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)
Abstract
:1. Introduction
1.1. Country Level
1.2. Practice Level
1.3. Aim and Research Questions
2. Methods
2.1. Study Design and Setting
2.2. Sampling and Recruitment
2.3. Measurements
- (1)
- Staff members are more involved in giving information and recommendations to patients contacting the practice by telephone.
- (2)
- 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.
- (3)
- Staff members are more involved in actively reaching out to patients that might postpone healthcare.
- (4)
- Staff members are more involved in the triage.
- (1)
- My responsibilities in this practice increased.
- (2)
- 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 [11].
- Strength of PC: data from the PHAMEU project [15]. 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. [11].
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. Results
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. Discussion
4.1. Main Findings
4.2. Implications for Policy and Practice
4.3. Strengths and Weaknesses
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- EXPH. The Organisation of Resilient Health and Social Care Following the COVID-19 Pandemic; Expert Panel on Effective Ways of Investing in Health: Brussels, Belgium, 2020. [Google Scholar]
- Merkur, S.; Maresso, A.; Cylus, J.; van Ginneken, E.; Lessof, S. Lessons from the first wave: The COVID-19 health system response monitor (hspm), an evidence resource and a source of analysis. Eurohealth 2020, 26, 5–9. [Google Scholar]
- Rawaf, S.; Allen, L.N.; Stigler, F.L.; Kringos, D.; Yamamoto, H.Q.; van Weel, C.; Global Forum on Universal Health Coverage and Primary Health Care. Lessons on the COVID-19 pandemic, for and by primary care professionals worldwide. Eur. J. Gen. Pract. 2020, 26, 129–133. [Google Scholar] [CrossRef] [PubMed]
- Sigurdsson, E.L.; Blondal, A.B.; Jonsson, J.S.; Tomasdottir, M.O.; Hrafnkelsson, H.; Linnet, K.; Sigurdsson, J.A. How primary healthcare in Iceland swiftly changed its strategy in response to the COVID-19 pandemic. BMJ Open 2020, 10, e043151. [Google Scholar] [CrossRef] [PubMed]
- Groenewegen, P.P.; van den Muijsenbergh, M.; Batenburg, R.; Van Poel, E.; van den Broek, S.; Vanden Bussche, P.; Willems, S. Snelle aanpassing praktijkorganisatie tijdens de coronapandemie. Huisarts Wet. 2022, 65, 16–20. [Google Scholar] [CrossRef] [PubMed]
- Van Poel, E.; Vanden Bussche, P.; Klemenc-Ketis, Z.; Willems, S. How did general practices organize care during the COVID-19 pandemic: The protocol of the cross-sectional PRICOV-19 study in 38 countries. BMC Fam. Pract. 2022, 23, 11. [Google Scholar] [CrossRef] [PubMed]
- WHO. Task Shifting to Tackle Health Worker Shortages; HIV/AIDS Programme; Strengthening Health Services to Fight HIV/AIDS; WHO: Geneva, Switzerland, 2006. [Google Scholar]
- EXPH. Task Shifting and Health System Design; Publications Office of the European Union: Brussels, Belgium, 2019. [Google Scholar]
- Groenewegen, P.P.; Heinemann, S.; Greß, S.; Schäfer, W. Primary care practice composition in 34 countries. Health Policy 2015, 119, 1576–1583. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bouchez, T.; Gautier, S.; Le Breton, J.; Bourgueil, Y.; Ramond-Roquin, A. The challenge for general practitioners to keep in touch with vulnerable patients during the COVID-19 lockdown: An observational study in France. BMC Prim. Care 2022, 23, 82. [Google Scholar] [CrossRef]
- Schmidt, A.E.; Merkur, S.; Haindl, A.; Gerkens, S.; Gandréd, C.; Or, Z.; Groenewegen, P.P.; Kroneman, M.; De Jong, J.D.; Albreht, T.; et al. Tackling the COVID-19 pandemic: Initial responses in 2020 in selected social health insurance countries in Europe, Health policy. Health Policy 2022, 126, 476–484. [Google Scholar] [CrossRef] [PubMed]
