The role of primary care during the pandemic: shared experiences from providers in five European countries

BACKGROUND: The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience. METHODS: The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care. RESULTS: Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues. CONCLUSION: Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic

Czynniki i motywacje wpływające na wybór ścieżki kariery w geriatrii we Francji: badanie poszukiwawcze

Wprowadzenie: Starzenie się społeczeństwa jest zjawiskiem na skalę światową. Opisywane jest ono często jako największe socjo-ekonomiczne wyzwanie 21. wieku (UNFPA,2012). Funkcjonujący we Francji system prowadzący do uzyskania specjalizacji geriatry prowadzi często do niejasności i zamieszania (Livreblanc de la geriatrie, 2011). Ostatnie badania wskazują na niespodziewanie rosnącą liczbę niepełnosprawności wśród generacji baby-boom w porównaniu z generacjami starszymi (Robine et al., 1999; Cambois, Blachier, Robine, 2005). W związku z tym powinno zostać rozwinięte zaplecze medycznych ekspertów (Johansson et al., 2010). Do tej pory we Francji nie prowadzono specjalnych badań w kierunku chęci studentów medycyny do podejmowania kariery w geriatrii i jedynie kilka badań zostało przeprowadzonych w kontekście Francji (Jeandel, 2011). Pytanie dotyczące tego kim są specjaliści medycyny geriatrycznej oraz czy ich liczba odpowiada zapotrzebowaniu pozostaje bez odpowiedzi (Franco, 2007). Celem tej pracy jest zidentyfikowanie czynników motywujących studentów medycyny do podejmowania specjalizacji w geriatrii i ich poziom świadomości dotyczących możliwości szkolenia w tym zakresie. Metoda: Jakościowe i ilościowe badanie przeprowadzone wśród wybranych grup. Ilościowe dane były zebrane poprzez międzysektorowe badanie zrealizowane w dwóch formach: poprzez kwestionariusz internetowy oraz bezpośredni przeprowadzony samodzielnie. W badaniu wzięło udział 55 studentów medycyny z różnych uniwersytetów. Jakościowe badanie polegało na pogłębionych wywiadach przeprowadzonych z kluczowymi podmiotami dysponującymi informacją w departamentach geriatrycznych w 6 różnych uniwersytetach. Wyniki: Analiza literatury oraz badanie ilościowe wskazały trzy główne zjawiska: 1) dokładność wiedzy studentów medycyny geriatrycznej dotyczącej demografii, 2) świadomość dotycząca szkolenia w zakresie geriatrii i planów kariery, 3) motywacje kierujące studentami zapisującymi się na kurs geriatrii. Wyniki pokazały istotne rozróżnienie między studentami geriatrii a pozostałymi studentami medycyny. Czynniki które wpływają na podjęcie decyzji o rozpoczęciu kariery w geriatrii są liczne i stanowią część procesu podejmowania decyzji, gdzie świadomość dotycząca opieki geriatrycznej i gerontologii ma kluczowe znaczenie. Wnioski: Przykład Francji ukazujący progresywny rozwój i implementację geriatrii wskazuje na możliwość przeprowadzenia zmian przy dużym wsparciu politycznym. Wyniki tego badania powinny stanowić potencjalną hipotezę dalszych badań i przeprowadzenia ich w reprezentatywnych grupach studentów.Introduction: The ageing population is a worldwide phenomenon often described as one of the biggest socio-economic challenges of the 21st century (UNFPA, 2012). In France, there are many different paths to become a geriatrician (Livreblanc de la geriatrie, 2011) which has resulted in a great deal of ambiguity and confusion in the system. Recent studies suggest an unexpected growing number of disabling conditions among baby-boomers compared to older generations (Robine et al., 1999; Cambois, Blachier, Robine, 2005). This is why a medical expertise should be developed, even though an interdisciplinary teamwork when caring the elderly seems essential (Johansson et al., 2010). In France no research specifically studied medical students' willingness to pursue a career in geriatric medicine and few studies have been conducted on the subject in the French context (Jeandel, 2011). The question of who are the specialists in geriatric medicine and whether or not their numbers respond to expectations remain unclear (Franco, 2007). The aim of this paper was then to identify the motivations of medical students towards specialisation in geriatrics medicine and their level of awareness regarding training options in geriatric medicine. Methodology Quantitative and qualitative study approaches were applied to collect primary data from selected samples. The quantitative approach was done through a cross-sectional exploratory survey done in two ways, via online projected questionnaires and self-administered questionnaires.55 Students within training in geriatric medicine from different universities were involved in the study. The qualitative approach followed in-depth interview methodology with key informants in the geriatric department of 6 different universities.Results From the literature and the quantitative approach, three main themes presented themselves: 1) particularities of the demographic data of medical students enrolled in a training in geriatric medicine; 2) the awareness regarding the training in geriatric medicine and career plans and 3) the motivations for enrolling in the programme in geriatric medicine compared to the motivations for being a doctor. The findings showed the importance of considering the population of medical students enrolled in a training in geriatric medicine separately from the rest of medical students. The factors that influence the decision to pursue a career in geriatric medicine are numerous and are part of a complex decision-making process where the awareness towards geriatric care and gerontology plays a key role.ConclusionThe French example of the progressive development and implementation of geriatric medicine shows that evolution can be relatively quick when there is political support. The results found in this research should be treated as potential hypothesis for the future and tested within representative samples of students in geriatrics

Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis

BackgroundFor over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. ObjectiveTo understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. MethodsThe study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. ResultsThree distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. ConclusionsThese findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-04464-

The PRINTEMPS Study: Protocol of a Cluster-Randomized Controlled Trial of the Local Promotion of a Smartphone Application and Associated Website for the Prevention of Suicidal Behaviors in the Adult General Population in France

International audienceBACKGROUND: Suicide constitutes a cause of death which could be prevented by e-health programs accessible to the general population. Effective promotion has the potential to maximize the uptake of such programs. However, few e-health programs have been combined with promotion campaigns. The primary objective of this trial is to assess the effectiveness of a tailored promotion, at a local level, of a mobile application and website offering evidence-based content for suicide prevention (the StopBlues program), and to compare the effectiveness of two types of local promotion in terms of their impact on suicidal acts. Secondary objectives focus on the effectiveness of the promotion in terms of the intensity of utilization of the StopBlues program, help-seeking behaviors and the level of psychological impairment of program users. METHODS/DESIGN: This is a three-arm, parallel-group, cluster-randomized controlled trial, with before-and-after observation. Thirty-four clusters, corresponding to geographical areas sharing a common local authority in France, will be included. They will be randomly assigned to one of the following arms with a ratio of 1:1:1: a control group; a basic promotion group in which promotion of the StopBlues program will be done by local authorities; and an intensified promotion group in which basic promotion will be supplemented by an additional one in a general practitioner's waiting room. The primary outcome measure will be the number of suicidal acts within each cluster over a 12-month period following the launch of the intervention. Baseline data will be collected for each cluster over the 12-month period prior to the trial. Secondary outcomes will include length of use of the StopBlues program, measures of help-seeking behaviors and level of psychological distress among users of the program, as well as the cost-effectiveness and budgetary impact of its promotion. A more sustained promotion by local authorities will also be implemented after 12\,months in the control group and assessed using the same outcome measures. DISCUSSION: This research should contribute to the sparse evidence base regarding the promotion of e-health programs and will support the wider delivery of the intervention evaluated if proven effective. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03565562. Registered on 11 June 2018