemic. Nonetheless, they experience many challenges to fulfill this role. This study aimed to examine associations between practice characteristics, patient population characteristics and the extent of deprivation of practice area on the one hand, and the level of outreach work performed by primary care practices (PCPs) during the COVID-19 pandemic on the other hand. METHODS Belgian data from the international PRICOV-19 study were analyzed. Data were collected between December 2020 and August 2021 using an online survey in PCPs. Practices were recruited through randomized and convenience sampling. Descriptive statistics and ordinal logistic regression analyses were performed. Four survey questions related to outreach work constitute the outcome variable. The adjusted models included four practice characteristics (practice type, being a teaching practice for GP trainees; the presence of a nurse or a nurse assistant and the presence of a social worker or health promotor), two patient population characteristics (social vulnerability and medical complexity) and an area deprivation index. RESULTS Data from 462 respondents were included. First, the factors significantly associated with outreach work in PCPs are the type of PCP (with GPs working in a group performing more outreach work), and the presence of a nurse (assistant), social worker or health promotor. Second, the extent of outreach work done by a PCP is significantly associated with the social vulnerability of the practice's patient population. This social vulnerability factor, affecting outreach work, differed with the level of medical complexity of the practice's patient population and with the level of deprivation of the municipality where the practice is situated. CONCLUSIONS In this study, outreach work in PCPs during the COVID-19 pandemic is facilitated by the group-type cooperation of GPs and by the support of at least one staff member of the disciplines of nursing, social work, or health promotion. These findings suggest that improving the effectiveness of outreach efforts in PCPs requires addressing organizational factors at the practice level. This applies in particular to PCPs having a more socially vulnerable patient population.
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Affiliation(s)
- Dorien Vanden Bossche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium.
| | - Esther Van Poel
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Pierre Vanden Bussche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Benoit Petré
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Cécile Ponsar
- Academic Center of Medicine, Institute of Health and Society, UCLouvain, Brussels, Belgium
| | - Peter Decat
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Van Poel E, Vanden Bussche P, Pétré B, Ponsar C, Collins C, De Jonghe M, Donneau AF, Gillain N, Guillaume M, Willems S. Quality of care in Belgian general practices during the COVID-19 pandemic: results of the cross-sectional PRICOV-19 study. BMC PRIMARY CARE 2024; 24:282. [PMID: 38443780 PMCID: PMC10916333 DOI: 10.1186/s12875-024-02305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
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.
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Affiliation(s)
- Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Pierre Vanden Bussche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Benoît Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Cécile Ponsar
- Institute of Health and Society, University of Louvain, Louvain, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Centre, Irish College of General Practitioners, Dublin, D02 XR68, Ireland
| | - Michel De Jonghe
- Centre Académique de Médecine Générale, Université Catholique de Louvain, Brussels, Belgium
| | | | - Nicolas Gillain
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Michèle Guillaume
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Bentulila Y, Lev Shalem L, Cohen B, Adler L. Physical work environment and burnout among primary care physicians in Israel: a cross-sectional study. BMC PRIMARY CARE 2024; 25:74. [PMID: 38418978 PMCID: PMC10900697 DOI: 10.1186/s12875-024-02310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Physician burnout remains a prevalent issue globally, negatively affecting work satisfaction and patient care. However, exploration of the physical work environments of physicians, a potential influencing factor for burnout, remains scarce. The physical work environment is everything that surrounds the physician, including the doctor's office, the clinic, the clinic's building, the waiting, and staff rooms. The aims of this study were to describe aspects of the physical work environment of primary care physicians (PCPs) and to explore the association between the physical work environment and burnout. METHODS In this cross-sectional study, we emailed questionnaires to an online community of PCPs in Israel in October 2021. We asked physicians about their satisfaction with their physical work environment, evaluated elements of the work environment, and assessed burnout status (with the Shirom-Melamed Burnout Measure, SMBM). We used the Chi-square and Mann-Witney tests to compare categorical and continuous variables and used logistic regression for the final model. RESULTS Two hundred twenty-one PCPs answered the questionnaire (27.6% response rate). Over a third (35.7%) of respondents reported high burnout. PCPs who were satisfied with their general physical environment had lower burnout rates than those who were unsatisfied (28.1% vs. 47.8%, p-value < 0.001). We found positive correlations between general satisfaction with the physical work environment and the scores achieved for the doctor's office, the clinic, the clinic's building, and the waiting room. In the multivariate analysis, high satisfaction with the general physical work environment was associated with decreased odds for burnout (OR-0.50, 95% CI 0.25-0.99, p-value-0.048). CONCLUSION The doctor's office, the clinic, the clinic's building, and the waiting room affected general satisfaction from the physical work environment. High satisfaction with the physical work environment reduced burnout rates. Future studies are needed to determine whether PCPs and managers should invest in the physical work environment to decrease burnout and increase satisfaction.
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Affiliation(s)
- Yaara Bentulila
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Liat Lev Shalem
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Bar Cohen
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Limor Adler
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel.
- Faculty of Medicine, Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel.
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Månsson Sandberg H, Landstad BJ, Tjulin Å, Brulin E. COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study. BMC PRIMARY CARE 2023; 24:269. [PMID: 38087223 PMCID: PMC10717449 DOI: 10.1186/s12875-023-02228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors. METHODS Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors. RESULTS The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion. CONCLUSIONS COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.
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Affiliation(s)
- Helena Månsson Sandberg
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Bodil J Landstad
- Faculty of Human Sciences, Mid Sweden University, Östersund, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | - Åsa Tjulin
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Emma Brulin
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
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Eide TB, van Poel E, Willems S, Jacobsen FF. Changes in work tasks and organization of general practice in Norway during the COVID-19 pandemic: results from a comparative international study. BMC PRIMARY CARE 2023; 24:227. [PMID: 37898780 PMCID: PMC10613352 DOI: 10.1186/s12875-023-02146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/30/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to huge and rapid changes in general practice in Norway as in the rest of Europe. This paper aims to explore to what extent the COVID-19 pandemic changed the work tasks and organization of Norwegian general practice. MATERIAL AND METHOD We analysed data from the Norwegian part of the international, cross-sectional PRICOV-19 study, collecting data from general practice via an online self-reported questionnaire. We included 130 Norwegian general practices, representing an estimated 520 Norwegian general practitioners (GPs). All Norwegian GPs were invited to participate. In the analyses, we focused on items related to the use of alternatives to face-to-face consultations, changes in the workload, tasks and delegated responsibilities of both the GPs and other personnel in the GP offices, adaptations in routines related to hygiene measures, triage of patients, and how the official rules and recommendations affected the practices. RESULTS There was a large and significant increase in the use of all forms of alternative consultation forms (digital text-based, video- and telephone consultations). The use of several different infection prevention measures were significantly increased, and the provision of hand sanitizer to patients increased from 29.6% pre-pandemic to 95.1% since the pandemic. More than half of the GPs (59.5%) reported that their responsibilities in the practice had increased, and 41% were happy with the task shift. 27% felt that they received adequate support from the government; however, 20% reported that guidelines from the government posed a threat to the well-being of the practice staff. We found no associations with the rurality of the practice location or size of the municipalities. CONCLUSION Norwegian GPs adapted well to the need for increased use of alternatives to face-to-face consultations, and reported a high acceptance of their increased responsibilities. However, only one in four received adequate support from the government, which is an important learning point for similar situations in the future.
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Affiliation(s)
- Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Esther van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Frode F Jacobsen
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway.
- VID Specialized University, Bergen, Norway.