- Groenewegen, P.P.; Boerma, W.G.W.; Spreeuwenberg, P.; Seifert, B.; Schäfer, W.; Batenburg, R.; Van Tuyl, L. Task shifting from general practitioners to practice assistants and nurses in primary care: A cross-sectional survey in 34 countries. Prim. Health Care Res. Dev. 2022, 23, e60. [Google Scholar] [CrossRef]
- OECD. Strengthening the Frontline: How Primary Health Care Helps Health Systems Adapt during the COVID 19 Pandemic; OECD: Paris, France, 2021. [Google Scholar]
- Martí, T.; Peris, A.; Cerezo, J.C. Spain Transforming Primary Health Care during the Pandemic: Accelerating Multidisciplinary Teamwork to Address Emerging Primary Care Needs in three Spanish Regions. WHO 2021; WHO: Copenhagen, Denmark, 2021. [Google Scholar]
- Harris, P.A.; Taylor, R.; Minor, B.L.; Elliott, V.; Fernandez, M.; O’Neil, L.; McLeod, L.; Delaqua, G.; Kirby, J.; Duda, S.N. The REDCap consortium: Building an international community of software platform partners. J. Biomed. Inform. 2019, 95, 103208. [Google Scholar] [CrossRef]
- Kringos, D.S.; Boerma, W.G.W.; Bourgueil, Y.; Cartier, T.; Dedeu, T.; Hasvold, T.; Hutchinson, A.; Lember, M.; Oleszczyk, M.; Rotar-Pavlic, D.; et al. The strength of primary care in Europe: An international comparative study. Br. J. Gen. Pract. 2013, 63, e742–e750. [Google Scholar] [CrossRef] [PubMed]
- Kroezen, M.; Van Dijk, L.; Groenewegen, P.P.; Francke, A.L. Nurse prescribing of medicines in Western European and Anglo-Saxon countries: A systematic review of the literature. BMC Health Serv. Res. 2011, 11, 127. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Maier, C.B. Nurse prescribing of medicines in 13 European countries. Hum. Resour. Health 2019, 17, 95. [Google Scholar] [CrossRef] [PubMed]
- Parke, C.S. Essential First Steps to Data Analysis—Scenario-Based Examples Using SPSS: Module 1: Checking the Representativeness of a Sample; Sage: London, UK, 2013. [Google Scholar]
- Snijders, T.; Bosker, R. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling; Sage: London, UK, 1999. [Google Scholar]
- Leyland, A.H.; Groenewegen, P.P. Multilevel Analysis for Public Health and Health Services Research: Health in Context; Springer International Publishing: New York, NY, USA, 2020. [Google Scholar]
- Raudenbush, S.W.; Sampson, R.J. Ecometrics: Toward a science of assessing ecological settings, with application to the systematic social observation of neighborhoods. Sociol. Methodol. 1999, 29, 1–41. [Google Scholar] [CrossRef]
- Collins, C.; Clays, E.; Van Poel, E.; Cholewa, J.; Tripkovic, K.; Nessler, K.; de Rouffignac, S.; Šantric Milicevic, M.; Bukumiric, Z.; Adler, L.; et al. Distress and Wellbeing among General Practitioners in 33 Countries during COVID-19: Results from the Cross-Sectional PRICOV-19 Study to Inform Health System Interventions Int. J. Environ. Res. Public Health 2022, 19, 5675. [Google Scholar] [CrossRef]
- RCGP. Fit for the Future: A Vision for General Practice; Royal College of General Practitioners: London, UK, 2019. [Google Scholar]
- Alboksmaty, A.; Kumar, S.; Parekh, R.; Aylin, P. Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK—Qualitative assessment. PLoS ONE 2021, 16, e0248387. [Google Scholar] [CrossRef]
- Heins, M.; Hek, K.; Hooiveld, M.; Hendriksen, J.; Korevaar, J. Impact Coronapandemie op Aantal en Type Huisartscontacten 2020 tot Mei 2022; Nivel: Utrecht, The Netherlands, 2022. [Google Scholar]
- Verhoeven, V.; Tsakitzidis, G.; Philips, H.; Van Royen, P. Impact of the COVID-19 pandemic on the core functions of primary care: Will the cure be worse than the disease? A qualitative interview study in Flemish GPs. BMJ Open 2020, 10, e039674. [Google Scholar]
