BACKGROUND: The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. OBJECTIVE: To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. METHODOLOGY: Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. MAIN OUTCOME MEASURES: Patient's first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. RESULTS: Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania's apps considered social needs. CONCLUSIONS: COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases.

Azienda Unità Sanitaria Locale di Modena Laboratorio EduCare University of Modena and Reggio Emilia 41121 Reggio Emilia Italy

Capio Kvillebäcken Health Centre 417 22 Gothenburg Sweden

Center for Family Medicine Medical Faculty Skopje 1000 Skopje North Macedonia

Center for Public Health and Healthcare Department of Medical Psychologie OE5430 Hannover Medical School 30625 Hannover Germany

Centre Hospitalier Neuro Psychiatrique CHNP 43 Avenue des Alliés L 9012 Ettelbruck Luxembourg

Communicable Diseases and Infection Control Unit Wellbeing Services County of Vantaa and Kerava P O Box 341 01301 Vantaa Finland

Department of Clinical Sciences in Malmö Centre for Primary Health Care Research Lund University 221 00 Malmö Sweden

Department of Family Medicine and Outpatient Care Medical Faculty Uzhhorod National University Narodna Square 3 88000 Uzhhorod Transcarpathian Region Ukraine

Department of Family Medicine Andrija Stampar School of Public Health School of Medicine University of Zagreb 10000 Zagreb Croatia

Department of Family Medicine Andrzej Frycz Modrzewski Krakow University 30 705 Krakow Poland

Department of Family Medicine Faculty of Medicine Rīga Stradins University LV 1007 Riga Latvia

Department of Family Medicine Faculty of Medicine Tel Aviv University Tel Aviv 6997801 Israel

Department of Family Medicine Faculty of Medicine University of Ljubljana Vrazov trg 2 1000 Ljubljana Slovenia

Department of Family Medicine Prof Dr Cemil Tascioglu City Hospital 34384 Istanbul Turkey

Department of Family Medicine Riga Stradins University LV 1007 Riga Latvia

Department of Family Medicine Semmelweis University 1085 Budapest Hungary

Department of Family Medicine Uniwersytet Jagielloński Collegium Medicum 31 061 Krakow Poland

Department of General Practice Faculté de Médicine Henri Warembourg University of Lille 59045 Lille CEDEX 1 France

Department of Geriatric Medicine Hôpitaux Robert Schuman L 1130 Luxembourg Luxembourg

Department of Medical Sciences Academy of Applied Studies Polytechnic 11000 Belgrade Serbia

Department of Pharmacology Sahlgrenska Academy University of Gothenburg 405 30 Gothenburg Sweden

Department of Primary Care and Public Health Imperial College London London SW7 2AZ UK

Department of Primary Care Medicine Medical University of Vienna 1090 Vienna Austria

Department of Public Health and Primary Care KU Leuven 3000 Leuven Belgium

Department of Public Health Institute of Health Sciences Faculty of Medicine Vilnius University 03101 Vilnius Lithuania

Department Urology and General Practice Faculty of Medicine Medical University of Plovdiv 4000 Plovdiv Bulgaria

European Parliament L 2929 Luxembourg Luxembourg

Faculty of Medicine Ss Cyril and Methodius University 1000 Skopje North Macedonia

Faculty of Medicine University of Helsinki P O Box 63 00014 Helsinki Finland

Federica Montseny Health Centre Gerencia Asistencial de Atención Primaria Servicio Madrileño de Salud Avenida de la Albufera 285 28038 Madrid Spain

Fundación de Investigación e Innovación Biosanitaria de Atención Primaria 28003 Madrid Spain

General Health System Cyprus 6037 Larnaca Cyprus

General Medicine Department Belarusian State Medical University 220116 Minsk Belarus

Health Center Dr Đorđe Kovačević 11550 Lazarevac Serbia

Health Center Krupa Na Uni 79227 Krupa na Uni Bosnia and Herzegovina

Health Centre Zagreb Centar 10000 Zagreb Croatia

Health Centre Zagreb West 10000 Zagreb Croatia

Institute of General Practice 1st Faculty of Medicine Charles University Albertov 7 110 00 Prague Czech Republic

Instituto de Investigación Sanitaria Gregorio Marañón calle del Dr Esquerdo 46 28007 Madrid Spain

Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid 28035 Madrid Spain

Irish College of General Practice D02 YN77 Dublin Ireland

Kinetic Therapy and Special Motricity Faculty of Physical Education and Sport Spiru Haret University 030045 Bucharest Romania

