Primary Care Survey Research Articles

Social and economic factors associated with antidepressant use: Results of a national survey in primary care

• The findings suggested inequity in access to drug treatment for depression in a middle-income country, especially for non-white individuals and those from lower social economic status brackets. • Public policies should be developed on primary health care services to optimize the detection and treatment of depression. • Polypharmacy was strongly associated to use of antidepressants. • Optimizing pharmacotherapy can minimize harm and undesired drug interactions. Background: Antidepressants are widely prescribed, and it is important to describe their use characteristics. We aimed to estimate the prevalence of antidepressant use and identify associated factors in a cross-sectional study from a middle-income country. Methods: Participants (n=8,803) from the National Survey on Access, Use, and Promotion of the Rational Use of Medicines in Brazil, a cross-sectional study with a representative sample, were asked about the use of any medicines in the past 30 days. Through the answers, we classified the antidepressants users and non-users. The association between antidepressant use, demographic and clinical characteristics was evaluated. Results: The prevalence of antidepressant use was 6.8% (95% CI 6.2 - 7.3). Most users whom self-reported a previous diagnosis of depression (70.6%) did not report antidepressant use, suggesting underuse. Fluoxetine and amitriptyline ranked first in use. White females, from higher economic status, self-reporting a previous diagnosis of depression, in polypharmacy and in use of psychotropics, with alcohol abstinence, were more likely to use the medicines. Limitations: The use of drugs was measured by self-report, which might have underestimated results. Indication for antidepressant use in depression or other conditions was not investigated. Conclusions: The prevalence of antidepressant use observed in Brazil is lower than in the USA and some European countries. Although patients have a universal right to health in Brazil, improved primary care actions are required to ensure access to treatment of depressive disorders, especially for non-white individuals and those from lower social-economic status brackets.

COVID-19 vaccinations and counselling: a mixed-methods survey of Australian general practice in July 2021.

GPs are integral to the COVID-19 vaccination rollout, providing education and administering vaccines. We sought to describe how counselling relating to COVID-19 vaccination was impacting Australian general practice consultations. We conducted an online, mixed-methods, cross-sectional survey of Australian community-based primary care from 7 to 15 July 2021. This survey, number 15 in a series of recurrent cross-sectional surveys conducted over a 14-month period, explored how counselling relating to COVID-19 vaccination was impacting general practice consultations, through multiple selection and open text responses; it also included questions on respondent and practice characteristics, and pandemic-related stress and strain. We calculated descriptive statistics for quantitative variables, and analysed free-text responses using an inductive content analysis approach. We received 73 responses (72 GPs) across all states/territories. Discussions with patients about COVID-19 vaccines and vaccination were common, increasing the duration of routine consultations by 6min on average (s.d. 2.9). Respondents described the impact of the resulting time pressures, and the stress and challenges of participating in COVID-19 vaccine communication and administration. Although our results are illuminating, they are limited by the small sample, with some different characteristics from national estimates, an uncertain response rate and the inability to pilot the survey prior to distribution. The significant impact on general practice consultation from COVID-19 vaccine counselling is on a background of ongoing pandemic-related stress and strain. With a strong track record of population vaccination, GPs are well-placed to deliver COVID-19 immunisations to the Australian population. However, they must be represented in planning and coordination, to reduce the overall burden on primary care.

Effect of Family Practice Contract Services on the Perceived Quality of Primary Care among Patients with Multimorbidity: A Cross-Sectional Study in Guangdong, China.

Family practice contract services, an important primary-care reform policy for improving primary healthcare quality in China, incorporate patients with multiple chronic conditions into the priority coverage groups and focus on their management. This study aims to explore the family practice contract services’ effectiveness in improving the quality of primary care experienced by this population. A cross-sectional study using a three-stage sampling was conducted from January to March 2019 in Guangdong, China. A multivariable linear regression, including interaction terms, was applied to examine the associations between the contract services and primary care quality among people with different chronic conditions. The process quality of primary care was measured in six dimensions using the validated assessment survey of primary care (ASPC) scale. People with contract services scored higher in terms of quality of primary care than those without contract services. Contract services moderated the association between chronic condition status and primary care quality. Significantly positive interactions were observed in the patient-centred care dimension and negative interactions were reflected in the accessibility dimension. Our findings suggest that family practice contract services play a crucial role in improving patient-perceived primary care quality and provide emerging evidence that patients with multimorbidity tend to benefit more from the services, especially in patient-centred care.

