BACKGROUND: Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES: To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS: Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS: COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION: In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.

1st Faculty of Medicine Institute of General Practice Charles University Prague Czech Republic

Azienda Unità Sanitaria Locale di Modena Modena Italy

Center for Public Health and Healthcare Hannover Germany

CHNP Rehaklinik Ettelbruck Luxembourg

Communicable Diseases and Infection Control Unit City of Vantaa and University of Helsinki Helsinki Finland

Comprehensive Health Research Center NOVA Medical School University Nova de Lisboa Lisboa Portugal

Department of Clinical Sciences in Malmö Centre for Primary Health Care Research Lund University Malmö Sweden

Department of Family Medicine and Outpatient Care Medical Faculty Uzhhorod National University Uzhhorod Ukraine

Department of Family Medicine Andrija Stampar School of Public Health School of Medicine University of Zagreb Health Centre Zagreb West Zagreb Croatia

Department of Family Medicine Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Department of Family Medicine Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Department of Family Medicine Semmelweis University Budapest Hungary

Department of Family Medicine UJCM University Jagielloński Collegium Medicum Jagielloński Poland

Department of Family Medicine University of Semmelweis Budapest Hungary

Department of General Practice University of Lille Lille France

Department of Pharmacology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

Department of Public Health and Primary Care KU Leuven Leuven Belgium

Department of Public Health Institute of Health Sciences Faculty of Medicine Vilnius University Vilnius Lithuania

Department Urology and General Practice Faculty of Medicine Medical University of Plovdiv Plovdiv Bulgaria

Faculty of Medicine Ss Cyril and Methodius University Skopje North Macedonia

Faculty of Medicine University of Porto Porto Portugal

Federica Montseny Health Centre Gerencia Asistencial Atención Primaria Servicio Madrileño de Salud Madrid Spain

Federica Montseny Health Centre Gerencia Asistencial de Atención Primaria Servicio Madrileño de Salud Madrid Spain

General Medicine Department Belarusian State Medical University Belarus

General Practice and Primary Care University of Vienna Vienna Austria

GHS Larnaca Cyprus

Hannover Medical School Center for Public Health and Healthcare Hannover Germany

Health center Kraljevo Kraljevo Serbia

Imperial College London London UK

Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain

Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid Madrid Spain

Irish College of General Practice MICGP Royal College of Physician MRCSI Ireland

Laboratorio EduCare University of Modena and Reggio Emilia Modena Italy

Medical Education Uni Laboratory of Hygiene and Epidemiology Medical Department Faculty of Health Sciences University of Ioannina Ioannina Greece

Medical Faculty Skopje Center for Family Medicine Skopje North Macedonia

Medical Specialties and Public Health School of Health Sciences University Rey Juan Carlos Madrid Spain

Närhälsan Kungshöjd Health Centre Gothenburg Sweden

Occupational Health Expert Spiru Haret University Bucharest Romania

Patient Safety Working Party of semFYC Catalunya Spain

Research Group Self Regulation and Health Institute for Health and Behaviour Department of Behavioural and Cognitive Sciences Faculty of Humanities Education and Social Sciences Luxembourg University Luxembourg Luxembourg

Research Unit for General Medicine and Primary Health Care Faculty of Medicine School of Health Science University of Ioannina Ioannina Greece

School of Social Sciences Hellenic Open University Patra Greece

Territorial Quality Unit Territorial Directorate of Camp de Tarragona Institut Català de la Salut Health Department Generalitat de Catalunya GIBA IIS Aragón Spain

USF das Conchas Regional Health Administration Lisbon and Tagus Valley Lisbon Portugal

Van Gürpınar District Public Hospital Istanbul Turkey

See more in PubMed

World Health Organization (WHO) . WHO Coronavirus (COVID-19) Dashboard [Internet]. 2022. [cited 2022 Jan 15]. Available from: https://covid19.who.int.

Rawaf S, Allen LN, Stigler FL, et al. . Lessons on the COVID-19 pandemic, for and by primary care professionals worldwide. Eur J Gen Pract. 2020;26(1):129–133. PubMed PMC

Van Poel E, Vanden Bussche P, Klemenc-Ketis Z, et al. . How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries. BMC Prim Care. 2022;23(1):11. PubMed PMC

Winkelmann JS. Germany. European Observatory on Health Systems and Policies: COVID-19, Health system responses monitor [Internet]. 2021. [cited 2021 Feb 2]. Available from: https://www.covid19healthsystem.org/countries/germany/livinghit.aspx?Section=3.2Managing cases&Type=Section.

Giulio de Belvis A, Fattore G, Morsella A, et al. Policy responses for Italy: managing cases [Internet]. COVID-19 Health System Response Monitor. 2021. [cited 2021 March 25]. Available from: https://www.covid19healthsystem.org/countries/italy/livinghit.aspx?Section=3.2Managing cases&Type=Section.

World Health Organization (WHO) . Clinical management of COVID-19. Interim guidance 27 May 2020 2020. WHO/2019-n.

