Paediatric primary care in Germany during the early COVID-19 pandemic: the calm before the storm

Abstract

ObjectivesGlobally, the COVID-19 pandemic has a major impact on healthcare provision. The effects in primary care are understudied. This study aimed to explore changes in consultation numbers and patient management during the COVID-19 pandemic, and to identify challenges for patient care.DesignSurvey of paediatric primary care practices on consultation numbers and patient management changes, and semistructured interviews to identify challenges for patient care. Surveys and interviews were partially linked in an explanatory sequential design to identify patient groups perceived to be at higher risk for worse care during the pandemic.SettingIn and around Düsseldorf, a densely populated area in Western Germany. The primary care facilities are spread over an area with approximately 2 million inhabitants.ParticipantsPrimary care in Germany is provided through practices run by self-employed specialist physicians that are contracted to offer services to patients under public health insurance which is compulsory to the majority of the population. The sample contained 44 paediatric primary care practices in the area, the response rate was 50%.ResultsNumbers of consultations for scheduled developmental examinations remained unchanged compared with the previous year while emergency visits were strongly reduced (mean 87.3 less/week in March–May 2020 compared with 2019, median reduction 55.0%). Children dependent on developmental therapy and with chronic health conditions were identified as patient groups receiving deteriorated care. High patient numbers, including of mildly symptomatic children presenting for health certificates, in combination with increased organisational demands and expected staff outages are priority concerns for the winter.ConclusionsPrimary care paediatricians offered stable service through the early pandemic but expected strained resources for the upcoming winter. Unambiguous guidance on which children should present to primary care and who should be tested would help to allocate resources appropriately, and this guidance needs to consider age group specific issues including high prevalence of respiratory symptoms, dependency on carers and high contact rates.

Experiences of Pediatric Pain Professionals Providing Care during the COVID-19 Pandemic: A Qualitative Study

“…A key finding within the first theme was that providers witnessed the heightened role of SES in mitigating or exacerbating the effects of the pandemic on youth with chronic pain. This finding aligns with previous work reporting a contrast in the care received by patients of varying SES during the pandemic [ 24 ]. In a German study, Vasconcelos et al found that pediatric patients with chronic conditions and those who were socio-economically disadvantaged were more likely to be reported as receiving worse care during the pandemic, in comparison to those with minor concerns who were more likely to be reported as receiving better care [ 24 ].…”

“…This finding aligns with previous work reporting a contrast in the care received by patients of varying SES during the pandemic [ 24 ]. In a German study, Vasconcelos et al found that pediatric patients with chronic conditions and those who were socio-economically disadvantaged were more likely to be reported as receiving worse care during the pandemic, in comparison to those with minor concerns who were more likely to be reported as receiving better care [ 24 ]. A qualitative study of adults with chronic pain also reported that existing systemic inequities intermingled with the existence of chronic health conditions lead to worse health outcomes and more precarious financial positions [ 22 ] for adults of lower SES [ 26 ].…”

“…Our analysis highlighted 3 main themes related to this experience from the perspective of HCP: (1) the duality of the impact of the COVID-19 pandemic restrictions on youth with chronic pain; (2) changes to the healthcare system and clinical practices; (3) the shift to virtual care among pediatric pain HCP. Similar findings have been reported by quantitative studies of HCP in other clinical areas, both adult and pediatric, across various regions of the world [ 7 , 8 , 12 , 17 , 22 , 23 , 24 ], however, this is one of the first qualitative studies to report on this phenomenon from the perspectives of HCP within the context of pediatric chronic pain care provision.…”

“…The second theme describes pandemic-related changes to the healthcare system and clinical practices which impact access to care. Several studies also reported similar professional concerns from HCP such as difficulty planning discharge [ 11 ] or community support for their patients, while also noting changes to care-seeking behaviour as many pediatric patients with chronic conditions (i.e., pain or diabetes) were limiting contact with the healthcare system due to fear of exposure to COVID-19 [ 24 , 27 , 28 ]. Specific to pain professionals, several authors highlighted service disruptions [ 11 , 23 , 26 ] as a main point of concern; for example, the closure of physiotherapy and psychological services made chronic pain management more difficult, leading to the worsening of patients’ health conditions.…”

Pediatricians’ experiences of managing outpatient care during the COVID-19 pandemic: A qualitative study in Germany

“…Whereas patients with symptoms suggesting a COVID-19 infection had been advised not to visit medical practices in person, many patients with other serious symptoms were also afraid to visit their doctor, or did not attend preventive medical check-ups for fear of becoming infected with COVID-19 ( 25 , 26 ). In pediatric practices emergency visits were significantly reduced, whereas developmental examinations remained mostly unchanged, compared to the previous year ( 27 ). Studies show, that vaccination uptake was affected during the pandemic, however could be resumed ( 28 , 29 ).…”