Primary health care; General practice; Quality of care; Equity; Patient safety; Timeliness; Personcenteredness; Efficiency; Effectiveness; COVID-19; PRICOV-19; Family Practice
Abstract :
[en] Background The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries. Methods The data collected from 479 Belgian practices during 2020-2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system. Results Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries. Conclusions Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Van Poel, Esther; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ; Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
Vanden Bussche, Pierre; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ; Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
Pétré, Benoît ; Université de Liège - ULiège > Département des sciences de la santé publique > Education thérapeutique du patient au service des soins intégrés
Ponsar, Cécile; Institute of Health and Soci-ety, University of Louvain, Louvain, Belgium
Collins, Claire; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ; Research Centre, Irish College of General Practitioners, Dublin, Ireland
De Jonghe, Michel; Centre Académique de Médecine Générale, Université Catholique de Louvain, Brussels, Belgium
Donneau, Anne-Françoise ; Université de Liège - ULiège > Département des sciences de la santé publique
Gillain, Nicolas ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique : aspects spécifiques
Guillaume, Michèle ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique : aspects spécifiques
Willems, Sara; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ; Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
Language :
English
Title :
Quality of care in Belgian general practices during the COVID-19 pandemic: results of the cross-sectional PRICOV-19 study
C. El Bcheraoui H. Weishaar F. Pozo-Martin J. Hanefeld Assessing COVID-19 through the lens of health systems’ preparedness: time for a change Global Health 2020 16 112 1 5
A. Windak T. Frese E. Hummers Z. Klemenc Ketis S. Tsukagoshi J. Vilaseca et al. Academic general practice/family medicine in times of COVID-19–perspective of WONCA Europe Eur J Gen Pract 2020 26 1 182 188 1:CAS:528:DC%2BB38Xhs12ntb3P 33337939 7751383 10.1080/13814788.2020.1855136
S. Park J. Elliott A. Berlin J. Hamer-Hunt A. Haines Strengthening the UK primary care response to covid-19 BMJ 2020 370 m3691 32978177 10.1136/bmj.m3691
A. Khalil-Khan M.A. Khan The impact of COVID-19 on primary care: a scoping review Cureus 2023 15 1 e33241 36618499 9815485
M. Kidd Australia’s primary care COVID-19 response Aust J Gen Pract. 2020 49 1 2 10.31128/AJGP-COVID-02
N. Shbaklo T. Lupia F.G. De Rosa S. Corcione Infection control in the era of COVID-19: a narrative review Antibiotics 2021 10 10 1244 1:CAS:528:DC%2BB3MXitlCltbbL 34680824 8532716 10.3390/antibiotics10101244
A. de Sutter C. Llor M. Maier C. Mallen A. Tatsioni H. van Weert et al. Family medicine in times of ‘COVID-19’: a generalists’ voice Eur J Gen Pract 2020 26 1 58 60 1:CAS:528:DC%2BB38Xhs12ntbzK 32349550 7241505 10.1080/13814788.2020.1757312
S. Matenge E. Sturgiss J. Desborough S. Hall Dykgraaf G. Dut M. Kidd Ensuring the continuation of routine primary care during the COVID-19 pandemic: a review of the international literature Fam Pract 2022 39 4 747 761 34611708 10.1093/fampra/cmab115
P.K. Kurotschka A. Serafini M. Demontis A. Serafini A. Mereu M.F. Moro et al. General practitioners’ experiences during the first phase of the COVID-19 pandemic in Italy: a critical incident technique study Front Public Health 2021 9 623904 33614587 7888233 10.3389/fpubh.2021.623904
A.K. Sahu J. Nayer P. Aggarwal Novel coronavirus: a capsule review for primary care and acute care physicians J Family Med Prim care 2020 9 4 1820 32670925 7346926 10.4103/jfmpc.jfmpc_217_20
Domus Medica. Tien vuistregels voor veilig (blijven) werken: check! 2020. Available from: https://www.domusmedica.be/actueel/tien-vuistregels-voor-veilig-blijven-werken-check. Accessed 7 Oct 2022.
la Société Scientifique de Médecine Générale. Actualité COVID-19 2022 [Available from: https://www.ssmg.be/avada_portfolio/actualite-covid-19/. Accessed 7 Nov 2023.
Sciensano. COVID-19 procedures [Available from: https://covid-19.sciensano.be/nl/covid-19-procedures. Accessed 7 Nov 2023.
