Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study

BACKGROUND During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics

Treatment and prevention of the common cold and flu – patients’ opinions

Cilj ovog istraživanja bio je istražiti kako opća populacija doživljava običnu prehladu i gripu te koje je iskustvo opće populacije s liječenjem i prevencijom tih bolesti s posebnim naglaskom na razloge koji utječu na stav prema cijepljenju. Namjerni uzorak ispitanika prikupljen je uz poštovanje uključnih kriterija, putem 6 liječnika opće/obiteljske medicine iz Doma zdravlja “Zagreb-Centar” odabranih prigodnim uzorkovanjem (3 s gradskog i 3 s prigradskog područja grada Zagreba). Podaci su prikupljeni polustrukturiranim individualnim intervjuima koji su snimani diktafonom te je potom učinjen transkript snimljenog materijala. Provedena su 24 polustrukturirana individualna intervjua. U svrhu analize i interpretacije podataka korištena je kvalitativna analiza sadržaja (engl. content analysis). Kvalitativnom analizom podataka dobiveno je sedam glavnih tema i objašnjenja perspektive ispitanika: percepcija obične prehlade; prevencija i liječenje obične prehlade; percepcija gripe; prevencija i liječenje gripe; usporedba obične prehlade i gripe. Većina ispitanika u ovom istraživanju pokazala je zadovoljavajuću razinu znanja o simptomima, trajanju, prijenosu i liječenju obične prehlade i gripe, opisala jasnu razliku te dvije bolesti, te navela adekvatne mjere prevencije obične prehlade. Nasuprot tome, većina ispitanika nije razlikovala uzroke obične prehlade i gripe te mjere prevencije gripe i obične prehlade. Ispitanici su cijepljenje protiv gripe smatrali potrebnim isključivo starijim i nepokretnim osobama, kroničnim bolesnicima i zdravstvenim djelatnicima. Ispitanici su naveli savjet liječnika kao ključni čimbenik u donošenju pozitivne odluke o cijepljenju protiv gripe, te je preporuka da, u cilju povećanja odaziva na sezonsko cijepljenje, liječnici opće/obiteljske medicine u svakodnevnom radu sa svojim pacijentima, primjenjujući konzultacije usmjerene osobi, procijene i, ukoliko je potrebno, modificiraju neadekvatne stavove o prevenciji gripe.The aim of this study was to explore lay people’s perception of common cold and influenza as well as their experience in treatment and prevention of those conditions, with emphasis on the reasons impacting their decision for or against influenza vaccination. 24 semi-structured, individual interviews were conducted, then transcribed and analysed to find emerging themes and sub-themes. Textual data were explored inductively using content analysis to generate categories and explanations. Seven major themes and explanatory models of lay people’s perspective emerged from the data: perception of the common cold, prevention and treatment of the common cold, perception of the influenza, prevention and treatment of the influenza, common cold versus influenza. Most participants emphasized the same preventative measures for both common cold and influenza, while considering influenza vaccination primarily as an option for chronic and old/bedridden patients. In shaping participants decisions for or against influenza vaccination, physician’s advice played a crucial role. Having that in mind, the recommendation would be for family physicians to elicit, assess and, if needed, modify inappropriate opinions towards vaccination daily, trough patient cantered consultations

Treatment and prevention of the common cold and flu – patients’ opinions

Cilj ovog istraživanja bio je istražiti kako opća populacija doživljava običnu prehladu i gripu te koje je iskustvo opće populacije s liječenjem i prevencijom tih bolesti s posebnim naglaskom na razloge koji utječu na stav prema cijepljenju. Namjerni uzorak ispitanika prikupljen je uz poštovanje uključnih kriterija, putem 6 liječnika opće/obiteljske medicine iz Doma zdravlja “Zagreb-Centar” odabranih prigodnim uzorkovanjem (3 s gradskog i 3 s prigradskog područja grada Zagreba). Podaci su prikupljeni polustrukturiranim individualnim intervjuima koji su snimani diktafonom te je potom učinjen transkript snimljenog materijala. Provedena su 24 polustrukturirana individualna intervjua. U svrhu analize i interpretacije podataka korištena je kvalitativna analiza sadržaja (engl. content analysis). Kvalitativnom analizom podataka dobiveno je sedam glavnih tema i objašnjenja perspektive ispitanika: percepcija obične prehlade; prevencija i liječenje obične prehlade; percepcija gripe; prevencija i liječenje gripe; usporedba obične prehlade i gripe. Većina ispitanika u ovom istraživanju pokazala je zadovoljavajuću razinu znanja o simptomima, trajanju, prijenosu i liječenju obične prehlade i gripe, opisala jasnu razliku te dvije bolesti, te navela adekvatne mjere prevencije obične prehlade. Nasuprot tome, većina ispitanika nije razlikovala uzroke obične prehlade i gripe te mjere prevencije gripe i obične prehlade. Ispitanici su cijepljenje protiv gripe smatrali potrebnim isključivo starijim i nepokretnim osobama, kroničnim bolesnicima i zdravstvenim djelatnicima. Ispitanici su naveli savjet liječnika kao ključni čimbenik u donošenju pozitivne odluke o cijepljenju protiv gripe, te je preporuka da, u cilju povećanja odaziva na sezonsko cijepljenje, liječnici opće/obiteljske medicine u svakodnevnom radu sa svojim pacijentima, primjenjujući konzultacije usmjerene osobi, procijene i, ukoliko je potrebno, modificiraju neadekvatne stavove o prevenciji gripe.The aim of this study was to explore lay people’s perception of common cold and influenza as well as their experience in treatment and prevention of those conditions, with emphasis on the reasons impacting their decision for or against influenza vaccination. 24 semi-structured, individual interviews were conducted, then transcribed and analysed to find emerging themes and sub-themes. Textual data were explored inductively using content analysis to generate categories and explanations. Seven major themes and explanatory models of lay people’s perspective emerged from the data: perception of the common cold, prevention and treatment of the common cold, perception of the influenza, prevention and treatment of the influenza, common cold versus influenza. Most participants emphasized the same preventative measures for both common cold and influenza, while considering influenza vaccination primarily as an option for chronic and old/bedridden patients. In shaping participants decisions for or against influenza vaccination, physician’s advice played a crucial role. Having that in mind, the recommendation would be for family physicians to elicit, assess and, if needed, modify inappropriate opinions towards vaccination daily, trough patient cantered consultations

