Patient experiences during the COVID-19 pandemic:A qualitative study in Dutch primary care

Background Changes in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positively and negatively. Aim To assess the experiences of patients in primary care during the COVID-19 pandemic. Design & setting A qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands. Method A qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach. Results Twenty-eight patients were interviewed (13 men and 15 women, aged 27–91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, seeing unfamiliar doctors, and care being segregated. Conclusion Despite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics, but also when implementing permanent changes to care provision in primary care

Comparison of methods to identify and characterize Post-COVID syndrome using electronic health records and questionnaires

Background: Some of those infected with coronavirus suffer from post-COVID syndrome (PCS). However, an uniform definition of PCS is lacking, causing uncertainty about the prevalence and nature of this syndrome. We aim to improve understanding by operationalizing different definitions of PCS in different data sources and describing features and clinical subtypes.Methods: We use different methods and data sources. First, a cohort with electronic health records (EHR) from general practices (GPs) and GP out-of-hours-services combined with sociodemographic data for n≈1.000.000 individuals. Second, questionnaires among n=276 individuals who had been infected with coronavirus. Using both data sources, we operationalized definitions of PCS to calculate frequency and characteristics. In a subgroup of the EHR data we conducted community detection analyses to explore possible clinical subtypes of PCS.Results: The frequency of PCS ranged from 15-33%, depending on the method and data source. Across all methods and definitions, the mean age of individuals with PCS was around 53 years and they were more often female. There were small sex differences in the type of symptoms and overall symptoms were persistent for 6 months. Exploratory network analysis revealed three possible clinical subtypes.Discussion: We showed that frequency rates of post-COVID syndrome differ between methods and data sources, but characteristics of the affected individuals are quite stable. Overall, PCS is a heterogeneous syndrome affecting a significant group of individuals who need adequate care. Future studies should focus on care trajectories and qualitative measures such as experiences and quality of life of individuals living with PCS

What can we learn from experiences in general practice during the COVID-19 pandemic?:A qualitative study

Background: Experiences with organizational changes in daytime general practices and out-of-hours (OOH) services during the COVID-19 pandemic may help to address the challenges in general practice care that were already a concern before the crisis. This study aimed to describe these experiences and the potential usefulness of the organizational changes for future general practice care and any future pandemics.Methods: Semi-structured interviews were performed among 11 directors of OOH services, and 19 (locum) general practitioners (GPs) or practice managers, who were purposively sampled. Video or telephone interviews were performed in two rounds: between November 2020 and January 2021 and between May 2021 and August 2021. The data were analyzed using thematic analysis methods.Results: Three themes emerged from the data: (1) Changes in the triage procedures; in GP practices and OOH services, stricter triage criteria were implemented, and GPs were more actively involved in the triage process. These measures helped to reduce the number of ‘low urgency’ face-to-face consultations. (2) Changes in GP care; there was a shift towards video and telephone consultations, allowing GPs to spend more time with patients during the remaining face-to-face consultations. For chronic patients, the shift towards telemonitoring appeared to encourage self-care, and postponing face-to-face consultations for regular checkups appeared to be unproblematic for stable patients. (3) Coordination of GP care and information communication flow during the COVID-19 pandemic; OOH directors perceived a lack of consistency in the information from various governmental and non-governmental parties on containment measures and guidelines related to COVID-19, making it difficult to act on them. The COVID-19 pandemic intensified collaboration between GPs, OOH services, and other healthcare professionals.Conclusions: The results of this study indicate that some of the organizational changes, such as stricter triage, remote consultations, and changes in managed care of chronic patients, may help in tackling the pre-existing challenges in GP care from before the COVID-19 pandemic. However, more extensive research and continuous monitoring are necessary to establish the effects on patients and their health outcomes. To navigate future pandemics, the intensified collaboration between health professionals should be maintained, while there is considerable room for improvement in the provision of unambiguous information.</p