- Schäfer, I.; Hansen, H.; Menzel, A.; Eisele, M.; Tajdar, D.; Lühmann, D.; Scherer, M. The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: Results of a longitudinal observational study. BMC Fam. Pract. 2021, 22, 125. [Google Scholar] [CrossRef]
- Leong, S.L.; Teoh, S.L.; Fun, W.H.; Lee, S.W.H. Task shifting in primary care to tackle healthcare worker shortages: An umbrella review. Eur. J. Gen. Pract. 2021, 27, 198–210. [Google Scholar] [CrossRef]
- Laurant, M.G.; Reeves, D.; Hermens, R.; Braspenning, J.C.; Grol, R.; Sibbald, B. Substitution of Doctors by Nurses in Primary Care (Review); Cochrane Library: Hoboken, NJ, USA, 2007. [Google Scholar]
- Martinez-Gonzalez, N.A.; Tandjung, R.; Djalali, S.; Rosemann, T. The impact of physician-nurse task shifting in primary care on the course of disease: A systematic review. Hum. Resour. Health 2015, 13, 55. [Google Scholar] [CrossRef] [Green Version]
- Lovink, M.H.; Persoon, A.; Koopmans, R.T.C.M.; Van Vught, A.J.A.H.; Schoonhoven, L.; Laurant, M.G.H. Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: A systematic literature review. J. Adv. Nurs. 2017, 73, 2084–2102. [Google Scholar] [CrossRef] [PubMed]
- Laurant, M.; van der Biezen, M.; Wijers, N.; Watananirun, K.; Kontopantelis, E.; Ajah, V.V. Nurses as substitutes for doctors in primary care (Review). Cochrane Database Syst. Rev. 2018, 7, CD001271. [Google Scholar] [CrossRef] [PubMed]
- Jiménez Carrillo, M.; Martín Roncero, U.; Aldasoro Unamuno, E.; Morteruel Arizcuren, M.; Baza Bueno, M. Percepciones y experiencias de la población ante la transformación de la modalidad de las consultas en atención primaria durante la pandemia. Aten. Primaria 2022, 54, 102263. [Google Scholar] [CrossRef] [PubMed]
- Coma, E.; Mora, N.; Méndez, L.; Benítez, M.; Hermosilla, E.; Fàbregas, M.; Fina, F.; Mercadé, A.; Flayeh, S.; Guiriguet, C.; et al. Primary care in the time of COVID-19: Monitoring the effect of the pandemic and the lockdown measures on 34 quality of care indicators calculated for 288 primary care practices covering about 6 million people in Catalonia. BMC Fam. Pract. 2020, 21, 208. [Google Scholar] [CrossRef] [PubMed]
- Liseckiene, I.; Ratkiene, G.; Jurgutis, A. Lithuania Transforming primary Health Care during the Pandemic: Multi-Disciplinary Primary Health Care during the COVID 19 Pandemic: Improving Access through Remote Consultations; WHO: Copenhagen, Denmark, 2021. [Google Scholar]
- Nolte, E.; Groenewegen, P.P. How Can We Transfer Service and Policy Innovations between Health Systems? Policy Brief 40; World Health Organization, European Observatory on Health Systems and Policies: Copenhagen, Denmark, 2021. [Google Scholar]
- Hewko, S.J.; Cooper, S.L.; Huynh, H.; Spiwek, T.L.; Carleton, H.L.; Reid, S.; Cummings, G.G. Invisible no more: A scoping review of the health care aide workforce literature. BMC Nurs. 2015, 14, 38. [Google Scholar] [CrossRef] [Green Version]
- Schäfer, W.; Kroezen, M.; Hansen, J.; Sermeus, W.; Aszalos, Z.; Batenburg, R. Core Competences of Healthcare Assistants in Europe (CC4HCA). An Exploratory Study into the Desirability and Feasibility of a Common Training Framework under the Professional Qualifications Directive; Publications Office of the European Union: Luxembourg, Luxemburg, 2018. [Google Scholar]
- Kroezen, M.; Schäfer, W.; Sermeus, W.; Hansen, J.; Batenburg, R. Healthcare assistants in EU member states: An overview. Health Policy 2018, 122, 1109–1117. [Google Scholar] [CrossRef] [Green Version]
- Greer, S.L.; Rozenblum, S.; Wismar, M.; Jarman, H. How Have Federal Countries Organized Their COVID-19 Response? 2020. Available online: https://eurohealthobservatory.who.int/monitors/hsrm/analyses/hsrm/how-have-federal-countries-organized-their-covid-19-response (accessed on 17 November 2022).
