Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19)
1.1. Country Level
1.2. Practice Level
1.3. Aim and Research Questions
2.1. Study Design and Setting
2.2. Sampling and Recruitment
- Staff members are more involved in giving information and recommendations to patients contacting the practice by telephone.
- Staff members are more involved in giving information or explaining what a caregiver has said to illiterate patients, patients with low health literacy or migrants.
- Staff members are more involved in actively reaching out to patients that might postpone healthcare.
- Staff members are more involved in the triage.
- My responsibilities in this practice increased.
- Since the COVID-19 pandemic, GPs or GP trainees are more involved in actively reaching out to patients that might postpone healthcare.
- Staff absence using the question: Since the COVID-19 pandemic, how many staff members had to take time off in practice due to COVID-19 (because of being infected or because of being in quarantine)?
- Coping with absenteeism of practice staff measured by three items about coping internally, coping in cooperation with neighboring practices, and improved cooperation with neighboring practices. These ways of coping can be a way to mitigate the pressures of the COVID-19 pandemic in general or of absenteeism in practice.
- GPs’ evaluation of their role changes through three items: I am happy with the task shifting in my professional role; I don’t feel prepared for the task shifting in my professional role; I need further training for these amended responsibilities.
- Practice size by the question: How many patients are registered in this practice? If there is no registration, please indicate the total practice population. Outliers were recoded to the tail of the distribution.
- Number of GPs and trainees by the question: How many GPs and GP trainees are working in this practice? Outliers were recoded to the tail of the distribution.
- Number of disciplines working in the practice using the total number of different disciplines, based on the question about the different disciplines working in the practice.
- Total number of paid staff by the question: How many people work in this practice? Outliers were recoded to the tail of the distribution.
- The payment system of GPs was entered as a dummy variable for fee-for-service and mix of fee-for-service and other payment elements vs. other payment systems.
- The practice location of the practice measured by the following options: big (inner) city, suburbs, (small) town, mixed urban–rural, rural.
- The composition of the practice measured along the following dimensions: Patients with a migration background, patients with limited health literacy or low literacy, patients who live in poverty, patients with a psychiatric vulnerability, patients over the age of 70, patients with chronic conditions, patients with little social support or limited informal care. The answering options were: below average, approximately the average, and above average, I do not know. Based on the correlations, we have combined the dimensions of patient age and chronic conditions into one variable and the other dimensions in another variable (sum).
- The numbers of infections and mortality during the first wave of the pandemic and (as an alternative) during the three months before the start of the data collection (source: ECDC for EU countries; national coordinators for countries outside EU).
- The role of GP practices during the pandemic, asked in a separate survey to all partners in the PRICOV-19 study. More specifically, this focused on the following areas: testing, manning the testing sites, contact tracing, writing sickness absence certificates, writing quarantine certificates, care for/treatment of COVID-19 patients, the vaccination campaign (with answering options yes, no, I don’t know and not applicable). In addition, we have created a new variable by summing the tasks of GPs.
- The extent to which tasks have already been shifted to staff in PC: scores on task shifting to staff by country from the QUALICOPC study .
- Strength of PC: data from the PHAMEU project . This variable was built from indicators in three dimensions: governance of primary care, workforce development and economic conditions for primary care, with values ranging from 1 (weak primary care) to 3 (strong primary care).
- Institutional factors: whether nurses have prescription rights in a country. Using data from Kroezen et al. and Maier [16,17], we classified countries into two categories: 1 = no prescription rights (Austria, Belgium, Bulgaria, Czech Republic, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxemburg, Malta, North Macedonia, Portugal, Rumania, Slovenia, Turkey); 2 = prescription rights (Cyprus, Denmark, Estonia, Finland, Ireland, Netherlands, Norway, Poland, Spain, Sweden, one canton in Switzerland, United Kingdom). The other eight countries were missing on this variable. This variable was previously used in Groenewegen et al. .
2.4. Statistical Analysis
- Empty model to calculate the clustering of the dependent variables within countries;
- Adding GP/practice variables;
- Adding interaction terms for the interaction between staff absence and coping mechanisms to model the possibility that staff absence is less problematic when adequately coped with;
- Adding country variables (one by one).