Service change and innovation in community end-of-life care during the COVID-19 pandemic: Qualitative analysis of a nationwide primary care survey

Background: Primary healthcare teams (general practice and community nursing services) within the United Kingdom provided the majority of community end-of-life care during COVID-19, alongside specialist palliative care services. As international healthcare systems move to a period of restoration following the first phases of the pandemic, the impact of rapidly-implemented service changes and innovations across primary and specialist palliative care services must be understood. Aim: To provide detailed insights and understanding into service changes and innovation that occurred in UK primary care to deliver end-of-life care during the first phase of the COVID-19 pandemic. Design: Cross-sectional online survey. Responses were analysed using descriptive statistics and thematic analysis. Setting/participants: United Kingdom survey of general practitioners and community nurses, circulated via regional and national professional networks. Results: A total of 559 valid responses were received from 387 community nurses, 156 general practitioners and 16 ‘other’. Over a third of respondents (n = 224; 40.8%) experienced changes in the organisation of their team in order to provide end-of-life care in response to the COVID-19 pandemic. Three qualitative themes were identified: COVID-19 as a catalyst for change in primary palliative care; new opportunities for more responsive and technological ways of working; and pandemic factors that improved and strengthened interprofessional collaboration. Conclusion: Opportunity has arisen to incorporate cross-boundary service changes and innovations, implemented rapidly at the time of crisis, into future service delivery. Future research should focus on which service changes and innovations provide the most benefits, who for and how, within the context of increased patient need and complexity.

Routinely asking patients about income in primary care: a mixed-methods study.

BackgroundIncome is a key social determinant of health, yet it is rare for data on income to be routinely collected and integrated with electronic health records.AimTo examine response bias and evaluate patient perspectives of being asked about income in primary care.Design & settingMixed-methods study in a large, multi-site primary care organisation in Toronto, Canada, where patients are asked about income in a routinely administered sociodemographic survey.MethodData were examined from the electronic health records of patients who answered at least one question on the survey between December 2013 and March 2016 (n = 14 247). The study compared those who responded to the income question with non-responders. Structured interviews with 27 patients were also conducted.ResultsA total of 10 441 (73%) patients responded to both parts of the income question: ‘What was your total family income before taxes last year?’ and ‘How many people does your income support?’. Female patients, ethnic minorities, caregivers of young children, and older people were less likely to respond. From interviews, many patients were comfortable answering the income question, particularly if they understood the connection between income and health, and believed the data would be used to improve care. Several patients found it difficult to estimate their income or felt the options did not reflect fluctuating financial circumstances.ConclusionMany patients will provide data on income in the context of a survey in primary care, but accurately estimating income can be challenging. Future research should compare self-reported income to perceived financial strain. Data on income linked to health records can help identify health inequities and help target anti-poverty interventions.

Prevalence of Dyslipidemia and Availability of Lipid-Lowering Medications Among Primary Health Care Settings in China

