PT  - JOURNAL ARTICLE
AU  - van der Velden, Alike W
AU  - Bax, Eva A
AU  - Bongard, Emily
AU  - Munck Aabenhus, Rune
AU  - Anastasaki, Marilena
AU  - Anthierens, Sibyl
AU  - Balan, Anca
AU  - Böhmer, Femke
AU  - Bruno, Pascale
AU  - Chlabicz, Slawomir
AU  - Coenen, Samuel
AU  - Colliers, Annelies
AU  - Emmerich, Susanne
AU  - Garcia-Sangenis, Ana
AU  - Ghazaryan, Hrachuhi
AU  - van der Linde, Sanne R
AU  - Malania, Lile
AU  - Pauer, József
AU  - Tomacinschii, Angela
AU  - Tonkin-Crine, Sarah
AU  - Vellinga, Akke
AU  - Zastavnyy, Ihor
AU  - Verheij, Theo
AU  - Goossens, Herman
AU  - Butler, Christopher C
TI  - Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries
AID  - 10.1136/bmjopen-2021-049257
DP  - 2021 Jul 01
TA  - BMJ Open
PG  - e049257
VI  - 11
IP  - 7
4099  - http://bmjopen.bmj.com/content/11/7/e049257.short
4100  - http://bmjopen.bmj.com/content/11/7/e049257.full
SO  - BMJ Open2021 Jul 01; 11
AB  - Objective To describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.Setting Primary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.Design and participants Before (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.Outcome measures Consultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.Results Care for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).Conclusions Despite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.Data are available upon reasonable request. Additional to the items reported here, outcomes for all items in the Case Report Form (online supplemental appendix 1) are available for all countries, or per individual country, upon request, explaining research question and methods, from the first author (AWvdV) who will seek agreement from the core research team.