- Seiler, M.; Staubli, G.; Hoeffe, J.; Gualco, G.; Manzano, S.; Goldman, R.D. A tale of two parts of Switzerland: Regional differences in the impact of the COVID-19 pandemic on parent. BMC Public Health 2021, 21, 1275. [Google Scholar] [CrossRef]
- Bosmans, M.W.G.; Boerma, W.G.W.; Groenewegen, P.P. Imbalances in Rural Primary Care: A Scoping Literature Review with an Emphasis on the WHO European Region; WHO: Geneva, Switzerland, 2021. [Google Scholar]
1. Giving Information by Telephone | 2. Explaining Low Literacy | 3. Actively Reaching Out to Patients | 4. More Involved in Triage | ||||||
---|---|---|---|---|---|---|---|---|---|
Country | Agree | Strongly Agree | Agree | Strongly Agree | Agree | Strongly Agree | Agree | Strongly Agree | N between |
Austria | 45.8 | 29.0 | 39.2 | 9.6 | 36.4 | 12.1 | 46.2 | 40.2 | 125–132 |
Belgium | 39.8 | 45.0 | 34.4 | 30.1 | 26.5 | 15.9 | 39.2 | 50.5 | 279–291 |
Bosnia and Herzegovina | 32.3 | 12.9 | 29.0 | 12.9 | 22.9 | 9.7 | 32.3 | 9.7 | 31 |
Bulgaria | 61.3 | 26.3 | 58.0 | 23.5 | 45.7 | 19.8 | 59.3 | 28.4 | 80–81 |
Croatia | 44.2 | 35.8 | 47.5 | 29.7 | 40.7 | 20.3 | 43.0 | 43.8 | 118–121 |
Cyprus | 70.0 | 20.0 | 30.0 | 50.0 | 40.0 | 40.0 | 70.0 | 20.0 | 10 |
Czech Rep | 43.7 | 42.7 | 51.1 | 24.5 | 51.0 | 9.8 | 44.7 | 42.7 | 94–103 |
Denmark | 30.6 | 52.8 | 32.4 | 29.4 | 47.2 | 19.4 | 47.2 | 38.9 | 34–36 |
Estonia | 46.2 | 46.2 | 42.7 | 27.0 | 52.9 | 12.8 | 35.6 | 52.9 | 89–106 |
Finland | 40.2 | 4.9 | 5.9 | 31.4 | 4.9 | 9.8 | 14.0 | 5.0 | 100–102 |
France | 39.3 | 38.6 | 25.3 | 28.3 | 24.2 | 17.0 | 34.7 | 39.7 | 367–420 |
Germany | 31.2 | 66.4 | 35.5 | 22.3 | 40.9 | 17.3 | 40.9 | 46.5 | 251–254 |
Greece | 65.1 | 19.8 | 61.4 | 19.3 | 47.7 | 12.8 | 55.7 | 23.8 | 86–88 |
Hungary | 41.2 | 48.5 | 48.6 | 32.4 | 35.1 | 16.2 | 47.9 | 41.1 | 173–194 |
Iceland | 31.1 | 57.1 | 37.5 | 25.0 | 18.5 | 3.7 | 35.7 | 46.4 | 24–28 |
Ireland | 59.0 | 26.0 | 36.9 | 11.3 | 49.1 | 10.7 | 48.6 | 42.9 | 160–175 |
Israel | 51.5 | 12.1 | 18.8 | 4.7 | 27.0 | 9.5 | 46.0 | 20.3 | 64–74 |
Italy | 25.8 | 69.2 | 26.8 | 66.9 | 31.4 | 45.5 | 33.1 | 56.1 | 156–159 |
Kosovo | 61.5 | 26.2 | 49.3 | 26.8 | 49.3 | 34.3 | 48.4 | 25.0 | 64–67 |
Latvia | 18.1 | 71.4 | 20.0 | 60.0 | 18.9 | 66.7 | 17.7 | 75.4 | 105–133 |
Lithuania | 36.5 | 53.9 | 36.7 | 44.9 | 50.0 | 22.9 | 34.6 | 55.8 | 48–52 |
