BACKGROUND: Primary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: (1) Describe PHC's clinical pathways for acute COVID-19 cases, including long-term care facilities, (2) Describe PHC COVID-19 pandemic indicators, (3) Develop COVID-19 PHC activity indicators, (4) Explain PHC's role in vaccination strategies, and (5) Create a PHC contingency plan for future pandemics. METHODS: A mixed-method study will employ two online questionnaires to gather retrospective PHC data on COVID-19 management and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health (PH) experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and PH will be devised to address future pandemic scenarios. ANALYSIS: Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving researchers from 28 European countries support the development. DISCUSSION: While PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC's role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants' involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments' daily dashboards in Europe, often overlooked in media and public debates.

Academisch Centrum voor Huisartsgeneeskunde KU Leuven Kapucijnenvoer Leuven Belgium

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

Capio Kvillebäcken Health Centre Gothenburg Sweden

Center for family medicine Medical faculty Skopje Skopje North Macedonia

Center for Public Health and Healthcare Hannover Medical School Hannover Germany

Chair of Patient Safety Working Group of Semfyc Board Member Madrid Spain

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

CHNP Rehaklinik Ettelbruck Luxembourg

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

Comprehensive Health Research Center NOVA Medical School Universidade Nova de Lisboa Lisbon Portugal

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

Department of Clinical Pharmacology Sahlgrenska University Hospital Gothenburg Sweden

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 Andrzej Frycz Modrzewski Krakow University Krakow Poland

Department of Family Medicine at the University of Semmelweis Budapest Hungary

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

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 at Uniwersytet Jagielloński Collegium Medicum Krakow Poland

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 Vilnus Lithuania

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

Dr Đorđe Kovačević Health Center Lazarevac Belgrade Serbia

EGPRN Brussels Belgium

European Parliament Luxembourg Luxembourg

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 de Atención Primaria Servicio Madrileño de Salud Madrid Spain

Fundación de Investigación e Innovación Biosanitaria de Atención Primaria Madrid Spain

General Medicine Department Belarusian State Medical University Minsk Belarus

General Practice and Primary Care Med University of Vienna Vienna Austria

Hannover Medical School Center for Public Health and Healthcare Hannover OE Germany

Health center Kraljevo Kraljevo Serbia

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

Health Centre Zagreb West and Department of Family Medicine University of Zagreb Zagreb Croatia

Imperial College London London UK

Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain

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

Las Cortes Health Centre Gerencia Asistencial de Atención Primaria Servicio Madrileño de Salud Madrid Spain

Medical Department Medical Education Unit Laboratory of Hygiene and Epidemiology 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

PZU Femilihelt Skopje North Macedonia

Red de Investigación de Cronicidad Atención Primaria y Promoción de la Salud Barcelona Spain

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

SemFYC representative in EGPRN Madrid Spain

semFYC Vice Chair Madrid Spain

Spiru Haret University Occupational Health Expert Practicing family doctor Bucharest Romania

Universidad Miguel Hernández Elche Spain

Universitas Health Centre Public Health Service of Aragon Zaragoza Spain

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

Van Gürpınar District Public Hospital Istambul Turkey

World Organization of Family Doctors Chief Executive Officer Brussels Belgium

World Organization of Family Doctors Past president Brussels Belgium

World Organization of Family Doctors President Brussels Belgium

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