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
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Sampling and Recruitment
2.3. Data Analysis
2.4. Ethical Approval
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Serrano-Ripoll, M.J.; Meneses-Echavez, J.F.; Ricci-Cabello, I.; Fraile-Navarro, D.; Fiol-deRoque, M.A.; Pastor-Moreno, G.; Castro, A.; Ruiz-Pérez, I.; Zamanillo-Campos, R.; Gonçalves-Bradley, D.C. Impact of viral epidemic outbreaks on mental health of healthcare workers: A rapid systematic review and meta-analysis. J. Affect. Disord. 2020, 277, 347–357. [Google Scholar] [CrossRef]
- Cabarkapa, S.; Nadjidai, S.E.; Murgier, J.; Ng, C.H. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain Behav. Immun. Health 2020, 8, 100144. [Google Scholar] [CrossRef]
- Pollock, A.; Campbell, P.; Cheyne, J.; Cowie, J.; Davis, B.; McCallum, J.; McGill, K.; Elders, A.; Hagan, S.; McClurg, D.; et al. Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: A mixed methods systematic review. Cochrane Database Syst. Rev. 2020, 11. [Google Scholar] [CrossRef]
- Billings, J.; Ching, B.C.F.; Gkofa, V.; Greene, T.; Bloomfield, M. Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: A systematic review and qualitative meta-synthesis. BMC Health Serv. Res. 2021, 21, 923. [Google Scholar] [CrossRef]
- West, C.P.; Dyrbye, L.N.; Erwin, P.J.; Shanafelt, T.D. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet 2016, 388, 2272–2281. [Google Scholar] [CrossRef]
- Naehrig, D.; Schokman, A.; Hughes, J.K.; Epstein, R.; Hickie, I.B.; Glozier, N. Effect of interventions for the well-being, satisfaction and flourishing of general practitioners—A systematic review. BMJ Open 2021, 11, e046599. [Google Scholar] [CrossRef]
- Batra, K.; Singh, T.P.; Sharma, M.; Batra, R.; Schvaneveldt, N. Investigating the Psychological Impact of COVID-19 among Healthcare Workers: A Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 9096. [Google Scholar] [CrossRef]
- Murray, M.; Murray, L.; Donnelly, M. Systematic review of interventions to improve the psychological well-being of general practitioners. BMC Fam. Pract. 2016, 17, 36. [Google Scholar] [CrossRef] [Green Version]
- Chambers, R.; Belcher, J. Self-reported health care over the past 10 years: A survey of general practitioners. Br. J. Gen. Pract. 1992, 42, 153–156. [Google Scholar]
- 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]
- Dyrbye, L.N.; Satele, D.; Shanafelt, T. Ability of a 9-item well-being index to identify distress and stratify quality of life in US workers. J. Occup. Environ. Med. 2016, 58, 810–817. [Google Scholar] [CrossRef]
- Harris, P.A.; Taylor, R.; Minor, B.L.; Elliott, V.; Fernandez, M.; O’Neal, L.; McLeod, L.; Delacqua, G.; Delacqua, F.; Kirby, J.; et al. The REDCap consortium: Building an international community of software platform partners. J. Biomed. Inform. 2019, 95, 103208. [Google Scholar] [CrossRef]
- United Nations Department of Economic and Social Affairs. Available online: https://esa.un.org/MigFlows/Definition%20of%20regions.pdf (accessed on 29 April 2022).