Dyslipidemia, the prevalence of which historically has been low in China, is emerging as the second leading yet often unaddressed factor associated with the risk of cardiovascular diseases. However, recent national data on the prevalence, treatment, and control of dyslipidemia are lacking. To assess the prevalence, treatment, and control of dyslipidemia in community residents and the availability of lipid-lowering medications in primary care institutions in China. This cross-sectional study used data from the China-PEACE (Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project, which enrolled 2 660 666 community residents aged 35 to 75 years from all 31 provinces in China between December 2014 and May 2019, and the China-PEACE primary health care survey of 3041 primary care institutions. Data analysis was performed from June 2019 to March 2021. Study period. The main outcome was the prevalence of dyslipidemia, which was defined as total cholesterol greater than or equal to 240 mg/dL, low-density lipoprotein cholesterol (LDL-C) greater than or equal to 160 mg/dL, high-density lipoprotein cholesterol (HDL-C) less than 40 mg/dL, triglycerides greater than or equal to 200 mg/dL, or self-reported use of lipid-lowering medications, in accordance with the 2016 Chinese Adult Dyslipidemia Prevention Guideline. This study included 2 314 538 participants with lipid measurements (1 389 322 women [60.0%]; mean [SD] age, 55.8 [9.8] years). Among them, 781 865 participants (33.8%) had dyslipidemia. Of 71 785 participants (3.2%) who had established atherosclerotic cardiovascular disease (ASCVD) and were recommended by guidelines for lipid-lowering medications regardless of LDL-C levels, 10 120 (14.1%) were treated. The overall control rate of LDL-C (≤70 mg/dL) among adults with established ASCVD was 26.6% (19 087 participants), with the control rate being 44.8% (4535 participants) among those who were treated and 23.6% (14 552 participants) among those not treated. Of 236 579 participants (10.2%) with high risk of ASCVD, 101 474 (42.9%) achieved LDL-C less than or equal to 100 mg/dL. Among participants with established ASCVD, advanced age (age 65-75 years, odds ratio [OR], 0.63; 95% CI, 0.56-0.70), female sex (OR, 0.56; 95% CI, 0.53-0.58), lower income (reference category), smoking (OR, 0.89; 95% CI, 0.85-0.94), alcohol consumption (OR, 0.87; 95% CI, 0.83-0.92), and not having diabetes (reference category) were associated with lower control of LDL-C. Among participants with high risk of ASCVD, younger age (reference category) and female sex (OR, 0.58; 95% CI, 0.56-0.59) were associated with lower control of LDL-C. Of 3041 primary care institutions surveyed, 1512 (49.7%) stocked statin and 584 (19.2%) stocked nonstatin lipid-lowering drugs. Village clinics in rural areas had the lowest statin availability. These findings suggest that dyslipidemia has become a major public health problem in China and is often inadequately treated and uncontrolled. Statins were available in less than one-half of the primary care institutions. Strategies aimed at detection, prevention, and treatment are needed.

Current allergy educational needs in primary care. Results of the EAACI working group on primary care survey exploring the confidence to manage and the opportunity to refer patients with allergy.

This study took the form of a cross-sectional observational study in which a structured electronic questionnaire was distributed to primary care providers, in eight languages, across 8 European countries between September 2019 and November 2019. Data associated with demographic parameters, professional qualifications, type of employment, level of confidence regarding competencies for diagnosis and treatment of allergic diseases, referral of patients to allergist and preferred method of learning and assessment were collected. A 5-point Likert scale was used to assess level of confidence. Exploratory analysis was carried out. A total of 687 responses were available for analysis, with 99.3% of responders working within Europe. 70.1% of participants were female; and 48.0% and 48.0% of participants respectively had received some undergraduate and/or postgraduate allergy education. Confidence in dealing with different aspect of allergy management differed between countries. The main reason for specialist referral was a perceived need for tertiary assessment (54.3%), and the main barrier for referral was the consideration that the patient's condition could be appropriately diagnosed and treated in a primary care facility. Up to 44.7% and 55.3% of participants reported that they preferred e-Learning over traditional learning. This study identified the specific areas of skills training and educational needs of GPs in managing allergic conditions in primary care, and provided insights into possible strategies for more feasible and cost-effective approaches.

Closing the knowledge gap in Malaysian pharmacists: a virtual Allergic Rhinitis Boot Camp initiative.