Luxemburg | 5.6 | 25.0 | 42.9 | 21.4 | 26.7 | 6.7 | 13.3 | 76.7 | 14–15 |
Malta | 42.9 | 14.3 | 0.0 | 14.3 | 28.6 | 0.0 | 42.9 | 42.9 | 7 |
Moldova | 58.8 | 38.2 | 56.7 | 35.8 | 66.7 | 27.3 | 49.3 | 46.3 | 66–68 |
Netherlands | 38.1 | 33.8 | 34.5 | 21.0 | 36.9 | 14.0 | 34.2 | 44.9 | 148–160 |
North Macedonia | 52.5 | 10.0 | 60.5 | 7.9 | 57.5 | 10.0 | 57.9 | 10.5 | 38–40 |
Norway | 41.1 | 37.9 | 30.0 | 10.0 | 34.4 | 11.2 | 51.2 | 23.6 | 100–127 |
Poland | 41.1 | 50.0 | 44.4 | 34.4 | 47.9 | 22.9 | 44.8 | 47.9 | 160–192 |
Portugal | 42.8 | 44.8 | 43.3 | 30.4 | 52.8 | 27.2 | 42.4 | 43.4 | 194–201 |
Romania | 41.1 | 51.1 | 40.5 | 48.3 | 37.4 | 47.3 | 37.0 | 55.4 | 89–92 |
Serbia | 48.0 | 12.2 | 46.7 | 10.9 | 40.7 | 11.6 | 43.3 | 19.6 | 86–98 |
Slovenia | 44.9 | 32.4 | 40.6 | 22.9 | 40.1 | 18.6 | 42.8 | 37.6 | 170–176 |
Spain | 45.7 | 30.6 | 39.1 | 21.8 | 35.9 | 18.3 | 47.3 | 26.0 | 271–278 |
Sweden | 30.3 | 67.1 | 26.4 | 9.7 | 48.0 | 13.3 | 50.0 | 31.6 | 72–76 |
Switzerland | 42.7 | 46.3 | 44.9 | 18.0 | 24.4 | 17.1 | 37.4 | 51.8 | 78–83 |
Turkey | 44.7 | 22.8 | 41.8 | 14.8 | 36.1 | 17.2 | 35.2 | 16.0 | 122–125 |
Ukraine | 49.8 | 22.7 | 46.3 | 24.1 | 49.8 | 14.3 | 54.5 | 19.6 | 216–225 |
United Kingdom | 43.5 | 30.4 | 40.9 | 40.9 | 60.9 | 4.3 | 47.8 | 39.1 | 22–23 |
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 |
Belgium | 37.2 | 30.1 | 34.3 | 15.9 | 233–440 |
Bosnia and Herzegovina | 34.4 | 53.1 | 45.5 | 15.2 | 32–33 |
Bulgaria | 41.2 | 52.9 | 54.4 | 17.8 | 85–90 |
Croatia | 22.4 | 68.0 | 40.3 | 27.1 | 125–129 |
Czech Rep | 30.5 | 54.2 | 49.0 | 8.3 | 59–96 |
Cyprus | 33.3 | 67.7 | 50.0 | 20.0 | 9–10 |
Denmark | 34.5 | 41.4 | 30.6 | 16.7 | 29–36 |
Estonia | 38.9 | 36.7 | 42.6 | 17.6 | 90–108 |
Finland | 23.4 | 18.8 | 25.3 | 2.1 | 64–95 |
France | 31.4 | 28.0 | 38.8 | 13.3 | 510–528 |
Germany | 35.1 | 33.5 | 29.1 | 7.6 | 248–251 |
Greece | 25.6 | 59.0 | 53.8 | 17.5 | 78–80 |
Hungary | 22.5 | 74.2 | 31.5 | 14.0 | 178–182 |
Iceland | 44.4 | 18.5 | 17.9 | 7.1 | 27–28 |
Ireland | 35.7 | 45.0 | 49.4 | 13.3 | 166–171 |
Israel | 40.8 | 14.3 | 39.2 | 10.8 | 49–74 |
Italy | 47.5 | 46.8 | 25.4 | 67.7 | 141–201 |
Kosovo | 39.1 | 48.4 | 54.1 | 31.1 | 64–74 |
Latvia | 14.2 | 76.4 | 22.0 | 63.6 | 127–132 |
Lithuania | 17.8 | 77.8 | 39.6 | 25.0 | 45–48 |
Luxemburg | 37.5 | 25.0 | 26.7 | 0.0 | 15–16 |
Malta | 66.7 | 22.2 | 25.0 | 0.0 | 8–9 |