- Böhma, K.; Schmidb, A.; Götze, R.; Landwehr, C.; Rothgang, H. Five types of OECD healthcare systems: Empirical results of a deductive classification. Health Policy 2013, 113, 258–269. [Google Scholar] [CrossRef]
- Kringos, D.S. The Strength of Primary Care in Europe; NIVEL: Utrecht, The Netherlands, 2012; pp. 145–164. [Google Scholar]
- Jefferson, L.; Golder, S.; Heathcote, C.; Castro-Avila, A.; Dale, V.; Essex, H.; van der Feltz-Cornelis, C.; McHugh, E.; Moe-Bryne, T.; Bloor, K. General practitioner wellbeing during the COVID-19 pandemic. A systematic review. BJGP 2022, 72, 718. [Google Scholar] [CrossRef]
- Muller, A.E.; Hafstad, E.V.; Himmels, J.P.W.; Smedslund, G.; Flottorp, S.; Stensland, S.Ø.; Stroobants, S.; Van De Velde, S.; Vist, G.E. The mental health impact of the COVID-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatr. Res. 2020, 293, 113441. [Google Scholar] [CrossRef]
- Valaine, L.; Ancāne, G.; Utināns, A.; Briģis, Ģ. Mental Health and Associated Demographic and Occupational Factors among Health Care Workers during the COVID-19 Pandemic in Latvia. Medicina 2021, 57, 1381. [Google Scholar] [CrossRef]
- Werdecker, L.; Esch, T. Burnout, satisfaction and happiness among German general practitioners (GPs): A cross-sectional survey on health resources and stressors. PLoS ONE 2021, 16, e0253447. [Google Scholar] [CrossRef]
- Monterrosa-Castro, A.; Redondo-Mendoza, V.; Mercado-Lara, M. Psychosocial factors associated with symptoms of generalized anxiety disorder in general practitioners during the COVID-19 pandemic. J. Investig. Med. 2020, 68, 1228–1234. [Google Scholar] [CrossRef]
- De Kock, J.H.; Latham, H.A.; Leslie, S.J.; Grindle, M.; Monoz, S.A.; Ellis, L.; Polson, R.; O’Malley, C.M. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: Implications for supporting psychological well-being. BMC Public Health 2021, 21, 104. [Google Scholar] [CrossRef]
- Matheson, C.; Robertson, H.D.; Elliott, A.M.; Iversen, L.; Murchie, P. Resilience of primary healthcare professionals working in challenging environments: A focus group study. Br. J. Gen. Pract. 2016, 66, e507–e515. [Google Scholar] [CrossRef]
- Merino, M.; Privado, J. Does Employee Recognition Affect Positive Psychological Functioning and Well-Being? The Spanish. J. Psychol. 2015, 18, E64. [Google Scholar] [CrossRef]
- Lum, A.; Goh, Y.L.; Wong, K.S.; Seah, J.; Teo, G.; Ng, J.Q.; Abdin, E.; Hendricks, M.M.; Tham, J.; Nan, W.; et al. Impact of COVID-19 on the mental health of Singaporean GPs: A cross-sectional study. BJGP Open 2021, 5. [Google Scholar] [CrossRef]
- Kurotschka, P.K.; Serafini, A.; Demontis, M.; Serafini, A.; Mereu, A.; Moro, M.F.; Carta, M.G.; Ghirotto, L. General Practitioners’ Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study. Front. Public Health 2021, 9. [Google Scholar] [CrossRef]
- Gray, R.; Sanders, C. A reflection on the impact of COVID-19 on primary care in the United Kingdom. J. Interprof. Care 2020, 34, 672–678. [Google Scholar] [CrossRef]
- 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] [CrossRef]
- Lasalvia, A.; Rigon, G.; Rugiu, C.; Negri, C.; Del Zotti, F.; Amaddeo, F.; Bonetto, C. The psychological impact of COVID-19 among primary care physicians in the province of Verona, Italy: A cross-sectional study during the first pandemic wave. Fam. Pract. 2022, 39, 65–73. [Google Scholar] [CrossRef]
