The Covid-19 pandemic: Reorganization of health services and coping of health care workers in Primary Health Care.

Conceição Outeirinho, Raquel Braga, Joana Costa-Gomes, Luís Alves, Ana Margarida Cruz, Ana Clavería, Antón Núñez-Torrón, Marina Jotic, Jacopo Dermutas, Tugba Çalışkan, Victoria Tkachenko, Poliana Jorge

Keywords: Primary Health Care; COVID-19; SARS-CoV-2; Pandemic; Health care services; Primary care management; anxiety; emergency management.

The COVID-19 pandemic has forced the reorganization of health care services, and the implementation of contingency plans which impacted Primary Health Care (PHC) workers’ daily demands.The training and support of health workers staff, its clinical, psychological and social support are additional challenges.

Research questions:
How have PHC services responded to the pandemic and how this has impacted PHC workers, namely regarding anxiety levels?

We conducted a cross-sectional survey with a convenience sample of Primary Care Services workers from 7 European countries (Portugal, Spain, Bosnia, Italy, Turkey, Ukraine and France) using an online questionnaire. Ethical aspects were guaranteed. We collected information on gender, age, professional group, perceived support, access to personal protective equipment (PPE), overall pressure felt by professionals and their anxiety levels by March 2020 and May 2021. The association between each variable and anxiety were estimated through multivariate logistic regression.

Our sample comprised 1045 PHC workers (73.8% female, mean age 44.8 years; 49.6% doctors). Almost 70% of participants claimed to monitor suspected covid patients and 66.5% reported there was a risk management protocol in place. In March 2020 54% of participants reported little/no PPEs availability whereas in May 2021 76% stated PPEs were available/very available. About 65% of the participants feel high/extreme pressure at their work. High/extreme anxiety levels were reported by 54,1% in March 2020 and 38.3% in May 2021. Multivariate logistic regression analysis showed that feeling supported regarding personal problems and encouraged to maintain social interactions was associated with lower anxiety levels (adjusted OR=0.292, p=0.009; adjusted OR=0.390, p=0.012).

Despite perceived high work-related pressure levels, PHC services adapted to the pandemic demands through the implementation of risk management plans. PHC workers anxiety levels reduced from March 2020 to May 2021. Feeling encouraged to maintain social interactions and supported regarding personal problems decreased the likelihood of anxiety.

Points for discussion: