The impact of rurality on the response of general practices to the COVID-19 pandemic outcomes from the PRICOV-19 study in 38 countries.

Ferdinando Petrazzuoli, Claire Collins, Esther Van Poel, Piet Vanden Bussche, Zalika Klemenc‑Ketis, Andrée Rochfort, Sara Willems

Keywords: quality of care, patient safety, pandemic, rurality, primary health care, COVID-19, PRICOV-19, general practice, family medicine

Background:
General practitioners (GPs) played a crucial role in the fight against the COVID-19 pandemic. However, they have experienced many barriers to fulfilling this role. The PRICOV-19 study investigates how GP practices in Europe were organized during COVID-19 to guarantee safe, effective, patient-centered, and equitable care. The PRICOV-19 study also aimed to describe the association between response to the pandemic and practice and health care system characteristics.

Research questions:
How did degree of rurality impact on the response of general practices to the COVID-19 pandemic?

Method:
Using a cross-sectional design, data were collected through an online questionnaire sent to GP practices in 37 European countries and Israel. The final version of the questionnaire included 53 items covering demographic details, management of patient flow, infection prevention and control, information processing, communication, collaboration and self-care.

Results:
A total of 5,539 GP practices participated in the study: 1,864 PC practices were located in Big (inner) city, 560 in Suburbs, 1,039 in (small) town, 1100 in a mixed urban–rural area, and 976 in a rural area. Statistically significant differences were found between rural, semi-rural and urban practices in the management of patient flow with the urban setting mainly adopting an appointment system while rural practices still operated a walk-in system. Significant differences were also found in the perceived limitations related to the building or the infrastructure of the practice to provide high-quality and safe care.

Conclusions:
The response to the Covid-19 pandemic in Europe was diverse and heterogeneous across and within countries. Practice location in terms of degree of rurality is shown here to be a key factor in how general practices across 38 countries responded to the COVID-19 pandemic and on the potential impact on patient safety and quality of care. Rurality should be a consideration when designing supports for general practice and family medicine within countries.

Points for discussion:
relevance of the rural-urban comparison

impact of Covid 19 pandemic in rural areas in your country