2.5. Ethical Approval
3.1. Scale Analysis
3.2. Task Changes
3.3. (Coping with) Absenteeism of Staff
3.4. Country and Health System Characteristics
3.5. Results of the Statistical Analysis
4.1. Main Findings
4.2. Implications for Policy and Practice
4.3. Strengths and Weaknesses
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|1. Giving Information|
|3. Actively Reaching Out to Patients||4. More Involved|
|Country||Agree||Strongly Agree||Agree||Strongly Agree||Agree||Strongly Agree||Agree||Strongly Agree||N between|
|Bosnia and Herzegovina||32.3||12.9||29.0||12.9||22.9||9.7||32.3||9.7||31|
|My Responsibilities Increased||GPs Are More Involved in Reaching Out to Patients|
|Country||Agree||Strongly Agree||Agree||Strongly Agree||N between|
|Austria||- b||- b||43.2||13.6||132|
|Bosnia and Herzegovina||34.4||53.1||45.5||15.2||32–33|
|Happy with the Task Shifting||Do Not Feel Prepared for the Task Shifting||Need Further Training|
|Country||Agree||Strongly Agree||Agree||Strongly Agree||Agree||Strongly Agree||N|
|Bosnia and Herzegovina||12.9||0.0||28.1||6.3||65.6||6.3||31–32|
|Coped with Internally||Coped with in Cooperation with Neighboring Practices||Improved Cooperation with Neighboring Practices|
|Country||Mean||Agree||Strongly Agree||Agree||Strongly Agree||Agree||Strongly Agree||N|
|Bosnia and Herzegovina||4.6 (0.59)||34.5||0.0||37.9||0.0||28.6||0.0||26–29|
|Czech Rep||0.9 (0.24)||23.3||3.3||45.4||21.7||24.0||7.3||90–99|
|North Macedonia||2.0 (0.51)||64.7||2.9||69.0||3.4||48.5||6.1||29–34|
|United Kingdom||9.7 (0.36)||28.6||9.5||28.6||4.8||61.9||28.6||21|
|Model 3: Interaction Terms|
Country Variables c
|Constant||2.822 (0.053)||2.472 (0.068)||2.485 (0.068)|
|Staff absence||−0.001 (0.001)||−0.004 (0.001) *|
|coped with internally b||−0.008 (0.007)||−0.014 (0.007)|
|coped with neighboring practices||−0.014 (0.008)||−0.013 (0.008)|
|improved cooperation with neighboring practices a,b||0.070 (0.009) **||0.070 (0.009) **|
|GPs happy with the task shifting||0.066 (0.008) **||0.065 (0.008) **|
|GPs do not feel prepared||0.014 (0.009)||0.013 (0.009)|
|Need further training||0.021 (0.009) *||0.021 (0.009) *|
|Practice size||1.02 × 10−6 (9.82 × 10−7)||1.03 × 10−6 (9.87 × 10−7)|
|Number of GPs and trainees||−0.000 (0.000)||−0.000 (0.000)|
|Total number of paid staff||0.000 (0.002)||0.001 (0.002)|
|Number of disciplines a,b||0.009 (0.004) *||0.009 (0.004) *|
|GPs paid (mixed) fee-for-service||−0.027 (0.025)||−0.028 (0.025)|
|Practice location (ref. big city)|
|-suburbs||−0.028 (0.028)||−0.028 (0.028)|
|-(small) towns||−0.018 (0.023)||−0.017 (0.022)|
|-mixed urban–rural||0.005 (0.022)||0.005 (0.022)|
|-rural||−0.020 (0.024)||−0.020 (0.024)|
|Practice population elderly/chronic conditions||0.017 (0.007) *||0.016 (0.007) *|
|Practice population other vulnerable populations||0.003 (0.003)||0.003 (0.003)|
|Interaction staff absence * coping internally||0.001 (0.000) **|
|Interaction staff absence * coping neighboring practices||0.005 (0.008)|
|Interaction staff absence * coping improved cooperation||−0.000 (0.000)|
|COVID-19 cases per million population during 1st wave||0.008 (0.005)|
(p = 0.107)
|Idem COVID-19 mortality||−0.004 (0.005)|
|COVID-19 cases per million population 3 months before survey||−0.001 (0.005)|
|Idem COVID-19 mortality||0.006 (0.005)|
|Role of GPs during pandemic||0.024 (0.036)|
|Strength of PC||−0.061 (0.398)|
|Nurse prescribing rights (yes)||−0.146 (0.119)|
|Degree of task shifting in 2012||−0.024 (0.056)|
|Country variance||0.10 (0.024)||0.10 (0.025)||0.10 (0.025)|
|Practice variance||0.29 (0.006)||0.28 (0.006)||0.28 (0.006)|
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Groenewegen, P.; Van Poel, E.; Spreeuwenberg, P.; Batenburg, R.; Mallen, C.; Murauskiene, L.; Peris, A.; Pétré, B.; Schaubroeck, E.; Stark, S.; Sigurdsson, E.L.; Tatsioni, A.; Vafeidou, K.; Willems, S. Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19). Int. J. Environ. Res. Public Health 2022, 19, 15329. https://doi.org/10.3390/ijerph192215329
Groenewegen P, Van Poel E, Spreeuwenberg P, Batenburg R, Mallen C, Murauskiene L, Peris A, Pétré B, Schaubroeck E, Stark S, Sigurdsson EL, Tatsioni A, Vafeidou K, Willems S. Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19). International Journal of Environmental Research and Public Health. 2022; 19(22):15329. https://doi.org/10.3390/ijerph192215329Chicago/Turabian Style
Groenewegen, Peter, Esther Van Poel, Peter Spreeuwenberg, Ronald Batenburg, Christian Mallen, Liubove Murauskiene, Antoni Peris, Benoit Pétré, Emmily Schaubroeck, Stefanie Stark, Emil L. Sigurdsson, Athina Tatsioni, Kyriaki Vafeidou, and Sara Willems. 2022. "Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19)" International Journal of Environmental Research and Public Health 19, no. 22: 15329. https://doi.org/10.3390/ijerph192215329