Medical Education Unit Laboratory of Hygiene and Epidemiology Medical Department Faculty of Health Sciences University of Ioannina 451 10 Ioannina Greece

Medical Specialties and Public Health School of Health Sciences University Rey Juan Carlos Avda de Atenas s n 28922 Alcorcón Spain

Research Group Self Regulation and Health Institute for Health and Behaviour Department of Behavioural and Cognitive Sciences University of Luxembourg Campus Belval Maison des Sciences Humaines 11 Porte des Sciences L 4366 Esch sur Alzette Luxembourg

Research Network on Chronicity Primary Care and Health Promotion RICAPPS 28029 Madrid Spain

Research Unit for General Medicine and Primary Health Care Faculty of Medicine School of Health Science University of Ioannina 451 10 Ioannina Greece

Rural Family Doctors' Association of Latvia LV 4501 Balvi Latvia

School of Social Sciences Hellenic Open University 263 35 Patra Greece

Universitas Health Centre SALUD University of Zaragoza Andres Vicente 42 50009 Zaragoza Spain

Van Gürpınar District Public Hospital 65900 Gürpınar Turkey

Zobrazit více v PubMed

Ares-Blanco S., Astier-Peña M.P., Gómez-Bravo R., Fernández-García M., Bueno-Ortiz J.M. The role of primary care during COVID-19 pandemic: A European overview. Aten. Primaria. 2021;53:102134. doi: 10.1016/j.aprim.2021.102134. PubMed DOI PMC

Greenhalgh T., Koh G.C.H., Car J. COVID-19: A remote assessment in primary care. BMJ. 2020;368:m1182. doi: 10.1136/bmj.m1182. PubMed DOI

Davalbhakta S., Advani S., Kumar S., Agarwal V., Bhoyar S., Fedirko E., Misra D.P., Goel A., Gupta L., Agarwal V. A Systematic Review of Smartphone Applications Available for Corona Virus Disease 2019 (COVID-19) and the Assessment of their Quality Using the Mobile Application Rating Scale (MARS) J. Med. Syst. 2020;44:164. doi: 10.1007/s10916-020-01633-3. PubMed DOI PMC

Hernández-Quevedo C., Scarpetti G., Webb E., Shuftan N., Williams G.A., Birk H.O., Jervelund S.S., Krasnik A., Vrangbæk K. Effective Contact Tracing and the Role of Apps. Eurohealth. 2020;26:40–44.

Parker R.F., Figures E.L., Paddison C.A., Matheson J.I., Blane D.N., Ford J.A. Inequalities in general practice remote consultations: A systematic review. BJGP Open. 2021;5:BJGPO.2021.0040. doi: 10.3399/BJGPO.2021.0040. PubMed DOI PMC

Bol N., Helberger N., Weert J.C.M. Differences in mobile health app use: A source of new digital inequalities? Inf. Soc. 2018;34:183–193. doi: 10.1080/01972243.2018.1438550. DOI

European Centre for Disease Prevention and Control . Mobile Applications in Support of Contact Tracing for COVID-19—A Guidance for EU EEA Member States. European Centre for Disease Prevention and Control; Solna, Sweden: 2020. pp. 1–11. European Centre for Disease Prevention and Control Tech Guide.

European Commission Mobile Contact Tracing Apps in EU Member States. [(accessed on 9 August 2022)]. Available online: https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/travel-during-coronavirus-pandemic/mobile-contact-tracing-apps-eu-member-states_en.

Blasimme A., Ferretti A., Vayena E. Digital Contact Tracing Against COVID-19 in Europe: Current Features and Ongoing Developments. Front. Digit. Health. 2021;3:660823. doi: 10.3389/fdgth.2021.660823. PubMed DOI PMC

Keesara S., Jonas A., Schulman K. COVID-19 and Health Care’s Digital Revolution. N. Engl. J. Med. 2020;382:e82. doi: 10.1056/NEJMp2005835. PubMed DOI

European Commission EU Digital COVID Certificate. [(accessed on 9 August 2022)]. Available online: https://commission.europa.eu/strategy-and-policy/coronavirus-response/safe-covid-19-vaccines-europeans/eu-digital-covid-certificate_en.

