Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study

Abstract

Background

Most COVID-19 patients were treated in primary health care (PHC) in Europe.

Objectives

To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient’s clinical pathways in Europe.

Methods

Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020.

Results

COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30).

Conclusion

In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.

Keywords:

• COVID-19
• Europe
• patient care management
• primary health care
• standard of care
• policy

Clinical investigators

Asja Ćosić Divjak^uu, Maryher Delphin Peña^vv, Mila Gómez-Johansson^ww, Miroslav Hanževački^xx, Shushman Ivanna^yy, Marijana Jandrić-Kočić^zz, Milena Kostić^aaa, Anna Krztoń-Królewiecka^bbb, Martin Sattler^ccc, Natalija Saurek-Aleksandrovska^ddd, Canan Tuz Yilmaz^eee, Kirsi Valtonen^fff and Kaliy Vasyl^ggg

^uuHealth Centre Zagreb Centar, Zagreb, Croatia

^vvDepartment of Geriatric Medicine, Hôpitaux Robert Schuma, Luxembourg

^wwNärhälsan Sannegården Health Centre, Gothenburg, Sweden

^xxDepartment of Family Medicine "Andrija Stampar" School of Public Health, School of Medicine, University of Zagreb, Croatia. Health Centre Zagreb West, Croatia.

^yyDepartment of Family Medicine and Outpatient Care UZHNU, Medical Faculty, Ukraine.

^zzHealth Centre, Krupa na Uni, Republic of Srpska, Bosnia and Herzegovina.

^aaaHealth Centre "Dr Đorđe Kovačević", Lazarevac, Belgrade, Serbia.

^bbbDepartment of Family Medicine, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland

^cccEuropean Parliament, Luxembourg, Luxembourg.

^dddFaculty of Medicine, University of Sv. Kiril I Metodij, Skopje, Republic of North Macedonia

^eeeBursa Uludağ University Family Medicine Department, Bursa, Turkey.

^fffCommunicable Diseases and Infection Control Unit, City of Vantaa, Vantaa, Finland.

^gggDepartment of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Ukraine

Acknowledgements

We would like to express our sincere gratitude to the the Deutsche Forschungsgemeinschaft (DFG) and to HL for their support and for providing the resources and encouragement to complete this work.

We would also like to thank all our colleagues for their contributions, feedback and support throughout this research project. Without their valuable participation, it would not have been possible to carry it out, helping us to understand better the context and draw meaningful conclusions.

ALN is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Northwest London (NWL) and NIHR NWL Patient Safety Research Collaboration, with infrastructure support from NIHR Imperial Biomedical Research Centre. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

Ethical approval

The ethical approval was obtained from the Ethics Committee of the Hospital Universitario La Paz (Madrid, Spain), ID PI-5030 and provided to all participants. Additional ethical approval was needed in Croatia and obtained from the Ethics committee, School of Medicine, University of Zagreb: Ur. Broj: 380-59-10106-22-111/76; Klasa: 641-01/22-02/01.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was supported by the European General Practice Research Network (EGPRN) Grant [2022/01]. This publication is funded by the Deutsche Forschungsgemeinschaft (DFG) as part of the “open access Publikationskosten-Programm.”