BackgroundIn primary care, general practitioners (GPs) and pharmacists are at the frontline to identify, classify and manage patients suffering from allergic rhinitis (AR). The Allergic Rhinitis and its impact on Asthma (ARIA) guidelines aid clinicians in disease management by providing evidence-based recommendations. A recently published ASEAN primary care survey demonstrated that the awareness of ARIA guidelines was high among GPs but notably lower in pharmacists. Hence, this study seeks to evaluate the effectiveness of a Boot Camp education initiative in bridging the unmet needs in pharmacist awareness and education.MethodsThe boot camp was organised as a virtual event. The participants answered the same questionnaire before (pre-assessment) and immediately after (post-assessment) the boot camp session. Statistical analysis was performed on the data paired between the pre- and post- assessments using SPSS v. 25.0 software.ResultsThe boot camp survey results showed that second-generation oral antihistamines and allergen avoidance are the most preferred options for AR treatment in pharmacy practice, irrespective of the disease severity. In both pre- and post-assessments, efficacy was ranked as the most important factor considered for choosing an antihistamine and which affects patient adherence. With the boot camp initiative, there was a statistically significant increase in awareness about the patient profiling tool (from 31.6% to 88.2%) and ARIA guidelines (from 40.4% to 91.2%) among the pharmacists (p<0.05). The proportion of pharmacists who were able to identify, classify and refer AR patients was significantly increased in post-assessment (p<0.05). Post the boot camp, among the proportion of pharmacists (91.2%) who were already aware of ARIA, a high percentage of them further agreed that ARIA guidelines were useful in identifying and treating patients with AR, as well as classifying AR, respectively (97.6%, 95.2%, and 93.5%).ConclusionsBased on improvements in knowledge and understanding of disease management post assessment, the Allergic Rhinitis Boot Camp initiative is effective and relevant to pharmacy practice. Outreach programs like this reiterate the emphasis on patient compliance and importance of utilizing ARIA guidelines in pharmacy practice that facilitates better management of AR in primary care.

Health Care Disparities and Access to Video Visits Before and After the COVID-19 Pandemic: Findings from a Patient Survey in Primary Care.

Background:In 2020, the Centers for Medicare & Medicaid Services reimbursement structure was relaxed to aid in the rapid adoption nationally of telemedicine during the COVID-19 pandemic. Due to limited access to internet service, cellular phone data, and appropriate devices, many patients may be excluded from telemedicine services.Methods:In this study, we present the findings of a survey of patients at an urban primary care clinic regarding their access to the tools needed for telemedicine before and after the COVID-19 pandemic. Patients provided information about their access to internet services, phone and data plans, and their perceived access to and interest in telemedicine. The survey was conducted in 2019 and then again in September of 2020 after expansion of telemedicine services.Results:In 2019, 168 patients were surveyed; and in 2020, 99 patients participated. In both surveys, 30% of respondents had limited phone data, no data, or no phone at all. In 2019, the patient responses showed a statistically significant difference in phone plan types between patients with different insurance plans (p < 0.10), with a higher proportion (39%) of patients with Medicaid or Medicaid waiver having a prepaid phone or no phone at all compared with patients with commercial insurance (26%). The overall awareness rate increased from 17% to 43% in the 2020 survey.Conclusions:This survey illustrated that not all patients had access to devices, cellular data, and internet service, which are all needed to conduct telemedicine. In this survey, patients with Medicaid or Medicaid waiver insurance were less likely to have these tools than those with a commercial payor. Finally, patients' access to these telemedicine tools correlated with their interest in using telemedicine visits. Providing equitable telemedicine care requires attention to and mitigation strategies for these gaps in access.

What matters for patients’ experiences with primary care? A study of variation in patient reported experience measures with regard to structural and organisational characteristics of primary care centres in a Swedish region.

Previous research on variation in patient reported experience measures (PREMs) suggest that it is important to be cautious when using comparative information about patients’ experiences, collected via patient surveys, to assess provider performance. Not all factors associated with variation in PREMs are related to factors that providers themselves can control. This study explores if structural characteristics of primary care practices (PCCs), that are difficult to control, and the way that providers manage and organise their work matter for patients’ experiences with care. The purpose was to analyse variation in PREMs at the PCC level in Swedish primary care, with regard to structural characteristics of PCCs, including patient mix, and variables representing how providers organise and manage their work. Since the choice reform in 2007-2010, there is a mix of public and private providers, all with public funding and operating under the same overall requirements. The analysis is based on data from a national patient survey in primary care and registry data from a large Swedish region. OLS regression analysis was used to study variation in seven PREM-dimensions in regards to variables representing structural and organisational characteristics and processes of work at PCCs, covering the years 2018-2019 (N=281 PCC year observations). The results imply that variables that can be changed by providers themselves matter more for patients’ experiences with care than factors that providers cannot control. The most significant associations were found between PREMs and proportion and continuity of GP visits and adherence to clinical guidelines regarding treatment of risk groups. However, it is a challenge for providers to offer a high proportion of visits with GPs and good continuity due to a persisting shortage of GPs in Sweden. Recent policy initiatives have been introduced in this area. From a policy perspective, variation in patients’ experiences with regard to socioeconomic conditions is also a concern. Published: Online August 2021