Moldova | 35.5 | 62.9 | 55.4 | 32.3 | 62–65 |
Netherlands | 30.8 | 31.4 | 41.0 | 9.0 | 144–156 |
North Macedonia | 36.8 | 0.0 | 88.1 | 4.8 | 41–42 |
Norway | 32.5 | 27.0 | 42.5 | 17.3 | 126–127 |
Poland | 41.2 | 49.5 | 47.6 | 19.9 | 182–191 |
Portugal | 27.7 | 65.6 | 48.5 | 22.7 | 195–198 |
Romania | 19.5 | 74.4 | 39.3 | 49.4 | 82–89 |
Serbia | 21.6 | 68.1 | 35.6 | 17.3 | 104–116 |
Slovenia | 50.3 | 29.5 | 32.2 | 6.4 | 171–173 |
Spain | 29.9 | 49.3 | 42.7 | 20.8 | 274–278 |
Sweden | 33.3 | 64.6 | 27.0 | 9.5 | 48–74 |
Switzerland | 0.0 | 28.6 | 37.8 | 7.3 | 7–82 |
Turkey | 32.5 | 52.1 | 32.3 | 26.6 | 117–124 |
Ukraine | 45.6 | 45.2 | 52.1 | 23.1 | 228–234 |
United Kingdom | 40.9 | 27.3 | 27.3 | 9.1 | 22 |
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 |
Austria | - b | - | - | - | - | - | - |
Belgium | 17.2 | 3.2 | 20.5 | 3.1 | 17.8 | 2.1 | 373–381 |
Bosnia and Herzegovina | 12.9 | 0.0 | 28.1 | 6.3 | 65.6 | 6.3 | 31–32 |
Bulgaria | 9.5 | 4.7 | 6.9 | 0.0 | 21.4 | 4.8 | 84–87 |
Croatia | 19.7 | 4.1 | 13.1 | 4.1 | 21.0 | 6.5 | 122–125 |
Czech Rep | 8.6 | 6.9 | 13.8 | 3.5 | 24.6 | 0.0 | 57–59 |
Cyprus | 11.1 | 0.0 | 11.1 | 0.0 | 22.2 | 0.0 | 9 |
Denmark | 25.0 | 3.6 | 24.1 | 6.9 | 32.1 | 7.1 | 28–29 |
Estonia | 20.5 | 1.1 | 18.0 | 2.3 | 37.8 | 2.2 | 88–90 |
Finland | 27.3 | 12.7 | 11.9 | 1.7 | 24.1 | 5.2 | 55–64 |
France | 13.9 | 3.2 | 19.1 | 5.2 | 15.4 | 3.3 | 487–510 |
Germany | 30.6 | 5.8 | 14.2 | 8.5 | 15.5 | 4.1 | 242–248 |
Greece | 26.7 | 10.7 | 21.1 | 1.3 | 47.4 | 7.9 | 75–78 |
Hungary | 19.7 | 4.4 | 18.2 | 4.0 | 31.9 | 6.0 | 176–183 |
Iceland | 23.1 | 23.1 | 7.7 | 0.0 | 18.5 | 0.0 | 26–27 |
Ireland | 38.3 | 10.2 | 9.5 | 3.0 | 24.0 | 2.9 | 167–171 |
Israel | 25.5 | 4.3 | 23.9 | 4.4 | 30.4 | 4.4 | 46–49 |
Italy | 18.6 | 11.4 | 33.6 | 8.6 | 47.1 | 9.4 | 138–141 |
Kosovo | 44.6 | 40.0 | 30.2 | 19.1 | 47.7 | 18.5 | 63–65 |
Latvia | 19.8 | 10.3 | 15.2 | 4.0 | 7.2 | 10.4 | 125–127 |
Lithuania | 24.4 | 0.0 | 9.1 | 6.8 | 43.2 | 11.4 | 44–45 |
Luxemburg | 20.0 | 0.0 | 21.4 | 0.0 | 28.6 | 0.0 | 14–15 |
Malta | 22.2 | 11.1 | 0.0 | 0.0 | 22.2 | 0.0 | 9 |
Moldova | 25.8 | 16.1 | 18.0 | 3.3 | 50.0 | 6.7 | 60–62 |
Netherlands | 12.8 | 2.7 | 14.8 | 3.4 | 8.0 | 2.0 | 148–156 |
North Macedonia | 25.0 | 10.0 | 14.6 | 9.8 | 41.5 | 4.9 | 40–41 |
Norway | 35.3 | 5.9 | 10.6 | 0.8 | 19.2 | 1.7 | 119–126 |
