BACKGROUND: During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS: Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS: Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS: The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics.

Azienda Unità Sanitaria Locale di Modena Laboratorio EduCare University of Modena and Reggio Emilia Modena Italy

Center for family medicine Medical faculty Skopje Skopje North Macedonia

Center for Public Health and Healthcare Hannover Medical School Hannover Germany

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

CHNP Rehaklinik Ettelbruck Luxembourg; 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

Communicable Diseases and Infection Control Unit City of Vantaa Vantaa Finland

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

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 2 Uzhhorod National University Uzhhorod Ukraine

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

Department of Family Medicine Andrzej Frycz Modrzewski Krakow University Krakow Poland

Department of Family Medicine at Riga Stradiņš University Riga Latvia; Member of the board of the Rural Family Doctors' Association of Latvia Latvia

Department of Family Medicine at the University of Semmelweis Budapest Hungary

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

Department of Family Medicine Faculty of Medicine Tel Aviv University Tel Aviv Israel WONCA Europe President Israel

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

Department of Family Medicine of Riga Stradins University Riga Latvia; President of the Rural Family Doctors' Association of Latvia

Department of Family Medicine Prof Dr Cemil Tascioglu City Hospital Istanbul Turkey

Department of Family Medicine Rīga Stradins University Riga Latvia

Department of Family Medicine UJCM at Uniwersytet Jagielloński Collegium Medicum Kraków Poland

Department of General Practice and Primary Care Med University of Vienna Vienna Austria

Department of General Practice University of Lille Lille France

Department of Geriatric Medicine Hôpitaux Robert Schuman Luxembourg Luxembourg

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

European Parliament Luxembourg Luxembourg

Faculty of Medicine Ss Cyril and Methodius University Skopje North Macedonia

Federica Montseny Health Centre Gerencia Asistencial Atención Primaria Servicio Madrileño de Salud Madrid Spain; Medical Specialties and Public Health School of Health Sciences University Rey Juan Carlos Madrid Spain; Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain

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

General Medicine Department Belarusian State Medical University Minsk Belarus

Health Center Dr Đorđe Kovačević Lazarevac Belgrade Serbia

Health center Kraljevo Kraljevo Serbia

Health center Krupa na Uni Krupa na Uni Republic of Srpska Bosnia and Herzegovina

Health Centre Zagreb Centar Zagreb Croatia

Institute of Primary Care University of Zurich and University Hospital Zurich Zurich Switzerland

Investigation Support Multidisciplinary Unit for Primary care and Community North Area of Madrid Gerencia Asistencial Atención Primaria Servicio Madrileño de Salud Madrid Spain

Kinetic Therapy and Special Motricity Spiru Haret University Bucharest Romania

Laboratory of Hygiene and Epidemiology Medical Department Faculty of Health Sciences University of Ioannina Greece; GHS Larnaca Cyprus

Member of Irish College of General Practice Dublin Ireland

Närhälsan Kungshöjd Health Centre Gothenburg Sweden; Department of Pharmacology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

Närhälsan Sannegården Health Centre Gothenburg Sweden

Pandemic Center Department of Public Health and Primary Health Care University of Bergen Bergen Norway; Norwegian National Institute of Public Health Bergen Norway

PZU Femilihelt Skopje North Macedonia

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

Technical Advisor for Quality and Safety Territorial Healthcare Quality Unit Territorial Healthcare Direction of Camp de Tarragona Healthcare Institut of Catalonia Health Departament Generalitat de Catalunya GIBA IIS Aragón Catalunya Spain; Chair of Patient Safety Working Party of semFYC Spain

UCL Global Business School for Health London UK

Van Gürpınar District Public Hospital Van Gürpınar Turkey

Zobrazit více v PubMed

World Health Organization (WHO). WHO Coronavirus (COVID-19) Dashboard. 2023. Available at: https://covid19.who.int (2 June 2023, date last accessed).

European Centre for Disease Prevention and Control. Novel coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK—sixth update. Rapid Risk Assessment. 2020.

European Centre for Disease Prevention and Control. Guidance for health system contingency planning during widespread transmission of SARS-CoV-2 with high impact on healthcare services. Stockholm: ECDC, 2020.

WHO. Clinical Services and Systems: Primary Care. 2023. Available at: https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/primary-care (2 June 2023, date last accessed).

Ares-Blanco S, Guisado-Clavero MR-D, et al.Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study. Eur J Gen Pract 2023;29:2182879. PubMed PMC

Mughal DF, Mallen C, McKee M.. The impact of COVID-19 on primary care in Europe. Lancet Reg Health Eur 2021;6:100152. PubMed PMC

Lechien JR, Chiesa-Estomba CM, Place S, et al.; COVID-19 Task Force of YO-IFOS. Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019. J Intern Med 2020;288:335–44. PubMed PMC

Stokes EK, Zambrano LD, Anderson KN, et al.Coronavirus disease 2019 case surveillance—United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–65. PubMed PMC

Long B, Carius BM, Chavez S, et al.Clinical update on COVID-19 for the emergency clinician: presentation and evaluation. Am J Emerg Med 2022;54:46–57. PubMed PMC

ECDC Europe. COVID-19: Situation Updates. 2021. Available at: https://www.ecdc.europa.eu/en/covid-19 (20 December 2022, date last accessed).

