“We literally worked in parking lots, cars, garages, and separately set up party tents.” Qualitative study on the experiences of GPs in the frame of the SARS-CoV-2 pandemic in Austria (preprint)

Background: Primary care is internationally recognised as one of the cornerstones of health care. During the COVID-19 pandemic, primary care physicians were assigned a variety of tasks and thus made a significant contribution to a country's pandemic response. They were expected to perform a variety of tasks, such as diagnosing and treating people with COVID-19, maintaining health care for all other patients, as well as several public health tasks, such as diagnostic testing and vaccination, protecting patients and staff from infection, and serving as community trusted persons. In Austria, there are no structured levels of care, no definition of the role of the general practitioner during a pandemic is given, and no specific support structures are present. The aim of this study was to assess the views and experiences of primary care physicians regarding supportive and hindering factors for pandemic preparedness in Austria.Methods: Qualitative study using semi-structured interviews. A total of 30 general practitioners were interviewed, with particular attention to an equitable distribution in small, medium and large primary care facilities. Qualitative content analysis was performed.Results: Interviewees described a wide range of infection control, organisational and communication measures that they had implemented. They made changes to practise equipment, found makeshift solutions when supplies were scarce, and established communication and information pathways when official communication lines were inadequate.Conclusion: General practitioners took on essential tasks and showed a high level of understanding of their role in the pandemic response. This was achieved mainly at an informal level and with high personal commitment. Their functioning in the absence of structural regulations and support shows that they had a clear intrinsic understanding of their responsibilities. To ensure reliability and sustainability and to reduce their burden, it will be necessary to clarify the role and tasks of a general practitioner and to provide the necessary support. This concerns both infrastructural support and communication and information strategies. As part of the reform to strengthen primary care, primary care needs to be seen, valued and involved in decision-making processes.

Symptoms and risk factors for hospitalization of COVID-19 presented in primary care (preprint)

ObjectiveTo extend knowledge of early symptoms as a precondition of early identification, and to gain understanding of associations between early symptoms and the development of a severe course of the disease. DesignRetrospective observational study SettingAustrian GP practices in the year 2020, patients above 18 years were included. ParticipantsWe recruited 22 practices who included altogether 295 participants with a positive SARS-CoV-2 test. Main outcome measuresData collection comprised basic demographic data, risk factors and the recording of symptoms at several points in time in the course of the illness. Descriptive analyses for possible associations between demographics and symptoms were conducted by means of cross table. Group differences (hospitalized yes/no) were assessed using Fishers exact test. The significance level was set to 0.05; due to the observational character of the study, no adjustment for multiplicity was performed. ResultsLittle more than one third of patients report symptoms generally understood to be typical for Covid-19. Most patients present with a variety of unspecific complaints. We found symptoms indicating complicated disease, depending on when they appear. The number of symptoms is likely to be a predictor for the need of hospital care. More than 50% of patients still experience symptoms 14 days after onset. ConclusionsUnderrating unspecific symptoms as possible indicators for SARS-CoV-2 infection harbours the danger of overlooking early disease. Monitoring patients during their illness using the indicators for severe disease we identified may help to identify patients who are likely to profit from early intervention. Data availability statementAll data referred to in the manuscript are available from: Department of General Medicine and Family Practice, Karl Landsteiner Privatuniversitaet, Krems, Austria Article SummaryO_ST_ABSStrengths and limitationsC_ST_ABSO_LIThis study investigates data on the course of COVID-19 collected exclusively from patients in primary care and explores a wide range of symptoms. C_LIO_LIGPs were free to make their own testing decision according to their clinical judgement, and they followed each patient individually from day 1 to day 10 or 14. C_LIO_LILimitations of our study concern the limited number of patients, due to the increased workload under difficult working conditions during the pandemic as well as the effort not being remunerated. However, the number of cases needed to identify group differences was calculated in advance, and this number has been reached. Our overall results are in accordance with our preliminary result analyses. C_LI