The Covid-19 Pandemic Accelerates Changes in Delivery of Primary Health Care Started in 2019: Face-To-Face, Telehealth and Physician Workload after 12 Months
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Abstract
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.
Article Details
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