- Long, L.; Moore, D.; Robinson, S.; Sansom, A.; Aylward, A.; Fletcher, E.; Welsman, J.; Dean, S.G.; Campbell, J.L.; Anderson, R. Understanding why primary care doctors leave direct patient care: A systematic review of qualitative research. BMJ Open 2020, 10, e029846. [Google Scholar] [CrossRef]
- Eley, E.; Jackson, B.; Burton, C.; Walton, E. Professional resilience in GPs working in areas of socioeconomic deprivation: A qualitative study in primary care. Br. J. Gen. Pract. 2018, 68, e819–e825. [Google Scholar] [CrossRef] [Green Version]
- Tsiga, E.; Panagopoulou, E.; Sevdalis, N.; Montgomery, A.; Benos, A. The influence of time pressure on adherence to guidelines in primary care: An experimental study. BMJ Open 2013, 3, e002700. [Google Scholar] [CrossRef] [Green Version]
- Nejasmic, D.; Vrdoljak, D.; Lang, B.V.; Borovac, J.A.; Marusic, A. Awareness, attitudes, barriers, and knowledge about evidencebased medicine among family physicians in Croatia: A cross-sectional study. BMC Fam. Pract. 2020, 21, 88. [Google Scholar] [CrossRef]
- Galbraith, N.; Boyda, D.; McFeeters, D.; Hassan, T. The mental health of doctors during the COVID-19 pandemic. BJPsych. Bull 2020, 45, 93–97. [Google Scholar] [CrossRef]
- Lingum, N.R.; Sokoloff, L.G.; Meyer, R.M.; Gingrich, S.; Sodums, D.J.; Santiago, A.T.; Feldman, S.; Guy, S.; Moser, A.; Shaikh, S.; et al. Building long-term care staff capacity during COVID-19 through just-in-time learning: Evaluation of a modified ECHO model. J. Am. Med. Dir. Assoc. 2020, 22, 238–244.E1. [Google Scholar] [CrossRef]
- Békési, D.; Teker, I.; Torzsa, P.; Kalabay, L.; Rózsa, S.; Eőry, A. To prevent being stressed-out: Allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study. Eur. J. Gen. Pract. 2021, 27, 277–285. [Google Scholar] [CrossRef]
- Vilovic, T.; Bozic, J.; Vilovic, M.; Rusic, D.; Zuzic-Furlan, S.; Rada, M.; Tomicic, M. Family Physicians’ Standpoint and Mental Health Assessment in the Light of COVID-19 Pandemic-A Nationwide Survey Study. Int. J. Environ. Res. Public Health 2021, 18, 2093. [Google Scholar] [CrossRef]
- Lange, M.; Joo, S.; Couette, P.A.; Le Bas, F.; Humbert, X. Impact on mental health of the COVID-19 outbreak among general practitioners during the sanitary lockdown period. Ir. J. Med. Sci. 2022, 191, 93–96. [Google Scholar] [CrossRef]
- Amerio, A.; Bianchi, D.; Santi, F.; Costantini, L.; Odone, A.; Signorelli, A.; Costanza, A.; Serafini, G.; Amore, M.; Aguglia, A. COVID-19 pandemic impact on mental health: A web-based cross-sectional survey on a sample of Italian general practitioners. Acta Biomed. 2020, 91, 83–88. [Google Scholar] [CrossRef]
- Luzet, J.; Beltran-Anzola, A.; Gilibert, M.; Tosello, B.; Gire, C. General practitioners’ experiences during the COVID-19 epidemic in the Bouches-du-Rhône department: Anxiety, impact on practice and doctor-patient relationship. La Presse Médicale Open 2021, 2, 100016. [Google Scholar] [CrossRef]
n | % | ||
---|---|---|---|
GP Individual Factors | |||
Years of experience (n = 3698) | |||
0–9 | 941 | 25.4 | |
10–19 | 930 | 25.1 | |
20–29 | 1022 | 27.6 | |
30–39 | 805 | 21.8 | |
Practice Factors | Location of practice (n = 3700) | ||
Big (inner) city | 1215 | 32.8 | |
