TY - JOUR

T1 - Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic

T2 - an observational study in 16 European countries

AU - van der Velden, Alike W.

AU - Bax, Eva A.

AU - Bongard, Emily

AU - Aabenhus, Rune Munck

AU - Anastasaki, Marilena

AU - Anthierens, Sibyl

AU - Balan, Anca

AU - Bohmer, Femke

AU - Bruno, Pascale

AU - Chlabicz, Slawomir

AU - Coenen, Samuel

AU - Colliers, Annelies

AU - Emmerich, Susanne

AU - Garcia-Sangenis, Ana

AU - Ghazaryan, Hrachuhi

AU - van der Linde, Sanne R.

AU - Malania, Lile

AU - Pauer, Jozsef

AU - Tomacinschii, Angela

AU - Tonkin-Crine, Sarah

AU - Vellinga, Akke

AU - Zastavnyy, Ihor

AU - Verheij, Theo

AU - Goossens, Herman

AU - Butler, Christopher C.

PY - 2021

Y1 - 2021

N2 - Objective To describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings. Setting Primary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available. Design and participants Before (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study. Outcome measures Consultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described. Results Care for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%). Conclusions Despite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.

AB - Objective To describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings. Setting Primary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available. Design and participants Before (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study. Outcome measures Consultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described. Results Care for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%). Conclusions Despite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.

KW - COVID-19

KW - primary care

KW - respiratory infections

KW - audit

KW - quality in healthcare

U2 - 10.1136/bmjopen-2021-049257

DO - 10.1136/bmjopen-2021-049257

M3 - Journal article

C2 - 34326052

VL - 11

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 7

M1 - 049257

ER -