Poland | 25.4 | 2.8 | 16.2 | 6.7 | 44.4 | 5.1 | 177–182 |
Portugal | 11.9 | 3.1 | 18.6 | 4.2 | 43.5 | 10.4 | 192–195 |
Romania | 27.5 | 15.0 | 22.5 | 8.8 | 45.0 | 17.5 | 80–82 |
Serbia | 31.6 | 14.5 | 16.5 | 6.1 | 21.9 | 11.4 | 114–117 |
Slovenia | 22.4 | 2.3 | 9.3 | 4.1 | 44.3 | 8.6 | 173–174 |
Spain | 18.4 | 9.4 | 10.4 | 2.9 | 30.5 | 6.8 | 277–279 |
Sweden | 19.2 | 0.0 | 19.2 | 8.5 | 6.4 | 0.0 | 47–48 |
Switzerland | 0.0 | 0.0 | 16.7 | 0.0 | 33.3 | 0.0 | 6–7 |
Turkey | 11.4 | 6.1 | 19.3 | 9.7 | 45.1 | 15.9 | 113–117 |
Ukraine | 34.4 | 10.1 | 38.0 | 11.8 | 53.8 | 12.6 | 221–227 |
United Kingdom | 59.1 | 0.0 | 22.7 | 0.0 | 18.2 | 0.0 | 22 |
Staff Absence (Weighted) | 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 |
Austria | 1.3 (0.19) | 33.1 | 14.5 | 42.7 | 18.6 | 29.1 | 4.7 | 124–127 |
Belgium | 1.5 (0.27) | 36.1 | 13.7 | 34.4 | 16.9 | 25.5 | 9.0 | 410–443 |
Bosnia and Herzegovina | 4.6 (0.59) | 34.5 | 0.0 | 37.9 | 0.0 | 28.6 | 0.0 | 26–29 |
Bulgaria | 0.9 (0.28) | 37.5 | 7.2 | 41.5 | 8.5 | 39.8 | 8.4 | 82–83 |
Croatia | 1.2 (0.52) | 28.2 | 8.1 | 44.8 | 24.0 | 39.0 | 14.6 | 117–125 |
Czech Rep | 0.9 (0.24) | 23.3 | 3.3 | 45.4 | 21.7 | 24.0 | 7.3 | 90–99 |
Cyprus | 2.9 (0.48) | 33.3 | 11.1 | 40.0 | 10.0 | 33.3 | 11.1 | 9–113 |
Denmark | 3.4 (0.44) | 29.4 | 2.9 | 58.8 | 17.7 | 20.0 | 5.7 | 34–35 |
Estonia | 1.6 (0.16) | 45.1 | 5.9 | 49.5 | 5.3 | 35.0 | 4.0 | 95–109 |
Finland | 5.8 (0.10) | 29.0 | 2.0 | 27.8 | 6.2 | 35.5 | 11.8 | 85–100 |
France | 1.9 (0.22) | 23.6 | 12.5 | 22.8 | 3.7 | 31.0 | 11.9 | 479–500 |
Germany | 2.0 (0.19) | 40.7 | 17.9 | 42.6 | 17.8 | 23.9 | 3.6 | 242–247 |
Greece | 4.3 (0.16) | 50.0 | 14.3 | 35.0 | 13.8 | 40.0 | 8.8 | 70–84 |
Hungary | 0.7 (0.26) | 22.4 | 5.8 | 50.0 | 12.8 | 40.2 | 8.9 | 172–179 |
Iceland | 6.8 (0.23) | 45.8 | 12.5 | 45.8 | 16.7 | 33.3 | 16.7 | 23–24 |
Ireland | 2.9 (0.27) | 41.8 | 6.1 | 23.3 | 7.6 | 39.2 | 7.2 | 159–166 |
Israel | 4.9 (0.30) | 30.0 | 2.9 | 45.7 | 0.0 | 20.9 | 0.0 | 67–70 |
Italy | 0.4 (0.10) | 16.2 | 4.6 | 6.1 | 1.0 | 4.6 | 0.5 | 198–200 |
Kosovo | 36.9 (0.45) | 40.3 | 50.0 | 31.4 | 47.1 | 40.0 | 45.7 | 46–72 |
Latvia | 1.0 (0.26) | 22.9 | 53.4 | 30.8 | 31.6 | 24.6 | 15.6 | 117–122 |
Lithuania | 16.9 (0.13) | 35.3 | 31.4 | 15.6 | 11.1 | 18.8 | 4.2 | 45–51 |
Luxemburg | 2.21 (0.31) | 26.7 | 6.7 | 28.6 | 7.1 | 64.3 | 14.3 | 14–53 |