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Delvento G, Curteanu A, Rotaru C, Van Poel E, Willems S, Prytherch H, Curocichin G. The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova - results from the PRICOV-19 survey. BMC PRIMARY CARE 2023; 24:221. [PMID: 37880576 PMCID: PMC10598887 DOI: 10.1186/s12875-023-02116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had an enormous impact on health systems in Europe and has generated unprecedented challenges for tertiary care. Less is known about the effects on the activities of local family doctors (FDs), who have shifted tasks and adapted their practice to accommodate the new services brought by the pandemic. The PRICOV-19 study was a multi-country survey aiming to understand the challenges posed by the pandemic in primary health care (PHC) practices around Europe. Within the framework of this study, we assessed the impact of the pandemic on PHC facilities in urban, rural, and mixed urban/rural areas in the Republic of Moldova. METHODS We present the results from the PRICOV-19 questionnaire designed at Ghent University (Belgium) and distributed between January and March 2021 to PHC facilities from the 35 districts of the Republic of Moldova. This analysis presents descriptive data on limitations to service delivery, staff role changes, implementation and acceptance of COVID-19 guidelines, and incidents reported on staff and patient safety during the pandemic. RESULTS Results highlighted the differences between facilities located in urban, rural, and mixed areas in several dimensions of PHC. Nearly half of the surveyed facilities experienced limitations in the building or infrastructure when delivering services during the pandemic. 95% of respondents reported an increase in time spent giving information to patients by phone, and 88% reported an increase in responsibilities. Few practices reported errors in clinical assessments, though a slightly higher number of incidents were reported in urban areas. Half of the respondents reported difficulties delivering routine care to patients with chronic conditions and a delay in treatment-seeking. CONCLUSIONS During the pandemic, the workload of PHC staff saw a significant increase, and practices met important structural and organizational limitations. Consequently, these limitations may have also affected care delivery for vulnerable patients with chronic conditions. Adjustments and bottlenecks need to be addressed, considering the different needs of PHC facilities in urban, rural, and mixed areas.
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Affiliation(s)
- Giulia Delvento
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
| | - Ala Curteanu
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chișinău, Moldova
- Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Mother and Child Institute, Chișinău, Republic of Moldova
| | - Cristina Rotaru
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chișinău, Moldova
- Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Nicolae Testemitanu Medical University, Chișinău, Republic of Moldova
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
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Stark S, Schaubroeck E, Kluge M, Burggraf L, Roos M, Borowski E, Van Poel E, Willems S, Kühlein T, Hueber S, Werner F. "The measures taken by the government overburdened the daily practice" - insights of the PRICOV-19 study on German general practitioners in times of COVID-19. BMC PRIMARY CARE 2023; 24:207. [PMID: 37821802 PMCID: PMC10568746 DOI: 10.1186/s12875-023-02115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/18/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures? METHODS This study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models. RESULTS The response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures. CONCLUSION GPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans.
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Affiliation(s)
- Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marie Kluge
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Larissa Burggraf
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department for Sociology, University of Education, Schwäbisch Gmünd, Germany
| | - Marco Roos
- General Practice, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Eve Borowski
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susann Hueber
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Felix Werner
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Plaiasu MC, Alexandru DO, Nanu CA. Patients' rights in physicians' practice during Covid-19 pandemic: a cross-sectional study in Romania. BMC Med Ethics 2023; 24:54. [PMID: 37496036 PMCID: PMC10373321 DOI: 10.1186/s12910-023-00935-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Although the Covid-19 epidemic challenged existing medical care norms and practices, it was no excuse for unlawful conduct. On the contrary, legal compliance proved essential in fighting the pandemic. Within the European legal framework for the pandemic, patients were still entitled to be treated equally, by a specialized physician, with the possibility of seeking a second medical opinion, in a confidential setting, following prior and informed consent. This study examines physicians' practices regarding patients' rights during the Covid-19 pandemic and the effects of age, experience, and specialty on physicians' behavior and preferences. Additionally, it explores the nexus of malpractice complaints, malpractice fear, and legal compliance. METHODS A cross-sectional study was conducted on a convenience sample of attending physicians and general practitioners to assess compliance with patients' rights regulations. Respondents were physicians practicing in private and public settings in Southwestern Romania from July 2021 to May 2022. RESULTS 396 attending physicians and 109 general practitioners participated in the research. Attending physicians acknowledged patients' rights in 55.7% of statements, while general practitioners showed a slightly higher level of compliance at 59.9%. Emergency and Anesthesia and Intensive Care physicians showed the lowest compliance. There were no significant behavioral differences based on physicians' age, years in practice, work sector, or location. However, when faced with the question of prioritizing treatment for patients with similar medical conditions, 46.2% of attending physicians reported favoring the younger patients. This preference was common among physicians under 39. Additionally, over half of the attending physicians reported working outside their area of expertise due to staff shortages. Malpractice fear was high among physicians, although unrelated to patients' claims, legal compliance, or working outside the scope of practice. It resulted in pressure and behavioral changes. CONCLUSION Adherence to patients' rights was low during the Covid-19 pandemic. Physicians could benefit from educational and administrative support to ensure better legal compliance. Further research is needed to determine if this behavior persists beyond the pandemic context.
