Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries

Abstract

ObjectiveTo describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.SettingPrimary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.Design and participantsBefore (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.Outcome measuresConsultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.ResultsCare for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).ConclusionsDespite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.

Antibiotic Prescribing Trends in Belgian Out-of-Hours Primary Care during the COVID-19 Pandemic: Observational Study Using Routinely Collected Health Data

“…Throughout Europe, primary care reorganized itself to provide primary care for patients with or without COVID-19 [ 1 , 2 , 3 , 4 ]. In this rapidly evolving pandemic situation, primary care plays a vital role in the health system [ 30 ].…”

“…In primary care, findings are mixed, but in general, they indicate a decrease when it comes to the number of antibiotic prescriptions dispended [ 4 ]. For example, during the beginning of the COVID-19 pandemic, the number of outpatients with antibiotic prescriptions decreased substantially in the United States [ 35 ].…”

“…The start of the COVID-19 pandemic raised new and radical logistical and clinical challenges for primary care physicians, who were forced to respond promptly to a fast-changing environment [ 1 , 2 , 3 , 4 ]. Out-of-hours (OOH) primary care rapidly reorganized itself.…”

Common Infections and Antibiotic Prescribing during the First Year of the COVID-19 Pandemic: A Primary Care-Based Observational Cohort Study

“…A prospective audit survey of consultation and management characteristics of patients with respiratory tract infections early in the first pandemic wave in 16 European countries showed that the proportion of patients prescribed antibiotics varied considerably between countries, and was generally lower during the pandemic as compared with the months before, except in Greece, Poland, and United Kingdom (UK) [15].…”

Family Medicine at the Forefront: Lessons Learnt From the COVID-19 Vaccine Rollout in Crete, Greece

“…Health technology has been used in the fight against this pandemic; for example, remote consultations have been extensively used (13,14). However, this is also a challenge as not all healthcare professionals have adequate digital literacy, whereas not everyone has access to new technologies.…”