The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries
Abstract
:1. Introduction
Study Aim and Hypotheses
- ➢
- Practice characteristics were related to the organization of outreach work in general practice during COVID-19, including:
- ⚬
- Practice structure: practice staff size, being a teaching practice, and patient population composition
- ⚬
- Burden and available support in practice (personnel and financial resources)
- ➢
- Country characteristics were related to the organization of outreach work in general practice during COVID-19, including:
- ⚬
- Intensity of the COVID-19 pandemic
- ⚬
- Availability of a patient list system
2. Methods
2.1. Study Design and Setting
2.2. Measurements
2.3. Sampling and Recruitment
2.4. Outcome Variables
2.5. Independent Variables: Practice Characteristics
2.6. Independent Variables: Country Characteristics
2.7. Data Analysis
3. Results
4. Discussion
4.1. Main Findings
4.2. Implications for Policy, Practice, and Research
4.3. Strengths and Limitations
5. Conclusions
- Note: * All references to Kosovo, whether the territory, institutions, or population, in this project shall be understood in full compliance with the United Nations Security Council Resolution 1244 and the ICJ Opinion on the Kosovo declaration of independence, without prejudice to the status of Kosovo.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Survey Items Included in the Outcome Variable: During COVID-19… | Value | Number | Valid Percent (%) |
---|---|---|---|
… a list was compiled from the electronic medical record for at least one group of patients with a chronic condition (n = 4618) | Yes | 1392 | 30.1 |
No | 3226 | 69.9 | |
… this practice contacted patients with a chronic condition who needed follow-up care (n = 4862) | Yes | 3051 | 62.8 |
No | 1811 | 37.2 | |
… this practice contacted psychologically vulnerable patients (n = 4660) | Yes | 1668 | 35.8 |
No | 2992 | 64.2 | |
… this practice contacted patients with previous problems of domestic violence or with a problematic child-rearing situation (n = 4338) | Yes | 746 | 17.2 |
No | 3592 | 82.8 |
Practice Characteristics | Median (IQR) | Value | Number | Valid Percent (%) |
---|---|---|---|---|
Number of paid staff members (n = 4897) | 7 (3–18) | - | - | - |
Being a teaching practice for GP trainees | - | Yes | 2203 | 47.3 |
(n = 4660) | No | 2457 | 52.7 | |
Patients with chronic conditions a (n = 4851) | - | Below average | 226 | 4.7 |
Average | 2645 | 54.8 | ||
Above average | 1980 | 40.8 | ||
Patients with financial problems a (n = 4774) | - | Below average | 1047 | 21.9 |
Average | 2581 | 54.1 | ||
Above average | 1146 | 24.0 | ||
Patients with a psychiatric vulnerability a (n = 4762) | - | Below average | 863 | 18.1 |
Average | 2986 | 62.7 | ||
Above average | 913 | 19.2 | ||
The responsibilities of the respondent were increased in practice during COVID-19 (n = 4269) | - | Strongly disagree | 106 | 2.5 |
Disagree | 195 | 4.6 | ||
Neutral | 605 | 14.2 | ||
Agree | 1446 | 33.9 | ||
Strongly agree | 1917 | 44.9 | ||
Availability of an administrative assistant or practice manager (n = 4979) | - | Yes | 2861 | 57.5 |
No | 2118 | 42.5 | ||
Availability of paramedical support staff (n = 4979) | - | Yes | 3214 | 64.6 |
No | 1765 | 35.4 | ||
Capitation payment system (n = 4879) | - | Yes | 2535 | 52.0 |
No | 2344 | 48.0 |
Country Characteristics | Median (IQR) | Value | Number | Valid Percent (%) |
---|---|---|---|---|
COVID-19 cases per million population during 3 months before survey (n = 38) | 26,879 (20,909–35,065) | - | - | - |
COVID-19 mortality per million population during 3 months before survey (n = 38) | 488 (383–626) | - | - | - |
Availability of a patient list system or patient registration with a GP (n = 38) | - | Yes No | 25 13 | 65.8 34.2 |
Model I: Empty Model Coefficient (SE) | Model II: Practice Structure Coefficient (SE) | Model III: Burden and Availability of Support Coefficient (SE) | Model IV: Country Characteristics Coefficient (SE) a | |
---|---|---|---|---|
Fixed part | ||||
Constant | 0.357 (0.033) *** | 0.344 (0.034) *** | 0.322 (0.035) *** | |
Practice staff size | ||||
Number of paid staff members | −0.000 (0.000) | −0.000 (0.000) | ||
GP trainee teaching practice (ref. no) | ||||
Being a teaching practice: yes | 0.012 (0.007) p = 0.087 | 0.007 (0.007) | ||
Patient population composition (ref. approximately average) | ||||
Patients with chronic conditions: below average | 0.001 (0.015) | 0.001 (0.015) | ||
Patients with chronic conditions: above average | 0.005 (0.007) | 0.005 (0.007) | ||
Patients with financial problems: below average | 0.008 (0.008) | 0.009 (0.008) | ||
Patients with financial problems: above average | 0.001 (0.009) | 0.001 (0.009) | ||
Patients with a psychiatric vulnerability: below average | 0.011 (0.009) | 0.012 (0.009) | ||
Patients with a psychiatric vulnerability: above average | 0.010 (0.009) | 0.009 (0.009) | ||
Burden | ||||
Increased responsibilities during COVID-19 | 0.006 (0.003) p = 0.076 | |||
Availability of support (ref. no) | ||||
Availability of administrative assistant or practice manager: yes | 0.017 (0.008) * | |||
Availability of paramedical support staff: yes | 0.024 (0.009) ** | |||
Capitation payment model: yes | −0.009 (0.010) | |||
Intensity of COVID-19 in the 3 months before country-specific study commencement | ||||
COVID-19 cases per million population | −0.000 (0.000) | |||
COVID-19 mortality per million population | 0.000 (0.000) | |||
Patient list system (ref. no) | ||||
Availability of patient list system/ patient registration with a GP: yes | 0.067 (0.069) | |||
Random part | ||||
Country variance | 0.042 (0.010) | 0.041 (0.010) | 0.041 (0.010) | |
Practice variance | 0.046 (0.001) | 0.046 (0.001) | 0.046 (0.001) | |
ICC (%) | 47.7 | 47.1 | 47.1 |
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Van Poel, E.; Collins, C.; Groenewegen, P.; Spreeuwenberg, P.; Bojaj, G.; Gabrani, J.; Mallen, C.; Murauskiene, L.; Šantrić Milićević, M.; Schaubroeck, E.; et al. The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries. Int. J. Environ. Res. Public Health 2023, 20, 3165. https://doi.org/10.3390/ijerph20043165
Van Poel E, Collins C, Groenewegen P, Spreeuwenberg P, Bojaj G, Gabrani J, Mallen C, Murauskiene L, Šantrić Milićević M, Schaubroeck E, et al. The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries. International Journal of Environmental Research and Public Health. 2023; 20(4):3165. https://doi.org/10.3390/ijerph20043165
Chicago/Turabian StyleVan Poel, Esther, Claire Collins, Peter Groenewegen, Peter Spreeuwenberg, Gazmend Bojaj, Jonila Gabrani, Christian Mallen, Liubove Murauskiene, Milena Šantrić Milićević, Emmily Schaubroeck, and et al. 2023. "The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries" International Journal of Environmental Research and Public Health 20, no. 4: 3165. https://doi.org/10.3390/ijerph20043165