Pandemic preparedness and management in European out-of-hours primary care services - a descriptive study.

BACKGROUND: Primary care is the first point of contact for all acute health problems. As such, primary care was at the frontline in the COVID-19 pandemic, playing a significant role in clinical responses and information to the public. This study aimed to describe the variations in patient management strategies used in the out-of-hours services in different European countries during the first phase of the pandemic. METHOD: We conducted a cross-sectional web-based survey in August 2020, selecting key informants from European countries using European networks. The questionnaire was developed in collaboration with researchers in the field of out-of-hours primary care. We performed descriptive analyses per region, structuring results into themes. RESULTS: Key informants from 38 regions in 20 European countries responded. Seven regions reported that their out-of-hours services had a pandemic preparedness plan, three had trained on the plan, and two had stockpiles of personal protection equipment before the outbreak. Extension of telephone triage lines and establishment of local infection-control teams and clinics were the main patient management strategies. Other strategies for patient contacts were also used in the regions, such as video-consultations (13 regions), electronic consultations (21 regions), patient's car as alternative waiting room (19 regions), outside tents for testing (24 regions), "drive-through" testing (26 regions), and separate departments for infected patients (14 regions). CONCLUSION: Few out-of-hours services were well prepared for a pandemic, but all expanded and reorganized rapidly, adopting new strategies for patient management and treatment. The results could be useful for planning of organization preparedness of out-of-hours primary care service for future pandemics.

Contacts in general practice during the COVID-19 pandemic: a register-based study.

BACKGROUND: The COVID-19 pandemic has altered the provision of health care and expanded telehealth consultations. AIM: To study the effect of the COVID-19 pandemic on contact patterns in general practice, and to identify patient groups at risk of losing care. DESIGN AND SETTING: Register-based study of Danish general practice, including daytime and out-of-hours (OOH) services. METHOD: All individuals residing in Denmark from 1 January 2017 to 31 October 2020 were included. The incidence rate for six contact types in general practice and adjusted incidence rate ratio were calculated by comparing the incidence rate in the pandemic period with the adjusted expected incidence rate based on the incidence rate in the pre-pandemic period. RESULTS: The number of face-to-face in-clinic consultations declined during the lockdown in March 2020. A subsequent increase in the number of clinic consultations was observed, rising to a level above that of the pre-pandemic period; this increase resulted mainly from the introduction of telehealth consultations (that is, video and extended telephone). The number of daytime email consultations increased, whereas the number of daytime home visits decreased. Likewise, the number of OOH telephone consultations increased, whereas the number of OOH home visits and clinic consultations decreased. Consultation rates of patients who are vulnerable, that is, those with low education, old age, and comorbidity, were most adversely affected by the pandemic. The most adverse impact in OOH clinic consultations was seen for children aged 0-9 years. CONCLUSION: New methods are called for to ensure access to general practice for patients who are vulnerable during a pandemic. The potential of telehealth consultations should be further investigated.