Suburbs | 374 | 10.1 | |
(Small) town | 673 | 18.2 | |
Mixed urban–rural | 751 | 20.3 | |
Rural | 687 | 18.6 | |
Number of GPs (n = 3675) | |||
1 | 1433 | 39.0 | |
2 | 585 | 15.9 | |
3–4 | 742 | 20.2 | |
5+ | 915 | 24.9 | |
Patients with chronic conditions (n = 3624) | |||
Below average | 178 | 4.9 | |
Approx. average | 2030 | 56.0 | |
Above average | 1416 | 39.1 | |
Patients with financial problems (n = 3571) | |||
Below average | 814 | 22.8 | |
Approx. average | 1962 | 54.9 | |
Above average | 795 | 22.3 |
n | Strongly Disagree % | Disagree % | Neutral % | Agree % | Strongly Agree % | Mean (SD) | |
---|---|---|---|---|---|---|---|
If staff members in this practice are absent because of COVID-19, this practice can count on the help of other PC practices in the neighborhood | 3540 | 20.7 | 22.9 | 13.2 | 30.7 | 12.4 | 1.91 (1.36) |
There is adequate support from government for proper functioning of practice | 3643 | 20.0 | 33.6 | 23.4 | 18.7 | 4.3 | 1.53 (1.13) |
Since COVID-19, my responsibilities in this practice increased | 3296 | 2.6 | 4.4 | 15.4 | 32.2 | 45.4 | 3.13 (1.00) |
I need further training for these amended responsibilities since COVID-19 | 3238 | 13.1 | 25.3 | 28.3 | 27.4 | 5.9 | 1.88 (1.13) |
Since COVID-19, in this practice, there is enough protected time provided for reviewing guidelines scientific literature | 3644 | 28.2 | 24.0 | 14.8 | 22.3 | 10.6 | 1.63 (1.37) |
n | % | ||
---|---|---|---|
During the past month, have you felt burned out from your work? | No | 1242 | 33.5 |
Yes | 2469 | 66.5 | |
During the past month, have you worried that your work is hardening you? | No | 1638 | 44.1 |
Yes | 2073 | 55.9 | |
During the past month, have you often been bothered by feeling down, depressed, or hopeless? | No | 2083 | 56.1 |
Yes | 1628 | 43.9 | |
During the past month, have you fallen asleep while sitting inactive in a public place? | No | 3322 | 89.5 |
Yes | 389 | 10.5 | |
During the past month, have you felt that all the things you had to do were piling up so high that you could not overcome them? | No | 1754 | 47.3 |
Yes | 1957 | 52.7 | |
During the past month, have you been bothered by emotional problems (such as feeling anxious, depressed, or irritable)? | No | 1589 | 42.8 |
Yes | 2122 | 57.2 | |
During the past month, has your physical health interfered with your ability to do your daily work at home and/or away from home? | No | 2481 | 66.9 |
Yes | 1230 | 33.1 | |
The work I do is meaningful to me. | 1 (Strongly disagree) | 35 | 0.9 |
2 | 54 | 1.5 | |
3 | 123 | 3.3 | |
4 | 222 | 6.0 | |
5 | 684 | 18.4 | |
6 | 987 | 26.6 | |
7 (Strongly agree) | 1606 | 43.3 | |
My work schedule leaves me enough time for my personal/family life. | 1 (Strongly disagree) | 755 | 20.3 |
2 | 938 | 25.3 | |
3 | 907 | 24.4 | |
4 | 750 | 20.2 | |
5 (Strongly agree) | 361 | 9.7 | |
eWBI scores | −2 | 310 | 8.4 |
−1 | 291 | 7.8 | |
0 | 331 | 8.9 | |
1 | 385 | 10.4 | |
2 | 414 | 11.2 | |
3 | 427 | 11,5 | |
4 | 428 | 11.5 | |
5 | 444 | 12.0 | |
6 | 419 | 11.3 | |
7 | 191 | 5.1 | |
8 | 59 | 1.6 | |
9 | 12 | 0.3 | |
Mean: 2.7; SD: 2.7; Median: 3 |
Linear Mixed Models, Fixed Effect Estimate (95% CI) for Total eWBI Score | ||||
---|---|---|---|---|
