The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries.

The COVID-19 pandemic disproportionately affected vulnerable populations' access to health care. By proactively reaching out to them, general practices attempted to prevent the underutilization of their services. This paper examined the association between practice and country characteristics and the organization of outreach work in general practices during COVID-19. Linear mixed model analyses with practices nested in countries were performed on the data of 4982 practices from 38 countries. A 4-item scale on outreach work was constructed as the outcome variable with a reliability of 0.77 and 0.97 at the practice and country level. The results showed that many practices set up outreach work, including extracting at least one list of patients with chronic conditions from their electronic medical record (30.1%); and performing telephone outreach to patients with chronic conditions (62.8%), a psychological vulnerability (35.6%), or possible situation of domestic violence or a child-rearing situation (17.2%). Outreach work was positively related to the availability of an administrative assistant or practice manager (p < 0.05) or paramedical support staff (p < 0.01). Other practice and country characteristics were not significantly associated with undertaking outreach work. Policy and financial interventions supporting general practices to organize outreach work should focus on the range of personnel available to support such practice activities.

Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19).

The COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed.

[Positive assessment of care has changed little during the COVID-19 pandemic, but there is still room for improvement]. / Positieve beoordeling van de zorg weinig veranderd tijdens de coronapandemie, maar nog altijd ruimte voor verbetering.

Introduction: Measuring patient experiences provides important insight into the quality of Dutch healthcare. The current research shows how quality of care has changed over the years and how it correlates with changes in healthcare and health during the COVID-19-pandemic. Method: Patient experiences were collected using satisfaction ratings and the quality indicator PREM Chronic Care, among a representative group of people with a chronic disease. Trend analyses with repeated measurements (2016-2020) were performed and differences between subgroups were tested with Mann-Whitney U tests. Results: Quality of care ratings are mainly positive, also during the COVID-19-pandemic in autumn of 2020. In that year, people are the least satisfied with the coordination between healthcare providers and with preventive healthcare of their illness (64% and 67% is satisfied respectively). Trend analyses show that satisfaction with preventive healthcare has declined and satisfaction with shared decision-making has fluctuated over the years. People who experience consequences for their health(care) during the COVID-19-pandemic, are less satisfied with different aspects of healthcare quality than those who experience no consequences. Conclusion: It seems important to pay attention to patient experiences about healthcare processes, with emphasis on additional information for prevention, support for changes in health and treatment during the COVID-19-pandemic, and good coordination between healthcare providers.

Positieve beoordeling van de zorg weinig veranderd tijdens de coronapandemie, maar nog altijd ruimte voor verbetering Positive assessment of care has changed little during the COVID-19 pandemic, but there is still room for improvement

Samenvatting Inleiding Het meten van patiëntervaringen geeft belangrijke inzichten in de kwaliteit van de Nederlandse gezondheidszorg. Het huidige onderzoek toetst in hoeverre de ervaren kwaliteit van zorg door de jaren heen is veranderd en hoe deze samenhangt met veranderingen in zorg en gezondheid tijdens de coronapandemie. Methode Patiëntervaringen zijn verzameld met tevredenheidsoordelen en de kwaliteitsindicator PREM Chronische Zorg, onder een representatieve steekproef van mensen met een chronische ziekte. Trendanalyses (2016–2020) zijn uitgevoerd en verschillen tussen subgroepen zijn getoetst met Mann-Whitney U‑toetsen. Resultaten De kwaliteit van de zorg wordt over het algemeen positief ervaren, ook tijdens de coronapandemie in het najaar van 2020. In dat jaar zijn mensen het minst tevreden over de afstemming tussen zorgverleners en over de preventieve begeleiding van hun ziekte (respectievelijk 64% en 67% is (helemaal) tevreden). Trendanalyses laten zien dat de tevredenheid over preventieve begeleiding is gedaald en dat de tevredenheid over gezamenlijke besluitvorming door de jaren heen schommelt. Mensen die gevolgen van de coronapandemie ervaren voor hun zorg of gezondheid beoordelen aspecten van de gezondheidszorg minder positief dan diegenen die geen gevolgen ervaren. Conclusie Het is belangrijk om aandacht te hebben voor patiëntervaringen met zorgprocessen, waarbij extra nadruk zou moeten liggen op informatie over preventie, ondersteuning bij veranderingen in de gezondheid en de behandeling tijdens de coronapandemie, en goede afstemming tussen zorgverleners. Digitaal aanvullende content De online versie van dit artikel (10.1007/s12508-022-00329-y) bevat aanvullend materiaal, toegankelijk voor daartoe geautoriseerde gebruikers.

Monitoring the mortality impact of COVID-19 in Europe: What can be learned from 2009 influenza H1N1p mortality studies?

OBJECTIVES: Understanding the proportion of pandemic deaths captured as 'laboratory-confirmed' deaths is crucial. We assessed the ability of laboratory-confirmed deaths to capture mortality in the EU during the 2009 pandemic, and examined the likelihood that these findings are applicable to the SARS-CoV-2 pandemic. METHODS: We present unpublished results from the Global Pandemic Mortality (GLaMOR) project, in which country-specific mortality estimates were made for the 2009 influenza H1N1p pandemic. These estimates were compared with laboratory-confirmed deaths during the 2009 pandemic to estimate the ability of surveillance systems to capture pandemic mortality. RESULTS: For the 2009 influenza H1N1p pandemic, we estimated that the proportion of true pandemic deaths captured by laboratory-confirmed deaths was approximately 67%. Several differences between the two pandemics (e.g. age groups affected) make it unlikely that this capture rate will be equally high for SARS-CoV-2. CONCLUSION: The surveillance of laboratory-confirmed deaths in the EU during the 2009 pandemic was more accurate than previously assumed. We hypothesize that this method is less reliable for SARS-CoV-2. Near-real-time excess all-cause mortality estimates, routinely compiled by EuroMOMO, probably offer a better indicator of pandemic mortality. We urge more countries to join this project and that national-level absolute mortality numbers are presented.