Primary health care during the COVID 19 pandemic in Croatia

Asja Ćosić Divjak, Goranka Petricek, Miro Hanževački, Ksenija Kranjčević, Valerija Bralić Lang, Marion Tomicic, Tamara Poljičanin, Sara Ares Blanco, Raquel Gomez Bravo

Keywords: COVID-19, Primary Health Care, Clinical Pathways, Croatia

Background:

Although Primary health care (PHC) is the cornerstone of health care, its role was not properly recognized during the COVID 19 pandemic. Reviewing and publishing data on PHC activities during the pandemic should enable better management of future pandemic situations.

Research questions:

There is insufficient data on PHC activities in response to the COVID-19 pandemic. It was also not investigated what exactly was the role of PHC in controlling the pandemic in Croatia.

Method:

Descriptive, cross-sectional, retrospective study on COVID-19 infection for September 2020 in the context of PHC in Croatia, part of PHC-Eurodata-Covid19 study (supported by the EGPRN Grant). Qualitative data acquired through a semi-structured questionnaire on COVID-19 pathway in PHC in Croatia. Main variable: PHC COVID-19 acute clinical pathway. Secondary variables: COVID-19 diagnosis, testing, hotline, remote assessment.

Results:

COVID 19 case detection and testing was performed at the PHC level. RT-PCR and rapid lateral flow test was performed free of charge with a medical referral. PHC as well as Laboratories reported results to patients. Contact tracing was made mainly by general practitioners and public health specialists. Mandatory isolation ranged from 10 to 14 days. Completion of isolation required 3 consecutive days without fever as well as significant improvement of respiratory and other symptoms. Sick leave was given by general practitioners. Patients’ hotels were available. Follow up was made mainly by phone call or email. X Ray and laboratory testing was also available. In case of deterioration patients were referred to hospital by ambulance.

Conclusions:

PHC was the first contact with health care system for most COVID-19 patients in Croatia – from testing, physical exploration, complementary diagnostics, treatment, sick leave and contact tracing. Publishing data on PHC activities should strengthen its role and consequently enable better management of future pandemic situations.

Points for discussion:

What measures at PHC level could strengthen response for future pandemics?