Model I: Fixed Effect Estimate (95% CI) | Model II: Fixed Effect Estimate (95% CI) | Model III: Fixed Effect Estimate (95% CI) | Model IV: Fixed Effect Estimate (95% CI) | |
Intercept | 2.65 (2.24, 3.07) *** | 2.04 (1.59, 2.50) *** | 0.91 (0.30, 1.53) ** | 1.00 (0.32, 1.68) ** |
GP experience | ||||
30–39 years | Ref. | Ref. | Ref. | |
20–29 years | 0.69 (0.45, 0.93) *** | 0.74 (0.50, 0.99) *** | 0.50 (0.25, 0.76) *** | |
10–19 years | 0.73 (0.49, 0.98) *** | 0.85 (0.60, 1.10) *** | 0.54 (0.28, 0.80) *** | |
0–9 years | 0.81 (0.56, 1.06) *** | 0.87 (0.62, 1.12) *** | 0.48 (0.21, 0.74) *** | |
Number of GP staff in practice | ||||
≥5 | Ref. | Ref. | ||
3–4 | 0.22 (−0.05, 0.49) | 0.19 (−0.08, 0.47) | ||
2 | 0.35 (0.06, 0.65) * | 0.35 (0.05, 0.65) * | ||
1 | 0.50 (0.22, 0.78) *** | 0.56 (0.27, 0.86) *** | ||
Practice location | ||||
Big (inner) city | Ref. | Ref. | ||
Suburbs | 0.09 (−0.22, 0.40) | 0.03 (−0.29, 0.34) | ||
(Small) town | 0.17 (−0.09, 0.42) | 0.07 (−0.19, 0.33) | ||
Mixed urban–rural | 0.40 (0.16, 0.65) ** | 0.29 (0.04, 0.55) * | ||
Rural | 0.07 (−0.18, 0.33) | 0.13 (−0.14, 0.39) | ||
Patient population: chronic disease | ||||
Below average | Ref. | Ref. | ||
Approximately average | 0.07 (−0.33, 0.47) | 0.01 (−0.40, 0.41) | ||
Above average | 0.66 (0.25, 1.07) ** | 0.47 (0.05, 0.89) * | ||
Patient population: financial problems | ||||
Below average | Ref. | Ref. | ||
Approximately average | 0.40 (0.19, 0.62) *** | 0.34 (0.11, 0.56) ** | ||
Above average | 0.69 (0.43, 0.95) *** | 0.59 (0.33, 0.86) *** | ||
Collaboration from neighborhood practices (0–4) | −0.17 (−0.24, −0.10) *** | |||
Adequate government support (0–4) | −0.31 (−0.40, −0.23) *** | |||
Responsibilities have increased (0–4) | 0.39 (0.30, 0.48) *** | |||
Further training for amended responsibilities needed (0–4) | 0.36 (0.27, 0.44) *** | |||
Enough protected time for reviewing guidelines/literature (0–4) | −0.33 (−0.40, −0.26) *** | |||
Intercept variance (s.e.) | 1.31 (0.35) *** | 1.35 (0.36) *** | 1.26 (0.33) *** | 0.49 (0.15) *** |
Residual variance (s.e.) | 6.42 (0.15) *** | 6.32 (0.15) *** | 6.11 (0.15) *** | 5.31 (0.14) *** |
MODEL INFORMATION | ||||
Akaike’s Information Criterion (AIC) | 17,535.32 | 17,423.17 | 16,262.10 | 12,889.80 |
−2 log likelihood | 17,531.32 | 17,419.17 | 16,258.10 | 12,885.80 |
Likelihood ratio test | 112.15 (df = 3) *** | 1161.07 (df = 11) *** | 3372.30 (df = 16) *** |
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Collins, C.; Clays, E.; Van Poel, E.; Cholewa, J.; Tripkovic, K.; Nessler, K.; de Rouffignac, S.; Šantrić Milićević, 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. https://doi.org/10.3390/ijerph19095675
Collins C, Clays E, Van Poel E, Cholewa J, Tripkovic K, Nessler K, de Rouffignac S, Šantrić Milićević 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. International Journal of Environmental Research and Public Health. 2022; 19(9):5675. https://doi.org/10.3390/ijerph19095675
Chicago/Turabian StyleCollins, Claire, Els Clays, Esther Van Poel, Joanna Cholewa, Katica Tripkovic, Katarzyna Nessler, Ségolène de Rouffignac, Milena Šantrić Milićević, Zoran Bukumiric, Limor Adler, and et al. 2022. "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" International Journal of Environmental Research and Public Health 19, no. 9: 5675. https://doi.org/10.3390/ijerph19095675