Ares-Blanco S., Guisado-Clavero M., Ramos Del Rio L., Gefaell Larrondo I., Fitzgerald L., Adler L., Assenova R., Bakola M., Bayen S., Brutskaya-Stempkovskaya E., 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. doi: 10.1080/13814788.2023.2182879. PubMed DOI PMC

Mughal D.F., Mallen C., McKee M. The impact of COVID-19 on primary care in Europe. Lancet Reg. Health–Eur. 2021;6:100152. doi: 10.1016/j.lanepe.2021.100152. PubMed DOI PMC

Kahnbach L., Lehr D., Brandenburger J., Mallwitz T., Jent S., Hannibal S., Funk B., Janneck M. Quality and Adoption of COVID-19 Tracing Apps and Recommendations for Development: Systematic Interdisciplinary Review of European Apps. J. Med. Internet Res. 2021;23:e27989. doi: 10.2196/27989. PubMed DOI PMC

Gheisari M., Ghaderzadeh M., Li H., Taami T., Fernández-Campusano C., Sadeghsalehi H., Afzaal Abbasi A. Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review. JMIR MHealth UHealth. 2024;12:e44406. doi: 10.2196/44406. PubMed DOI PMC

Witteveen D., de Pedraza P. The Roles of General Health and COVID-19 Proximity in Contact Tracing App Usage: Cross-sectional Survey Study. JMIR Public Health Surveill. 2021;7:e27892. doi: 10.2196/27892. PubMed DOI PMC

Ritsema F., Bosdriesz J.R., Leenstra T., Petrignani M.W.F., Coyer L., Schreijer A.J.M., van Duijnhoven Y.T.H.P., van de Wijgert J.H.H.M., Schim van der Loeff M.F., Matser A. Factors Associated with Using the COVID-19 Mobile Contact-Tracing App among Individuals Diagnosed with SARS-CoV-2 in Amsterdam, The Netherlands: Observational Study. JMIR mHealth uHealth. 2022;10:e31099. doi: 10.2196/31099. PubMed DOI PMC

El-Sherif D.M., Abouzid M., Elzarif M.T., Ahmed A.A., Albakri A., Alshehri M.M. Telehealth and Artificial Intelligence Insights into Healthcare during the COVID-19 Pandemic. Healthcare. 2022;10:385. doi: 10.3390/healthcare10020385. PubMed DOI PMC

Reitzle L., Schmidt C., Färber F., Huebl L., Wieler L.H., Ziese T., Heidemann C. Perceived Access to Health Care Services and Relevance of Telemedicine during the COVID-19 Pandemic in Germany. Int. J. Environ. Res. Public Health. 2021;18:7661. doi: 10.3390/ijerph18147661. PubMed DOI PMC

Coma E., Mora N., Méndez L., Benítez M., Hermosilla E., Fàbregas M., Fina F., Mercadé A., Flayeh S., Guiriguet C., 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. doi: 10.1186/s12875-020-01278-8. PubMed DOI PMC

Iacobucci G. COVID-19: Underfunding of health workforce left many European nations vulnerable, says commission. BMJ. 2021;372:724. doi: 10.1136/bmj.n724. PubMed DOI

Ares-Blanco S., Astier-Peña M.P., Gómez-Bravo R., Fernández-García M., Bueno-Ortiz J.M. Human resource management and vaccination strategies in primary care in Europe during COVID-19 pandemic. Aten. Primaria. 2021;53:102132. doi: 10.1016/j.aprim.2021.102132. PubMed DOI PMC

OECD . The COVID-19 Pandemic and the Future of Telemedicine. OECD; Paris, France: 2023. pp. 1–41. OECD Health Policy Studies.

Pandit J.A., Radin J.M., Quer G., Topol E.J. Smartphone apps in the COVID-19 pandemic. Nat. Biotechnol. 2022;40:1013–1022. doi: 10.1038/s41587-022-01350-x. PubMed DOI

Guisado-Clavero M., Ares-Blanco S., Ben Abdellah L.D. Using mobile applications and websites for the diagnosis of COVID-19 in Spain. Enfermedades Infecc. Microbiol. Clin. 2021;39:454–457. doi: 10.1016/j.eimc.2020.08.002. PubMed DOI PMC

European Union . Regulation (EU) 2017/745 of the European Parliament and of THE COUNCIL of 5 April 2017 on Medical Devices, Amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and Repealing Council Directives 90/385/EEC and 93/42/EE. European Union; Luxembourg: 2017.

Kofler N., Baylis F. Passports Are a Bad Idea. Nature. 2020;581:379–381. doi: 10.1038/d41586-020-01451-0. PubMed DOI

Miller H., Johns L. Interoperability of Electronic Health Records: A Physician-Driven Redesign. Manag. Care. 2018;27:37–40. PubMed