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Objective: To assess the changes in Catalan General Practitioners practices a year after the outbreak of the pandemic by analysing the schedule and the types and complexity of consultations.
Methods: This is a multicentre descriptive study with General Practitioners from 27 primary care centres in the province of Barcelona, serving a population area of more than 400,000 inhabitants. The physicians volunteered to take part in the study. For the study, records of clinical activity were analysed prospectively and in real time, to compare the type of visit, reasons for consultation, adequacy and complexity of the consultation during a week of May 2019 versus a week of May 2021.
Results: During 2019 and 2021, a total of 88 General Practitioners participated in the study, collecting information of a total of 579 working days. We found statistically significant differences (p<0.001) in the number of face-to-face consultations (from 67.6% to 27.6%), phone consultations (from 8.31% to 35.4%) and remote consultation (from 0 to 11.3%), in 2019 and 2021, respectively. Clinical complexity, number of visits per day and number of reasons for consultation did not change significantly. The adequacy of the reasons for consultation decreased from 88.1% in 2019 to 83.8% in 2021 (p<0.001). Time to check medical tests, for reports and referrals increased significantly. The delay at 2 hours from the start of the consultation did not vary, but toward the end of the shift there was a significant increase of more than 6 minutes. Whereas fatigue at the beginning of the shift was higher in 2021 than in 2019, fatigue at the end of the day did not vary.
Conclusions: In May 2021 doctors start the shift already tired, face-to-face visits decreased by more than half, phone consultations increased and the remote consultation was established in primary care services in Catalonia. The number of visits increased slightly, whereas the number of reasons for consultation and their adequacy did not substantially change. Clinical work without a patient and the delay at the end of the shift increased. A break of ten minutes per day was maintained. Further studies are needed to verify if this new pattern persists over time.
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2. Gibson J, Sutton M, Spooner S CK. Ninth National GP Worklife Survey. University of Manchester: Policy Research Unit in Commissioning and the Healthcare System Manchester Centre for Health Economics.; 2018.
3. La Schäfer W, Gw Boerma W, Kringos DS, et al. QUALICOPC, a Multi-Country Study Evaluating Quality, Costs and Equity in Primary Care.; 2011. doi:10.1186/1471-2296-12-115
4. Schäfer WLA, Van Den Berg MJ, Groenewegen PP. The association between the workload of general practitioners and patient experiences with care: results of a cross-sectional study in 33 countries. doi:10.1186/s12960-020-00520-9
5. Groenewegen PP, Bosmans MWG, Boerma WGW, Spreeuwenberg P. The primary care workforce in Europe: a cross-sectional international comparison of rural and urban areas and changes between 1993 and 2011. Eur J Public Health. 2020;30(4):iv12-iv17. doi:10.1093/eurpub/ckaa125
6. Boerma WGW. Profiles of general practice in Europe : an international study of variation in the tasks of general practitioners. 2003. https://doi.org/10.26481/dis.20030917wb.
7. Delgado Sánchez A, Saletti-Cuesta L, Toro-Cárdenas S, López-Fernández LA, de Dios Luna del Castillo J, Mateo-Rodríguez I. [Validation of scale to evaluate the relationship between family-work in family physicians]. Rev Esp Salud Publica. 2011;85(2):149-162. doi:10.1590/S1135-57272011000200004
8. Prasad K, Poplau S, Brown R, et al. Time Pressure During Primary Care Office Visits: a Prospective Evaluation of Data from the Healthy Work Place Study. J Gen Intern Med. 2020;35(2):465-472. doi:10.1007/s11606-019-05343-6
9. Linzer M, Bitton A, Tu S-P, et al. The End of the 15-20 Minute Primary Care Visit. J Gen Intern Med. 2015;30(11):1584-1586. doi:10.1007/s11606-015-3341-3
10. Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study. J Gen Intern Med. 2000;15(7):441-450. doi:10.1046/j.1525-1497.2000.05239.x
11. Rimmer A. GPs want longer consultations, BMA survey finds. BMJ. 2015;350:h1910. doi:10.1136/bmj.h1910
12. Deveugele M, Derese A, Van Den Brink-Muinen A, Bensing J, De Maeseneer J. Primary care Consultation length in general practice: cross sectional study in six European countries. doi:10.1136/bmj.325.7362.472
13. Morreel S, Philips H, Verhoeven V. Organisation and characteristics of out-of-hours primary care during a COVID-19 outbreak: A real-time observational study. PLoS One. 2020;15(8):e0237629. doi:10.1371/journal.pone.0237629
14. Shah SS, Safa A, Johal K, Obika D, Valentine S. A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic. BMC Fam Pract. 2021;22(1):248. doi:10.1186/s12875-021-01594-7
15. Solans O, Vidal-Alaball J, Roig Cabo P, et al. Characteristics of Citizens and Their Use of TeleConsultation in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study. J Med Internet Res. 2021;23(5):e28629. doi:10.2196/28629
16. López Seguí F, Walsh S, Solans O, et al. TeleConsultation Between Patients and Health Care Professionals in the Catalan Primary Care Service: Message Annotation Analysis in a Retrospective Cross-Sectional Study. J Med Internet Res. 2020;22(9):e19149. doi:10.2196/19149
17. Casanova Ucles A, Montero Alía J, Gros Garcia T, et al. Observatori de la Medicina de Família al Maresme: una anàlisi de la complexitat assistencial. But Prim Cat. 2019;37(4):1-9. http://www.butlleti.cat/ca/Vol37/iss4/2.