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Affiliation(s)
- Maria Cristina Plaiasu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St, Craiova, 200349, Romania.
| | - Dragos Ovidiu Alexandru
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St, Craiova, 200349, Romania
| | - Codrut Andrei Nanu
- Department no. 14 of Orthopedics, Anesthesia and Intensive Care, University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu St., Sector 2, Bucharest, 020021, Romania
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Kugai S, Wild D, Krumpholtz Y, Schmidt M, Balzer K, Mayerböck A, Weltermann B. German GPs' Self-Perceived Role in the COVID-19 Pandemic: Leadership, Participation in Regional Services and Preferences for Future Pandemic Preparedness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6088. [PMID: 37372676 DOI: 10.3390/ijerph20126088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/21/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
General practitioners (GPs) played a vital role during the COVID-19 pandemic. Little is known about GPs' view of their role, leadership, participation in regional services and preferences for future pandemic preparedness. This representative study of German GPs comprised a web-based survey and computer-assisted telephone interviewing (CATI). It addressed GPs' satisfaction with their role, self-perceived leadership (validated C-LEAD scale), participation in newly established health services, and preferences for future pandemic preparedness (net promotor score; NPS; range -100 to +100%). Statistical analyses were conducted using Spearman's correlation and Kruskal-Wallis tests. In total, 630 GPs completed the questionnaire and 102 GPs the CATI. In addition to their practice duties, most GPs (72.5%) participated in at least one regional health service, mainly vaccination centres/teams (52.7%). Self-perceived leadership was high with a C-LEAD score of 47.4 (max. 63; SD ± 8.5). Overall, 58.8% were not satisfied with their role which correlated with the feeling of being left alone (r = -0.349, p < 0.001). 77.5 % of respondents believed that political leaders underestimated GPs' potential contribution to pandemic control. Regarding regional pandemic services, GPs preferred COVID-19 focus practices (NPS +43.7) over diagnostic centres (NPS -31). Many GPs, though highly engaged regionally, were dissatisfied with their role but had clear preferences for future regional services. Future pandemic planning should integrate GPs' perspectives.
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Affiliation(s)
- Simon Kugai
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Dorothea Wild
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Yelda Krumpholtz
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Manuela Schmidt
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Katrin Balzer
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Astrid Mayerböck
- uzbonn, Survey Center Bonn-Center for Empirical Social Research and Evaluation, Oxfordstraße 15, 53111 Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Döpfmer S, Kuschick D, Toutaoui K, Riens B, Dierks M, Wolf F, Rost L, Krause M, Schulze D, Heintze C, Kümpel L. [Medical care in GP practices during the Covid-19 pandemic: A questionnaire-based survey among general practitioners and medical practice assistants asking for their opinion about changes, needs and burdens]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023:S1865-9217(23)00040-5. [PMID: 37169707 PMCID: PMC10168534 DOI: 10.1016/j.zefq.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/20/2023] [Accepted: 03/14/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION The coronavirus pandemic did not only result in changes in the provision and utilization of health care services in general practice but also in an increased workload for physicians and medical practice assistants. The VeCo practice study retrospectively explores the experiences of both professional groups two years after the start of the pandemic. METHODS In March and April 2022, general practitioners and medical practice assistants in the three German federal states of Berlin, Brandenburg and Thuringia were asked to complete a paper-based questionnaire. RESULTS 657 general practitioners and 762 medical practice assistants completed the questionnaire. Both professional groups agreed to statements indicating a reduction in regular health care provisions. Nevertheless, 74% of the physicians and 82.9% of the medical practice assistants considered the health care provided to their patients during the pandemic as good. This was only possible through considerable additional effort and stress. While more than half of both groups reported that work was still enjoyable, three quarters of both groups stated that the challenges arising from the pandemic outstripped their capacity. Both groups would like to receive more recognition from society (medical practice assistants 93.2%, general practitioners 85.3%) and from their patients (87.7% and 69.9%, respectively). DISCUSSION General practitioners and medical practice assistants reduced regular health care provision but were still able to maintain a good quality of care for their patients during the pandemic. It became clear that more appreciation and adequate financial compensation are necessary to ensure long-term sustainability of GP care. CONCLUSION The subjective view of general practitioners and medical practice assistants on their health care provision shows that appreciation and adequate financial renumeration, particularly when working under most difficult conditions, are necessary to increase the attractiveness of a career in general practice, for both physicians and medical practice assistants.