The patient satisfaction in primary care consultation-Questionnaire (PiC): An instrument to assess the impact of patient-centred communication on patient satisfaction.

Primary care consultation is significantly influenced by communication between the General Practitioner (GP) and their patients. Hypothesising that patient satisfaction can be tested based on an expectation-experience comparison, the aim of this article is to discuss the influence of communication on patient satisfaction. A standardised questionnaire was developed striving for a universal primary care survey tool that focuses on patient satisfaction in the context of patient-centred-communication. The sample consisted of 14 German GPs with 80 patients each (n = 1120). Due to the inclusion in an overarching cluster-randomised-study (CRT), the medical practices to be examined were divided into intervention and control groups. The intervention was developed as a reflective training on patient-centred communication. The results in the present sample show no correlation between patient-centred-communication and patient satisfaction. There are also no significant differences between the intervention and control group. The results raise the question to what extent patient satisfaction can be shaped significantly through patient-centred-communication. The presented project represents part of the basic research in general medical care research and contributes to the transparent processing of theoretical assumptions. With the results described here, communication models with a focus on patient centredness can be evaluated with regard to their practical relevance and transferability.

Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey.

BackgroundThousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning.AimTo understand the views of GPs and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic.Design & settingA web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks, during September and October 2020.MethodResponses were analysed using descriptive statistics and an inductive thematic analysis.ResultsValid responses were received from 559 individuals (387 community nurses, 156 GPs, and 16 unspecified roles), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress.ConclusionPrimary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.

Sharing Medical Decisions with the Child. An Exploratory Survey in Paediatric Primary Care.

ABSTRACT Objective This paper presents an analysis of the shared decision-making between parents, children and physicians in paediatric primary care, taking into consideration that it is difficult but useful to promote the engagement of both the parents and the children in medical practice. Concordance between medical professionals and patients is a therapeutic strategy that is useful for achieving engagement between them, as they are the co-producers for the patients’ health and are both responsible for their choices during the course of treatment. Methods The study involved observing and audio recording 185 medical visits that included children with a mean age of 8.16 years (±2.41). Medical dialogues are described, with particular attention paid to the clinical conditions discussed, and the outcomes of the visits are reported. Shared decision-making is analyzed through the Observing PaTient Involvement in shared decisiON making (OPTION) tool, an observational grid composed of 12 items aimed at evaluating doctors’ abilities to involve their patients in the decisions made concerning their therapeutic plans. The observations were carried out to obtain the paediatricians’ dialogue with the parents and children. Results In all the dialogues, low levels of shared decision-making were detected. This type of communication allows for a fast and efficient execution of the visit, without the active involvement of the patients and with evident risks for their tendency to go to various health facilities. Conclusions Dialogue in the field of paediatric primary care seems to be influenced and characterized by unconditional forms of adherence to medical knowledge. Further exploration of this would be useful, along with the implementation of specific interventions aimed at promoting shared decision-making, to enhance the decision-making skills of mothers and children and to promote their engagement during the process of the medical care.

Methodology for a six-state survey of primary care nurse practitioners

BackgroundPrimary care practices employing nurse practitioners (NPs) can play an important role in improving access to high quality health care services. However, most studies on the NP role in health care use administrative data, which have many limitations. PurposeIn this paper, we report the methods of the largest survey of primary care NPs to date. MethodsTo overcome the limitations of administrative data, we fielded a cross-sectional, mixed-mode (mail/online) survey of primary care NPs in six states to collect data directly from NPs on their clinical roles and practice environments. FindingsWhile we were able to collect data from over 1,200 NPs, we encountered several challenges with our sampling frame, including provider turnover and challenges with identification of NP specialty. DiscussionIn future surveys, researchers can employ strategies to avoid the issues we encountered with the sampling frame and enhance large scale survey data collection from NPs.