European Observatory of Health Systems and Policies. COVID-19 Health System Response Monitor. 2022. Available at: https://eurohealthobservatory.who.int/monitors/hsrm/overview (20 December 2022, date last accessed).

Coma E, Mora N, Méndez L, et al.Primary care in the time of COVID-19: monitoring the effect of the pandemic and the lockdown measures on 34 quality of care indicators calculated for 288 primary care practices covering about 6 million people in Catalonia. BMC Fam Pract 2020;21:208. PubMed PMC

Qi C, Osborne T, Bailey R, et al.Impact of COVID-19 pandemic on incidence of long-term conditions in Wales: a population data linkage study using primary and secondary care health records. Br J Gen Pract 2023;73:e332–9. PubMed PMC

Coma E, Guiriguet C, Mora N, et al.Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people. BMJ Open 2021;11:e047567. PubMed PMC

ECDC. The European Surveillance System (TESSy). 2017. Available at: https://www.ecdc.europa.eu/en/publications-data/european-surveillance-system-tessy (30 May 2023, date last accessed).

ECDC. Clinical Characteristics of COVID-19. 2022. Available at: https://www.ecdc.europa.eu/en/covid-19/latest-evidence/clinical#:∼:text=Symptoms are often episodic and,%2C cough%2C and sore throat (30 May 2023, date last accessed).

ECDC. EpiPulse—the European surveillance portal for infectious diseases. 2021.

Guisado-Clavero M, Ares-Blanco S, Serafini A, et al.The role of primary health care in long-term care facilities during the covid-19 pandemic in 30 European countries: a retrospective descriptive study (Eurodata study). Prim Heal Care Res Dev 2023;24:e60. PubMed PMC

ECDC. Surveillance and Disease Data on COVID-19. 2021. Available at: https://www.ecdc.europa.eu/en/covid-19/situation-updates (25 May 2023, date last accessed).

Declich S, Carter AO.. Public health surveillance: historical origins, methods and evaluation. Bull World Health Organ 1994;72:285–304. PubMed PMC

European Centre for Disease Prevention and Control. Strategies for the surveillance of COVID-19. Technical report. 2020. 1–7.

World Health Organization (WHO). Global Surveillance for COVID-19 disease caused by human infection with novel coronavirus (COVID-19): interim guidance. Geneva, 2020.

Gallo V, Chiodini P, Bruzzese D, et al.Comparing the COVID-19 pandemic in space and over time in Europe, using numbers of deaths, crude rates and adjusted mortality trend ratios. Sci Rep 2021;11:16443. PubMed PMC

Kondilis E, Papamichail D, Gallo V, Benos A.. COVID-19 data gaps and lack of transparency undermine pandemic response. J Public Health (Oxf) 2021;43:e307–8. PubMed PMC

Ronquillo JG, Lester WT, Zuckerman DM.. Using informatics to guide public health policy during the COVID-19 pandemic in the USA. J Public Health (Oxf) 2020;42:660–4. PubMed PMC

Ågerfalk PJ, Conboy K, Myers MD.. Information systems in the age of pandemics: COVID-19 and beyond. Eur J Inf Syst 2020;29:203–7.

European Commission. Proposal for a regulation of the European Parliament and of the Council on the European Health Data Space. COM(2022) 197 Final. 2022. 1–122.

Desborough J, Dykgraaf SH, Phillips C, et al.Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics. Fam Pract 2021:38:811–25. PubMed PMC

Catala M, Coma E, Alonso S, et al.Risk diagrams based on primary care electronic medical records and linked real-time PCR data to monitor local COVID-19 outbreaks during the summer 2020: a prospective study including 7,671,862 people in Catalonia. Front Public Health 2021;9:693956. PubMed PMC

Kyle MA, Tipirneni R, Thakore N, et al.Primary care access during the COVID-19 pandemic: a simulated patient study. J Gen Intern Med 2021;36:3766–71. PubMed PMC

Ares-Blanco S, Álvarez MP, Larrondo IG, et al.SARS-CoV-2 pneumonia follow-up and long COVID in primary care: a retrospective observational study in Madrid city. PLoS One 2021;16:e0257604. PubMed PMC

World Health Organization. Indicators to monitor health-care capacity and utilization for decision-making on COVID-19. 2020. 1–10.

Centers for Disease Control and Prevention (CDC). Indicators for monitoring COVID-19 community levels and making public health recommendations. 2022. PubMed

Australian Institute of Health and Welfare. Primary Health Care Data Development. National Primary Health Care Data Collection. 2022. Available at: https://www.aihw.gov.au/reports-data/health-welfare-services/primary-health-care/primary-health-care-data-development (15 December 2022, date last accessed).

Moguerza JM, Perelló Oliver S, Martín de Diego I, et al.Health sufficiency indicators for pandemic monitoring. Int J Environ Res Public Health 2021;18:538. PubMed PMC

Pullano G, Di Domenico L, Sabbatini CE, et al.Underdetection of cases of COVID-19 in France threatens epidemic control. Nature 2021;590:134–9. PubMed

Boëlle P-Y, Souty C, Launay T, et al.Excess cases of influenza-like illnesses synchronous with coronavirus disease (COVID-19) epidemic, France, March 2020. Euro Surveill 2020;25:2000326. PubMed PMC