B. Vaes B. Vos M. Foidart R. De Schreye D. Schrans H. Philips et al. Burden of COVID-19 on primary care: a prospective Nationwide Observational Study Arch Public Health 2021 80 1 250 10.1186/s13690-022-01003-0
K. Danhieux V. Buffel A. Pairon A. Benkheil R. Remmen E. Wouters J. van Olmen The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium BMC Fam Pract 2020 21 1 255 1:CAS:528:DC%2BB3cXisFemsL3E 33278877 7718831 10.1186/s12875-020-01326-3
N. Khan D. Jones A. Grice S. Alderson S. Bradley P. Carder et al. A brave new world: the new normal for general practice after the COVID-19 pandemic BJGP Open 2020 4 3 bjgpopen20X101103 32487520 7465568 10.3399/bjgpopen20X101103
S. Rawaf L.N. Allen F.L. Stigler D. Kringos H. Quezada Yamamoto C. van Weel et al. Lessons on the COVID-19 pandemic, for and by primary care professionals worldwide Eur J Gen Pract 2020 26 1 129 133 1:CAS:528:DC%2BB38Xhs12ntbzL 32985278 7534357 10.1080/13814788.2020.1820479
S. Singu A. Acharya K.B. Challagundla S.N. Byrareddy Impact of social determinants of health on the emerging COVID-19 pandemic in the United States Front Public Health 2020 8 406 32793544 7385373 10.3389/fpubh.2020.00406
C.L. McNeely L.A. Schintler B. Stabile Social determinants and COVID-19 disparities: Differential pandemic effects and dynamics World Med Health Policy 2020 12 3 206 217 10.1002/wmh3.370
A. Jani Preparing for COVID-19’s aftermath: simple steps to address social determinants of health J R Soc Med 2020 113 6 205 207 32314660 7439594 10.1177/0141076820921655
S. Matenge E. Sturgiss J. Desborough S.D. Hall G. Dut M. Kidd Ensuring the continuation of routine primary care during the COVID-19 pandemic: a review of the international literature Fam Pract. 2021 39 4 747 761 8515263 10.1093/fampra/cmab115
D. Golinelli F. Sanmarchi A. Capodici G. Gribaudo M. Altini S. Rosa et al. Variations of the quality of care during the COVID-19 pandemic affected the mortality rate of non-COVID-19 patients with hip fracture Plos One 2022 17 2 e0263944 1:CAS:528:DC%2BB38Xks1Ggsb8%3D 35171967 8849602 10.1371/journal.pone.0263944
L.J. Labrague J.A.A. de Los Santos D.C. Fronda Factors associated with missed nursing care and nurse-assessed quality of care during the COVID‐19 pandemic J Nurs Adm Manag 2022 30 1 62 70 10.1111/jonm.13483
E. Van Poel P. Vanden Bussche Z. Klemenc-Ketis S. Willems How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries BMC Prim care 2022 23 1 1 11
P.A. Harris R. Taylor B.L. Minor V. Elliott M. Fernandez L. O’Neal et al. The REDCap consortium: building an international community of software platform partners J Biomed Inform 2019 95 103208 31078660 7254481 10.1016/j.jbi.2019.103208
National Institute for Health and Disability Insurance. Een zorgverlener zoeken. Available from: https://webappsa.riziv-inami.fgov.be/silverpages/. Accessed 1 Nov 2022.
Institute of Medicine Committee on Quality of Health Care Crossing the Quality Chasm: a New Health System for the 21st Century 2001 Washington (DC) National Academies Press (US)
P. Korneta M. Kludacz-Alessandri R. Walczak The impact of COVID-19 on the performance of primary health care service providers in a capitation payment system: a case study from Poland Int J Environ Res Public Health 2021 18 4 1407 33546467 7913620 10.3390/ijerph18041407
T. Bouchez S. Gautier J. Le Breton Y. Bourgueil A. Ramond-Roquin 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 1 82 1:CAS:528:DC%2BB38Xhs1SnsrbM 35436865 9014789 10.1186/s12875-022-01694-y
E. Van Poel C. Collins P. Groenewegen P. Spreeuwenberg G. Bojaj J. Gabrani 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 4 3165 36833862 9960761 10.3390/ijerph20043165
M.J. Splinter P. Velek M.K. Ikram B.C.T. Kieboom R.P. Peeters P.J.E. Bindels et al. Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: a population-based cross-sectional study PLoS Med 2021 18 11 e1003854 1:CAS:528:DC%2BB3MXislegsLzI 34813591 8610236 10.1371/journal.pmed.1003854
P. Groenewegen E. Van Poel P. Spreeuwenberg R. Batenburg C. Mallen L. Murauskiene 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 22 15329 36430047 9690243 10.3390/ijerph192215329
D. Schrans D. Avonts T. Christiaens S. Willems K. De Smet K. van Boven et al. The search for person-related information in general practice: a qualitative study Fam Pract 2016 33 1 95 99 26787770 10.1093/fampra/cmv099
C.A. O’Donnell N. Burns F.S. Mair C. Dowrick C. Clissmann M. van den Muijsenbergh et al. Reducing the health care burden for marginalised migrants: the potential role for primary care in Europe Health Policy 2016 120 5 495 508 27080344 10.1016/j.healthpol.2016.03.012