Ares-Blanco S, Astier-Peña MP, Gómez-Bravo R, et al. . El papel de la atención primaria en la pandemia COVID-19: Una mirada hacia Europa [the role of primary care in the COVID-19 pandemic: a look towards Europe]. Aten Primaria. 2021;53(8):102134. PubMed PMC

Margolius D, Hennekes M, Yao J, et al. . On the front (phone) lines: results of a COVID-19 hotline. J Am Board Fam Med. 2021;34(Suppl):S95–S102. PubMed

Davalbhakta S, Advani S, Kumar S, et al. . A systematic review of smartphone applications available for corona virus disease 2019 (COVID19) and the assessment of their quality using the mobile application rating scale (MARS). J Med Syst. 2020;44(9):164. PubMed PMC

World Health Organization (WHO) . WHO Coronavirus Disease (COVID-19) Dashboard | WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. 2022. [cited 2022 May 27]. Available from: https://covid19.who.int.

ECDC Europe . COVID-19 | European Centre for Disease Prevention and Control [Internet]. 2022. [cited 2022 May 27]. Available from: https://www.ecdc.europa.eu/en/covid-19/country-overviews.

World Health Organization (WHO). Antigen-detection in the diagnosis of SARS-CoV-2 infection using rapid immunoassays Interim guidance. 2020. [Internet] [cited 2023 Feb 3]. Available from: https://apps.who.int/iris/bitstream/handle/10665/334253/WHO-2019-nCoV-Antigen_Detection-2020.1-eng.pdf.

Dinnes J, Sharma P, Berhane S, et al. . Rapid, point-of-care antigen tests for diagnosis of SARS-CoV-2 infection. Cochrane Database Syst Rev. 2022;7(7):CD013705. PubMed PMC

Centre for Disease Prevention E. Guidance for discharge and ending isolation in the context of widespread community transmission of COVID-19-first update Scope of this document . 2020. [Internet] [cited 2023 Feb]. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-guidance-discharge-and-ending-isolation-first%20update.pdf.

World Health Organization (WHO) . Criteria for releasing COVID-19 patients from isolation. [Internet] [cited 2023 Feb 3]. Available from: https://apps.who.int/iris/rest/bitstreams/1282284/retrieve

Haldane V, De Foo C, Abdalla SM, et al. . Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021;27(6):964–980. PubMed

Bicchieri C, Fatas E, Aldama A, et al. . In science we (should) trust: expectations and compliance across nine countries during the COVID-19 pandemic. PLoS One. 2021;16(6):e0252892. PubMed PMC

Calvo-Bonacho E, Catalina-Romero C, Fernández-Labandera C, et al. . COVID-19 and sick leave: an analysis of the Ibermutua cohort of over 1,651,305 Spanish workers in the first trimester of 2020. Front Public Heal. 2020;8:580546. PubMed PMC

Jacob L, Koyanagi A, Smith L, et al. . Prevalence of, and factors associated with, long-term COVID-19 sick leave in working-age patients followed in general practices in Germany. Int J Infect Dis. 2021;109:203–208. PubMed PMC

Westerlind E, Palstam A, Sunnerhagen KS, et al. . Patterns and predictors of sick leave after covid-19 and long covid in a national Swedish cohort. BMC Public Health. 2021;21(1):1023. PubMed PMC

Heymann J, Raub A, Waisath W, et al. . Protecting health during COVID-19 and beyond: a global examination of paid sick leave design in 193 countries. Glob Public Health. 2020;15(7):925–934. PubMed

Pelak M, Pettit AR, Terwiesch C, et al. . Rethinking primary care visits: how much can be eliminated, delegated or performed outside of the face-to-face visit? J Eval Clin Pract. 2015;21(4):591–596. PubMed

Kousgaard MB, Thorsen T, Due TD.. Experiences of accreditation impact in general practice - a qualitative study among general practitioners and their staff. BMC Fam Pract. 2019;20(1):146. PubMed PMC

Haldane V, Zhang Z, Abbas RF, et al. . National primary care responses to COVID-19: a rapid review of the literature. BMJ Open. 2020;10(12):e041622. PubMed PMC

Guisado-Clavero M, Herrero Gil A, Pérez Álvarez M, et al. . Clinical characteristics of SARS-CoV-2 pneumonia diagnosed in a primary care practice in Madrid (Spain). BMC Fam Pract. 2021;22(1):83. PubMed PMC

Chevallier Lugon C, Smit M, Salamun J, et al. . Novel outpatient management of mild to moderate COVID-19 spares hospital capacity and safeguards patient outcome: the Geneva PneumoCoV-Ambu study. PLoS One. 2021;16(3):e0247774. PubMed PMC

Hippensteel JA, LaRiviere WB, Colbert JF, et al. . Heparin as a therapy for COVID-19: current evidence and future possibilities. Am J Physiol Lung Cell Mol Physiol. 2020;319(2):L211–L217. PubMed PMC

Banerjee J, Canamar CP, Voyageur C, et al. . Mortality and readmission rates among patients with COVID-19 after discharge from acute care setting with supplemental oxygen. JAMA Netw Open. 2021;4(4):e213990. PubMed PMC

Hartnett KP, Kite-Powell A, DeVies J, National Syndromic Surveillance Program Community of Practice, et al.. Impact of the COVID-19 pandemic on emergency department Visits - United States, January 1, 2019-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(23):699–704. PubMed PMC

Moynihan R, Sanders S, Michaleff ZA, et al. . Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open. 2021;11(3):e045343. PubMed PMC

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