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Affiliation(s)
- Susanne Döpfmer
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - Doreen Kuschick
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kahina Toutaoui
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Burgi Riens
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Marius Dierks
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Florian Wolf
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Liliana Rost
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Markus Krause
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Daniel Schulze
- Institut für Biometrie und Klinische Epidemiologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Heintze
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Lisa Kümpel
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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18
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Ladwig KH, Johar H, Miller I, Atasoy S, Goette A. Covid-19 pandemic induced traumatizing medical job contents and mental health distortions of physicians working in private practices and in hospitals. Sci Rep 2023; 13:5284. [PMID: 37002346 PMCID: PMC10064592 DOI: 10.1038/s41598-023-32412-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The Covid-19 pandemic during its early phases posed significant psychological threats particularly for medical frontline personal. It is unclear whether the medical workforce with the passage of time has adapted to these threats or have generalized to wider medical settings. An online survey was conducted reaching 1476 physicians in Germany with valid data from 1327 participants. Depression and anxiety were screened with the PHQ-2 and the GAD-2. Among a subtotal of 1139 (86.6%) physicians reporting personal treatment experiences with Covid-19 patients, 553 (84.8%) worked in a private practice (PP) and 586 (88.3%) in a hospital (HP). Covid-19 provoked profound conflicts between professional and ethical values: more physicians in PPs than HPs reported external constraints on their medical care being in conflict with the code of medical ethics (39.1 vs. 34.4%, p < 0.002) and significantly more HPs failed to maintain the dignity of their patients during the pandemic (48 vs. 27%, p < 0.0001). Comparison with reference groups among physicians with comparable size and settings during the first wave of Covid-19 revealed a significant increase in the prevalence of depression (23.0%) and anxiety (24.16%). Feelings of helplessness (63.3% in HPs and 53.4% in PPs) were associated with female sex, minor years of medical experience, sleeping problems and being encountered to unsettling events. Exposure to unsettling events and helplessness was significantly mediated by sleep disturbances (ß = 0.29, SE = 0.03, p < 0.0001). Covid-19 induced stress job content issues have broadened to medical disciplines beyond frontline workers. Emotional perturbations among physicians have attained a critical magnitude.
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Affiliation(s)
- Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partnersite Munich Heart Alliance, Munich, Germany
| | - Hamimatunnisa Johar
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia
| | - Inna Miller
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partnersite Munich Heart Alliance, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Gießen, Germany
| | - Andreas Goette
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.
- St. Vincenz-Krankenhaus GmbH, Medizinische Klinik II, Am Busdorf 2, 33098, Paderborn, Germany.
- MAESTRIA Consortium AFNET e.V., Münster, Germany.
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19
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Fomenko E, Keygnaert I, Van Poel E, Collins C, Gómez Bravo R, Korhonen P, Laine MK, Murauskiene L, Tatsioni A, Willems S. Screening for and Disclosure of Domestic Violence during the COVID-19 Pandemic: Results of the PRICOV-19 Cross-Sectional Study in 33 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3519. [PMID: 36834213 PMCID: PMC9964689 DOI: 10.3390/ijerph20043519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic left no one untouched, and reports of domestic violence (DV) increased during the crisis. DV victims rarely seek professional help, yet when they do so, they often disclose it to their general practitioner (GP), with whom they have a trusting relationship. GPs rarely screen and hence rarely take the initiative to discuss DV with patients, although victims indicate that offering this opportunity would facilitate their disclosure. This paper aims to describe the frequency of screening for DV by GPs and disclosure of DV by patients to the GP during the COVID-19 pandemic, and to identify key elements that could potentially explain differences in screening for and disclosure of DV. The PRICOV-19 data of 4295 GP practices from 33 countries were included in the analyses, with practices nested in countries. Two stepwise forward clustered ordinal logistic regressions were performed. Only 11% of the GPs reported (much) more disclosure of DV by patients during COVID-19, and 12% reported having screened for DV (much). Most significant associations with screening for and disclosure of DV concerned general (pro)active communication. However, (pro)active communication was performed less frequently for DV than for health conditions, which might indicate that GPs are insufficiently aware of the general magnitude of DV and its impact on patients and society, and its approach/management. Thus, professional education and training for GPs about DV seems highly and urgently needed.