Treatment and prevention of the common cold and flu – patients’ opinions

Cilj ovog istraživanja bio je istražiti kako opća populacija doživljava običnu prehladu i gripu te koje je iskustvo opće populacije s liječenjem i prevencijom tih bolesti s posebnim naglaskom na razloge koji utječu na stav prema cijepljenju. Namjerni uzorak ispitanika prikupljen je uz poštovanje uključnih kriterija, putem 6 liječnika opće/obiteljske medicine iz Doma zdravlja “Zagreb-Centar” odabranih prigodnim uzorkovanjem (3 s gradskog i 3 s prigradskog područja grada Zagreba). Podaci su prikupljeni polustrukturiranim individualnim intervjuima koji su snimani diktafonom te je potom učinjen transkript snimljenog materijala. Provedena su 24 polustrukturirana individualna intervjua. U svrhu analize i interpretacije podataka korištena je kvalitativna analiza sadržaja (engl. content analysis). Kvalitativnom analizom podataka dobiveno je sedam glavnih tema i objašnjenja perspektive ispitanika: percepcija obične prehlade; prevencija i liječenje obične prehlade; percepcija gripe; prevencija i liječenje gripe; usporedba obične prehlade i gripe. Većina ispitanika u ovom istraživanju pokazala je zadovoljavajuću razinu znanja o simptomima, trajanju, prijenosu i liječenju obične prehlade i gripe, opisala jasnu razliku te dvije bolesti, te navela adekvatne mjere prevencije obične prehlade. Nasuprot tome, većina ispitanika nije razlikovala uzroke obične prehlade i gripe te mjere prevencije gripe i obične prehlade. Ispitanici su cijepljenje protiv gripe smatrali potrebnim isključivo starijim i nepokretnim osobama, kroničnim bolesnicima i zdravstvenim djelatnicima. Ispitanici su naveli savjet liječnika kao ključni čimbenik u donošenju pozitivne odluke o cijepljenju protiv gripe, te je preporuka da, u cilju povećanja odaziva na sezonsko cijepljenje, liječnici opće/obiteljske medicine u svakodnevnom radu sa svojim pacijentima, primjenjujući konzultacije usmjerene osobi, procijene i, ukoliko je potrebno, modificiraju neadekvatne stavove o prevenciji gripe.The aim of this study was to explore lay people’s perception of common cold and influenza as well as their experience in treatment and prevention of those conditions, with emphasis on the reasons impacting their decision for or against influenza vaccination. 24 semi-structured, individual interviews were conducted, then transcribed and analysed to find emerging themes and sub-themes. Textual data were explored inductively using content analysis to generate categories and explanations. Seven major themes and explanatory models of lay people’s perspective emerged from the data: perception of the common cold, prevention and treatment of the common cold, perception of the influenza, prevention and treatment of the influenza, common cold versus influenza. Most participants emphasized the same preventative measures for both common cold and influenza, while considering influenza vaccination primarily as an option for chronic and old/bedridden patients. In shaping participants decisions for or against influenza vaccination, physician’s advice played a crucial role. Having that in mind, the recommendation would be for family physicians to elicit, assess and, if needed, modify inappropriate opinions towards vaccination daily, trough patient cantered consultations

Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study

BACKGROUND: Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES: To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS: Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS: COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION: In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics

The Use of COVID-19 Mobile Apps in Connecting Patients with Primary Healthcare in 30 Countries: Eurodata Study

Background: The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. Objective: To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. Methodology: Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. Main outcome measures: Patient’s first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. Results: Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania’s apps considered social needs. Conclusions: COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases

Exploring the accessibility of primary health care data in Europe's COVID-19 response: developing key indicators for managing future pandemics (Eurodata study)

Abstract Background Primary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: (1) Describe PHC’s clinical pathways for acute COVID-19 cases, including long-term care facilities, (2) Describe PHC COVID-19 pandemic indicators, (3) Develop COVID-19 PHC activity indicators, (4) Explain PHC’s role in vaccination strategies, and (5) Create a PHC contingency plan for future pandemics. Methods A mixed-method study will employ two online questionnaires to gather retrospective PHC data on COVID-19 management and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health (PH) experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and PH will be devised to address future pandemic scenarios. Analysis: Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving researchers from 28 European countries support the development. Discussion While PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC’s role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants’ involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments’ daily dashboards in Europe, often overlooked in media and public debates