Follow-up of patients with chronic conditions within primary care practices during COVID-19: Results from 7 Central and Eastern-European countries from the cross-sectional PRICOV-19 study.

European Journal of General Practice 2024, VOL. 30, NO. 1, 2391468 https://doi.org/10.1080/13814788.2024.2391468 Research Article Follow-up of patients with chronic conditions within primary care practices during COVID-19: Results from 7 Central and Eastern-European countries from the cross-sectional PRICOV-19 study Giulia Delventoa,b , Christian Schindlera,b, Cristina Rotaruc , Ala Curteanuc,d, Ghenadie Curochicine, Helen Prythercha,b , Victoria Tkachenkof , Bohumil Seifertg, Peter Torzsah , Radost Asenovai, Carmen Busneagj, Adam Windakk , Sara Willemsl,m , Esther Van Poell,m and Claire Collinsl,n Swiss Tropical and Public Health Institute, Allschwil, Switzerland; bUniversity of Basel, Basel, Switzerland; cHealthy Life Project, Reducing the Burden of Non-Communicable Diseases in Moldova, Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova; dMother and Child Institute, Chișinău, Moldova; eDepartment of Family Medicine, Nicolae Testemitanu, Chișinău, Moldova; fDepartment of Family Medicine, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine; gInstitute of General Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic; hDepartment of Family Medicine, Semmelweis University, Budapest, Hungary; iDepartment of General Medicine, Plovdiv University, Plovdiv, Bulgaria; jDepartment of Kinetic Therapy and Special Motricity, Spiru Haret University, Bucharest, Romania; k Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland; lDepartment of Public Health and Primary Care, Ghent University, Ghent, Belgium; mQuality and Safety, Ghent University, Ghent, Belgium; nIrish College of General Practitioners, Dublin, Ireland a KEY MESSAGES • In 7 Central and Eastern European countries, 68% of PC practices effectively followed-up patients with chronic conditions during the pandemic. • Key determinants for successful follow-up included government support, GP time availability, and staffing levels of GPs. • Video consultations and payment mechanisms did not show significant associations with optimal patient follow-up. ABSTRACT Background: The COVID-19 pandemic posed severe challenges to delivery of services at Primary Care level and for achieving follow-up of patients with chronic diseases. Objectives: We analysed data from the PRICOV-19 study to explore determinants of active follow-up for chronic disease patients in seven Central and Eastern European (CEE) countries during the pandemic. Methods: Pricov-19 was a cross-sectional study conducted within PC (Primary Care) practices in 37 European countries. We analysed data from 7 CEE countries (Bulgaria, Czech Republic, Hungary, Poland, Moldova, Romania, Ukraine) collected between November 2020 and December 2021. Practices were recruited through random or convenience sampling and participation of practices was voluntary. We performed descriptive statistics to identify the level of follow-up of chronic disease and what health system and practice-specific factors were associated with better follow-up. We used logistic regression and meta-analysis techniques to explore associations and heterogeneity between countries. Results: 67.8% out of 978 practices reported actively following up chronic patients. Positive associations were found between active follow-up and such as having more GPs (aOR = 1.18, p-value = 0.005), an above-average chronic patient population (aOR = 3.13, p-value = 0.006), adequate government support (aOR = 2.35, p-value = 0.001), and GPs having time for guideline reading (aOR = 0.008, p-value = 1.71). Conclusions: Patient follow-up, was influenced by different health system and practice-specific factors. The implications suggest the need for government support to enhance PC practice organisation during crises and solutions to decrease GP workload and provide tailored care for patients with chronic disease. CONTACT Giulia Delvento ; Christian Schindler Institute, P.O. Box, CH-4123 Allschwil, Switzerland ARTICLE HISTORY Received 2 February 2024 Revised 26 July 2024 Accepted 7 August 2024 KEYWORDS Patient follow-up; outreach; quality of care; COVID-19; multi-country Swiss Tropical and Public Health © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 G. DELVENTO ET AL. Introduction The COVID-19 pandemic disrupted healthcare delivery worldwide, including within the most well-resourced and advanced health systems [1, 2]. In the early phases of the pandemic, there was a lack of attention and investment into primary healthcare (PHC), due to funds diverted towards supporting overburdened hospitals struggling to remain functional during peak increases in COVID-19 cases [3]. At PHC level, reductions in access to care for patients with chronic disease during COVID-19 have been observed across different studies, potentially leading to treatment delays [4–9]. Routine visits at the primary care level were postponed thus contributing to treatment delays or missed diagnoses [10, 11]. Other factors may also be linked to poor patient follow-up as evidenced in other studies, such as the number of staff in the primary care (PC) practice and the type of payment system in place for doctor’s remuneration [12]. Both of these factors can also impact the time availability of the GP for actively following up chronic disease patients due to an increase in workload which has also been demonstrated to be a potential determinant of poor follow up [13]. Governmental support in times of crisis has also been shown to be crucial to ensure adaptation of PC practices to emerging needs brought by the pandemic and the rapid adoption of new telemedicine technologies [14]. In this paper, we describe determinants of active follow-up at PC practices for patients with chronic disease within seven Central and Eastern European (CEE) countries, namely Bulgaria, Czech Republic, Hungary, Republic of Moldova, Poland, Romania, and Ukraine. Active follow-up was defined as the GP practice proactively contacting patients in need of chronic care during the COVID-19 pandemic. These CEE countries have experienced important reforms of the health care sector and in primary health in the past years and have made important progress towards expanding universal health coverage, by reducing the incidence of catastrophic health spending and progressively strengthening their health systems at a primary care level. Despite the progress, issues remain at different levels, for instance, with the retention of the health workforce (...truncated)