Organisation and characteristics of out-of-hours primary care during a COVID-19 outbreak: A real-time observational study

Abstract

Background During the COVID-19 pandemic, general practitioners worldwide re-organise care in very different ways because of the lack of evidence-based protocols. Objective This paper describes the organisation and the characteristics of consultations in Belgian out-of-hours primary care during five weekends at the peak of a COVID-19 outbreak and compares it to a similar period in 2019. Methods Real-time observational study using pseudonymised routine clinical data extracted out of reports from home visits, telephone- and physical consultations (iCAREdata). Nine general practice cooperatives (GPCs) participated covering a population of 1 513 523. Results All GPCs rapidly re-organised care in order to handle the outbreak and provide a safe working environment. The average consultation rate was 222 per 100 000 citizens per weekend. These consultations were handled by telephone alone in 40% (N = 6293). A diagnosis at risk of COVID-19 was registered in 6692 (43%) consultations,. Out of 5311 physical consultations, 1460 were at risk of COVID-19 of which 443 (30%) did not receive prior telephone consultation to estimate this risk. Compared to 2019, the workload initially increased due to telephone consultations but afterwards declined drastically. The physical consultation rate declined by 45% with a marked decline in diagnoses unrelated to COVID-19. Conclusions General practitioners can rapidly re-organise out-of-hours care to handle patient flows during a COVID-19 outbreak. Forty percent of the out-of-hours primary care contacts are handled by telephone consultations alone. We recommend to give a telephone consultation to all patients and not to rely on call takers to differentiate between infectious and regular care. The demand for physical consultations declined drastically provoking questions about patient’s safety for care unrelated to COVID-19.

Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study

“…Reports indicate that accident and emergency department attendance and hospital admissions for non-COVID-19-related acute concerns in the UK have declined since March, 2020. 2 , 3 , 4 However, it is not yet clear what has happened in primary care across the UK where clinical work has changed rapidly to include more remote consultations, 14 , 15 , 16 , 17 although a regional report indicates reduced primary care consultations. 18 …”

Transformations in the landscape of primary health care during COVID-19: Themes from the European region

“…There has been limited examination of the PHC models of care employed during the pandemic to date. Researchers have instead examined local or regional PHC levels of preparedness or response to the pandemic 5 , 6 , 7 or studied patient activity in PHC, noting decreases in the provision of chronic care [8] and screening [9] , and declines in the number of physical consultations in both practice [ 10 , 11 ] and pharmacies [12] . Publications of surveys of PHC providers have attempted to highlight their levels and causes of anxiety [ 13 , 14 ].…”

COVID-19 collateral: Indirect acute effects of the pandemic on physical and mental health in the UK

“…Reports indicate that accident and emergency department attendance and hospital admissions for non-COVID-related acute concerns in the UK have declined since March 2020. 2–4 However, it is not yet clear what has happened in primary care across the UK where clinical work has changed rapidly to include more remote consultations, 14–17 although a regional report indicates reduced primary care consultations. 18…”