Malta | 3.5 (0.29) | 50.0 | 0.0 | 42.9 | 0.0 | 16.7 | 0.0 | 6–8 |
Moldova | 21.8 (0.25) | 47.6 | 30.2 | 40.3 | 17.7 | 38.7 | 22.6 | 62–64 |
Netherlands | 4.1 (0.34) | 43.1 | 24.2 | 36.7 | 30.0 | 40.1 | 17.8 | 150–153 |
North Macedonia | 2.0 (0.51) | 64.7 | 2.9 | 69.0 | 3.4 | 48.5 | 6.1 | 29–34 |
Norway | 2.6 (0.25) | 32.8 | 5.0 | 24.1 | 3.5 | 11.9 | 1.7 | 34–119 |
Poland | 4.2 (0.34) | 39.9 | 9.0 | 20.4 | 3.0 | 22.1 | 2.3 | 167–178 |
Portugal | 5.9 (0.24) | 25.8 | 10.8 | 14.9 | 1.7 | 33.3 | 6.1 | 180–186 |
Romania | 0.7 (0.24) | 44.0 | 14.7 | 48.1 | 9.1 | 44.2 | 5.2 | 75–81 |
Serbia | 15.9 (0.36) | 34.2 | 15.4 | 22.2 | 9.3 | 31.2 | 8.3 | 84–117 |
Slovenia | 0.8 (0.24) | 34.8 | 6.8 | 48.5 | 31.5 | 44.1 | 13.0 | 161–166 |
Spain | 10.2 (0.24) | 9.1 | 1.1 | 7.92 | 0.8 | 10.8 | 1.9 | 260–266 |
Sweden | 16.6 (0.36) | 40.3 | 8.3 | 25.0 | 1.4 | 52.1 | 15.5 | 70–72 |
Switzerland | 2.1 (0.19) | 43.6 | 11.5 | 33.8 | 5.4 | 11.4 | 3.8 | 74–80 |
Turkey | 4.0 (0.39) | 42.6 | 16.5 | 13.2 | 4.4 | 21.2 | 2.7 | 104–115 |
Ukraine | 25.8 (0.44) | 32.7 | 8.2 | 36.0 | 7.4 | 35.8 | 6.7 | 193–208 |
United Kingdom | 9.7 (0.36) | 28.6 | 9.5 | 28.6 | 4.8 | 61.9 | 28.6 | 21 |
Model 1: Empty Model Coefficient (SE) | Model 2: Practice Variables Coefficient (SE) | Model 3: Interaction Terms Coefficient (SE) | Model 4: Country Variables c Coefficient (SE) | |
---|---|---|---|---|
Fixed part | ||||
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) | |||
Random part | ||||
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) | |
ICC (%) | 25.7 | 27.0 | 26.9 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Groenewegen, P.; Van Poel, E.; Spreeuwenberg, P.; Batenburg, R.; Mallen, C.; Murauskiene, L.; Peris, A.; Pétré, B.; Schaubroeck, E.; Stark, S.; et al. 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, et al. 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/ijerph192215329
Chicago/Turabian StyleGroenewegen, Peter, Esther Van Poel, Peter Spreeuwenberg, Ronald Batenburg, Christian Mallen, Liubove Murauskiene, Antoni Peris, Benoit Pétré, Emmily Schaubroeck, Stefanie Stark, and et al. 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
APA StyleGroenewegen, 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. (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(22), 15329. https://doi.org/10.3390/ijerph192215329