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Affiliation(s)
- Elizaveta Fomenko
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Ines Keygnaert
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Raquel Gómez Bravo
- Centre Hospitalier Neuropsychiatrique, Rehaklinik, L-9002 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, University of Luxembourg, L-4366 Esch-sur-Alzette, Luxembourg
| | - Päivi Korhonen
- Department of General Practice, University of Turku and Turku University Hospital, 20521 Turku, Finland
| | - Merja K. Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
- Folkhälsan Research Center, 00280 Helsinki, Finland
| | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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20
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Rao X, Luo L, Su Q, Wang X. Did the general practice residents well adapt to real public health prevention --a study from the COVID-19 prevention training in China. BMC MEDICAL EDUCATION 2022; 22:831. [PMID: 36456960 PMCID: PMC9713135 DOI: 10.1186/s12909-022-03882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
Abstract
OBJECT GP residents's has the obligation to take task with the public health prevetion. GP residents receive the public health training during their college study period and the residents training. The sudden outbreak of the COVID-19 epidemic, highlight the importance and competence of the community prevention as the front line of epidemic prevention and control, pushing the general practitioner (GP) residents into the front team of epidemic prevention and control. Residents' participation in epidemic prevention and control is not only a field workload participation in public health disease prevention and control, but also a rare and value-oriented training experience. This study aims to explores the research on the training content, ability improvement and cognitive load of the resident, and to demonstrate past and future training effects of epidemic prevention and control. METHODS Object cognitive load scale (NASA-TLX scale) and self-developed questionnaires were adopted to conduct a questionnaire survey on resident doctors who were in GP training program from West China Hospital of Sichuan University, and finally 190 questionnaires were collected. SPSS 23.0 statistical software for statistical analysis of data. RESULT Most indicators of cognitive load NASA scale are at a "moderate" level by the GP residents, generally indicating that the intensity of on-site epidemic prevention and control (training) can be tolerated. The chi-square test is used to study the status of "How responsible you are for epidemic prevention and control in a community in the future", the residents grade shows no significant difference while " how many months after the outbreak when you participated in the epidemic prevention" shows significant difference, the result show that GP residents already have konwledge and skills for the public health prevetion, they need more attitude and mental preparation. Continuing education will have a significant positive relationship with the GP residents's confidence of the prevetion ofpublic health prevetion. CONCLUSION Former medical school education and training at the regulatory training stage have a good effect for residents to master the ability of epidemic prevention and control, and to prepare for the needs of epidemic prevention and control physically and mentally. After this stage, the epidemic prevention and control training under the real situation will make a great contribution to the self-assessment and performance improvement of the final general practitioners.
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Affiliation(s)
- Xin Rao
- Department of General Practice, General Practice Center, West China Hospital of Sichuan University, Chengdu, China
- Institute of Hospital Management, West China Hospital, SCU, Chengdu, China
| | - Li Luo
- Sichuan University, China, Chengdu, China
| | - Qiaoli Su
- Department of General Practice, General Practice Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xingyue Wang
- Department of Graduate Medical Education, West China Hospital of Sichuan University, China, Chengdu, China
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21
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Groenewegen P, Van Poel E, Spreeuwenberg P, Batenburg R, Mallen C, Murauskiene L, Peris A, Pétré B, Schaubroeck E, Stark S, Sigurdsson EL, Tatsioni A, Vafeidou K, Willems S. Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15329. [PMID: 36430047 PMCID: PMC9690243 DOI: 10.3390/ijerph192215329] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed.
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Affiliation(s)
- Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Utrecht University, 3584 CS Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Radboud University, 6535 XN Nijmegen, The Netherlands
| | | | - Liubove Murauskiene
- Department of Public Health, Faculty of Medicine, University of Vilnius, 03101 Vilnius, Lithuania
| | - Antoni Peris
- Castelldefels Agents de Salut (Casap), 08860 Castelldefels, Spain
| | - Benoit Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, 4000 Liège, Belgium
| | - Emmily Schaubroeck
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Emil L. Sigurdsson
- Department of family medicine, University of Iceland, 102 Reykjavík, Iceland
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Kyriaki Vafeidou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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