International Organization of Migration World Migration Report 2020 2019 Geneva International Organization for Migration 10.18356/b1710e30-en
A. Kourti A. Stavridou E. Panagouli T. Psaltopoulou C. Spiliopoulou M. Tsolia et al. Domestic violence during the COVID-19 pandemic: a systematic review Trauma, violence, and abuse. 2021 15248380211038690 719 745
M. Koch S. Park Do government responses impact the relationship between age, gender and psychological distress during the COVID-19 pandemic? A comparison across 27 European countries Soc Sci Med 2022 292 114583 34864277 10.1016/j.socscimed.2021.114583
World Health Organization A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals 2018 Geneva World Health Organization
R. Chou T. Dana D.I. Buckley S. Selph R. Fu A.M. Totten Epidemiology of and risk factors for coronavirus infection in health care workers: a living rapid review Ann Intern Med 2020 173 2 120 136 32369541 10.7326/M20-1632
World Health Organization Infection prevention and control of epidemic-and pandemic-prone acute respiratory infections in health care 2014 Geneva World Health Organization
H. Fernemark J. Skagerström I. Seing M. Hårdstedt K. Schildmeijer P. Nilsen Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden BMJ Open 2022 12 2 e055035 35135771 10.1136/bmjopen-2021-055035
A. Turner A. Scott J. Horwood C. Salisbury R. Denholm L. Scott et al. Maintaining face-to-face contact during the COVID-19 pandemic: a longitudinal qualitative investigation in UK primary care BJGP Open. 2021 5 5 1 11 10.3399/BJGPO.2021.0036
A. Windak K. Nessler E. Van Poel C. Collins E. Wójtowicz L. Murauskiene et al. Responding to COVID-19: the suitability of primary care infrastructure in 33 countries Int J Environ Res Public Health 2022 19 24 17015 36554901 9779330 10.3390/ijerph192417015
Nederlands Huisartsen Genootschap. Richtlijn Infectiepreventie in de huisartsen- en verloskundigenpraktijk 2021 [Available from: https://www.nhg.org/themas/publicaties/nhg-richtlijn-infectiepreventie. Accessed 7 Oct 2022.
S. Kirk D. Parker T. Claridge A. Esmail M. Marshall Patient safety culture in primary care: developing a theoretical framework for practical use Qual Saf Health Care 2007 16 4 313 320 17693682 2464946 10.1136/qshc.2006.018366
L. Sharp K. Rannus A. Olofsson D. Kelly W.H. Oldenmenger EONS RECaN group Patient safety culture among European cancer nurses—An exploratory, cross-sectional survey comparing data from Estonia, Germany, Netherlands, and United Kingdom J Adv Nurs 2019 7512 3535 3543 10.1111/jan.14177
D. Jones R.D. Neal S.R. Duffy S.E. Scott K.L. Whitaker K. Brain Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care Lancet Oncol 2020 21 6 748 750 1:CAS:528:DC%2BB3cXosFSrtr0%3D 32359404 7251992 10.1016/S1470-2045(20)30242-4
S.L. Albert M.M. Paul A.M. Nguyen D.R. Shelley C.A. Berry A qualitative study of high-performing primary care practices during the COVID-19 pandemic BMC Fam Pract 2021 22 1 237 1:CAS:528:DC%2BB3MXis1WlsLvE 34823495 8614080 10.1186/s12875-021-01589-4
C. Curran S. Lydon M.E. Kelly A.W. Murphy P. O’Connor An analysis of general practitioners’ perspectives on patient safety incidents using critical incident technique interviews Fam Pract 2019 36 6 736 742 30926981 10.1093/fampra/cmz012
C. Collins E. Clays E. Van Poel J. Cholewa K. Tripkovic K. Nessler 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 9 5675 1:CAS:528:DC%2BB38Xhtlentb3O 35565070 9101443 10.3390/ijerph19095675
O. Saint-Lary S. Gautier J. Le Breton S. Gilberg P. Frappé M. Schuers et al. How GPs adapted their practices and organisations at the beginning of COVID-19 outbreak: a French national observational survey BMJ Open 2020 10 12 e042119 33268433 10.1136/bmjopen-2020-042119
S. Gaal P. van den Hombergh W. Verstappen M. Wensing Patient safety features are more present in larger primary care practices Health Policy 2010 97 1 87 91 20409607 10.1016/j.healthpol.2010.03.007
P. Huston J. Campbell G. Russell F. Goodyear-Smith R.L. Phillips C. van Weel W. Hogg COVID-19 and primary care in six countries BJGP Open. 2020 4 4 bjgpopen20X101128 32900708 7606153 10.3399/bjgpopen20X101128
A.W. van der Velden E.A. Bax E. Bongard R.M. Aabenhus M. Anastasaki S. Anthierens et al. Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries BMJ Open 2021 11 7 e049257 34326052 10.1136/bmjopen-2021-049257
I. Ricci-Cabello A.J. Avery D. Reeves U.T. Kadam J.M. Valderas Measuring patient safety in primary care: the development and validation of the patient reported experiences and outcomes of Safety in Primary Care (PREOS-PC) Ann Fam Med 2016 14 3 253 261 27184996 4868564 10.1370/afm.1935