Reliability of a Risk-Factor Questionnaire for Osteoporosis: A Primary Care Survey Study with Dual Energy X-ray Absorptiometry Ground Truth.

(1) Purpose: Predisposing factors to osteoporosis (OP) as well as dual-source x-ray densitometry (DXA) steer therapeutic decisions by determining the FRAX index. This study examines the reliability of a standard risk factor questionnaire in OP-screening. (2) Methods: n = 553 eligible questionnaires encompassed 24 OP-predisposing factors. Reliability was assessed using DXA as a gold standard. Multiple logistic regression and Spearman’s correlations, as well as the confounding influence of age and body mass index, were analyzed in SPSS (IBM Corporation, Armonk, NY, USA). (3) Results: Our study revealed low patient self-awareness regarding OP and its risk factors. One out of every four patients reported a positive history for osteoporosis not confirmed by DXA. The extraordinarily high incidence of rheumatoid arthritis and thyroid disorders likely reflect confusion with other diseases or health anxiety. FRAX-determining risk factors such as malnutrition, liver insufficiency, prior fracture without trauma, and glucocorticoid therapy did not correlate with increased OP incidence, altogether demonstrating how inaccurate survey information could influence therapeutic decisions on osteoporosis. (4) Conclusions: Contradictive results and a low level of patient self-awareness suggest a high degree of uncertainty and low reliability of the current OP risk factor survey.

Primary care survey of venous leg ulceration management and referral pre-EVRA trial.

Venous leg ulceration (VLU) is a public health concern that is largely managed in community settings. The present study aimed to survey current VLU management in the community. A 14-question survey was distributed to primary care professionals, and 90 responses were received. Some 54% of respondents stated that they would assess ankle brachial pressure indices (ABPI) for those with VLU, while 25% reported that they would not. Additionally, 62% reported not organising duplex ultrasound scanning. Compression therapy was offered by 82% of respondents. When asked whether VLU patients were referred to specialist services in secondary or tertiary care, some 32% reported that they would. However, 57% reported that, if a study suggested that referral to specialist services was beneficial, they would change their practice. On the basis of the findings, the authors concluded that there is diversity in VLU diagnostic and treatment pathways. New, high-quality evidence may improve practice, but care delivery is influenced by local factors including time and resource distribution.

Poor attainment of blood pressure, lipids and diabetes targets in people at high cardiovascular risk in Europe: a report from the ESC-EORP EUROASPIRE V Survey in 16 European countries

Abstract Introduction The EUROASPIRE V survey in primary care was carried out by the European Society of Cardiology, EURObservational Research Programme in 2017–2018 and investigated the risk factor management in patients at high cardiovascular (CVD) risk in16 European countries. Purpose To provide an audit the implementation of the 2016 Joint European Societies' guidelines on CVD prevention in people at high risk of developing CVD in primary care and to see whether the practice of preventive cardiology had improved by comparison with the previous EUROASPIRE IV survey in 2014–2015. Methods All patients were free of coronary or other atherosclerotic diseasebut considered at high CVD risk since they had been started on blood pressure and/or lipid and/or glucose lowering treatments. They were interviewed and examined by means of standardized methods ≥6 months after the start of therapy. Results 2,759high CVD risk individuals (58% females), mean age 59 (SD 12) years, were interviewed and examined (participation rate 70%). The risk factor control was very poor, with less than half (47%) of patients on blood pressurelowering medication reaching the target of &amp;lt;140/90 mmHg (&amp;lt;140/85 mmHg in people with self-reported diabetes). Among treated dyslipidaemic patients only 47% attained LDL-cholesterol target of &amp;lt;2.6 mmol/L. Among treated type 2 diabetic patients, 65% achieved the HbA1c target of &amp;lt;7.0mmol/L. However, many patients on no antihypertensive or lipid-lowering medications had elevated blood pressure (43%) and elevated LDL-cholesterol (81%), respectively. The use of blood pressure lowering medication in people with hypertension was: ACE inhibitors/ARBs 79%, beta-blockers 37%, diuretics 36% and calcium channel blockers 32%; with 42% on one, 34% on two, 18% on three and 6% on ≥4 blood pressure lowering drugs. Among people on lipid-lowering medication, statins were prescribed in 97% and fibrates in 3%. Less than two-thirds of patients reported complete adherence with the intake of their blood pressure and lipid-lowering medications. The comparison with EUROASPIRE IV in the same centres that took part in both surveys showed no change in the BP management. There was a slight improvement in the control of LDL-cholesterol and glucose in patients with diabetes. Conclusions The results of EUROASPIRE V clearly demonstrate that the control of blood pressure, LDL-cholesterol and diabetes in patients at high CVD risk remains poor with large proportions not achieving the targets defined in the prevention guidelines. There is a considerable potential to raise the standards of preventive cardiology and to improve the management of patients at high CVD risk in Europe. Funding Acknowledgement Type of funding source: Other. Main funding source(s): European Society of Cardiology

Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

ObjectivesCancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different...

SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium.

COVID-19 also affects pregnant and breastfeeding women. Hence, clinicians and policymakers require reliable evidence on COVID-19 epidemiology and consequences in this population. We aimed to assess the susceptibility of pregnant women to SARS-CoV-2 and women’s perceived impact of the pandemic on their breastfeeding practices, medical counseling and social support. We performed a cross-sectional study using an online survey in primary care in Belgium. Pregnant and breastfeeding women and women who breastfed in the preceding four weeks were eligible to participate. The survey was distributed through social media in April 2020. In total, 6470 women participated (i.e., 2647 pregnant and 3823 breastfeeding women). Overall, 0.3% of all respondents reported to have tested positive for SARS-CoV-2, not indicating a higher susceptibility of pregnant women to contracting COVID-19. More than 90% refuted that the pandemic affected their breastfeeding practices, nor indicated that the coronavirus was responsible for breastfeeding cessation. Half of the women even considered giving longer breastmilk because of the coronavirus. In contrast, women’s medical counseling and social support were negatively affected by the lockdown. Women without previous breastfeeding experience and in the early postpartum period experienced a higher burden in terms of reduced medical counseling and support. In the future, more consideration and alternative supportive measures such as tele-visits by midwives or perinatal organizations are required for these women.

Primary health care and national household random sampling surveys: contributions from Brazil

Abstract Primary health care has been considered by the World Health Organization (WHO) as the most efficient way of organizing health systems in order to achieve universal health coverage, preserving its attributes and focusing on people. Several countries in the world have developed instruments to measure access, use of services and lifestyles of their populations. In Europe, European Union members have validated the European Health Interview Survey (EHIS / Eurostat), which is in its third wave of application. Brazil, for over 20 years, has developed, through the Brazilian Institute of Geography and Statistics (IBGE) - the Brazilian Federal Statistics Bureau - in partnership with the Ministry of Health, a national household health survey throughout its territory, the so-called National Health Survey (PNS). PNS-2019 questionnaire innovated by including a module of questions that allows assessing the scores of the attributes proposed by Shi and Starfield in the 2000s. The Primary Care Assessment Tool (PCAT) was included in its brazilian statistically validated version for adult users and applied in more than 100,000 households in all five regions and 27 states in Brazil. Over a six-month period, a sample of approximately 10,000 adults was registered, according to the inclusion criteria of the PCAT considered (being 18 years old or older, having had more than one medical appointment in the last six months, having performed this appointment in a public primary health care facility). We consider it essential to use statistically validated instruments that allow cross-country comparisons and we encourage Governments all over the world to follow Brazilian example in incorporating in their national health surveys a module containing the validated version of the PCAT. This instrument has already been validated and used in the evaluation of primary care in regions of all five continents of the world, demonstrating, therefore, its capacity for cultural adaptation to each reality. Key messages PCAT's set of instruments remains current for the evaluation of primary health care services from the users' perspective nationwide. The importance of using National Health Surveys in each country, with random household sampling to assess health systems and conditions.