18. José J, Alía M, Uclés AC, et al. Observatori de la medicina familiar i comunitària al Maresme ( OMFaM ): Impacte de la pandèmia COVID-19 sobre el burnout professional . Gemma SEDA GOMBAU . PhD Unitat de Suport a la Recerca Metropolitana Nord , Fundació Gol ), Mataró , Spain . Grup de Rec. 2020.
19. Casanova Uclés A, López Torrent E, Zurilla Duarte E, et al. Caracterización de las interrupciones que se producen en las consultas de los médicos de familia. Observatorio de la Medicina de Familia del Maresme. Atención Primaria. 2020;52(9):645-647. doi:10.1016/J.APRIM.2020.01.005
20. Seda-Gombau G, Montero-Alía JJ, Moreno-Gabriel E, Torán-Monserrat P. Impact of the COVID-19 Pandemic on Burnout in Primary Care Physicians in Catalonia. Int J Environ Res Public Health. 2021;18(17). doi:10.3390/ijerph18179031
21. Crosbie B, O’Callaghan ME, O’Flanagan S, Brennan D, Keane G, Behan W. A real-time measurement of general practice workload in the Republic of Ireland: a prospective study. Br J Gen Pract. 2020;70(696):e489-e496. doi:10.3399/bjgp20X710429
22. Schäfer I, Hansen H, Menzel A, et al. 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(1):125. doi:10.1186/s12875-021-01471-3
23. Coma E, Mora N, Méndez L, 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(1):208. doi:10.1186/s12875-020-01278-8
24. Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract J R Coll Gen Pract. 2017;67(664):e736-e743. doi:10.3399/bjgp17X693137
25. Banks J, Farr M, Salisbury C, et al. Use of an electronic consultation system in primary care: a qualitative interview study. Br J Gen Pract J R Coll Gen Pract. 2018;68(666):e1-e8. doi:10.3399/bjgp17X693509
26. Farr M, Banks J, Edwards HB, et al. Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production. BMJ Open. 2018;8(3):e019966. doi:10.1136/bmjopen-2017-019966
27. López Seguí F, Vidal-Alaball J, Sagarra Castro M, García-Altés A, García Cuyàs F. General Practitioners’ Perceptions of Whether TeleConsultation Reduce the Number of Face-to-face Visits in the Catalan Public Primary Care System: Retrospective Cross-Sectional Study. J Med Internet Res. 2020;22(3):e14478. doi:10.2196/14478
28. Roig Cabo P, López Seguí F, Sierra Lujan RM, Seda Gombau G, Moreno Millán N, Torán Monserrat P. [Impact of the eConsultation on the primary care agenda]. Aten primaria. 2021;53(8):102070. doi:10.1016/j.aprim.2021.102070
29. Id SM, Philips H, Verhoeven V. Organisation and characteristics of out-of-hours primary care during a COVID-19 outbreak: A real-time observational study. 2020. doi:10.1371/journal.pone.0237629
30. Newbould J, Abel G, Ball S, et al. Evaluation of phone first approach to demand management in English general practice: observational study. BMJ. 2017;358:j4197. doi:10.1136/bmj.j4197
31. Newbould J, Exley J, Ball S, Corbett J, Pitchforth E, Roland M. GPs’ and practice staff’s views of a phone first approach to demand management: a qualitative study in primary care. Br J Gen Pract J R Coll Gen Pract. 2019;69(682):e321-e328. doi:10.3399/bjgp19X702401