The role of primary care during the pandemic: shared experiences from providers in five European countries.

BACKGROUND: The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience. METHODS: The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care. RESULTS: Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues. CONCLUSION: Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.

A gap analysis for future supply of and demand for psychiatrists in Austria.

BACKGROUND: In the recent past, a rising caseload demonstrates increasing demand for psychiatrists, and ageing of the current mental health workforce will soon result in growing numbers of retirees. Under these conditions there is some concern whether we soon will face widening gaps in supply. AIMS OF THE STUDY: This study calculates projections of future use and supply of psychiatrists' services in Austria until 2030. Resulting gaps are calculated for different scenarios. DATA AND METHODS: We mostly use administrative data from several public authorities. To estimate the demand for services, we start from utilization data rather than medical need for services, as we do not have sufficient epidemiological information for Austria. We define several scenarios for the future development of use, all calculated separately for hospital and non-hospital services. Future supply of psychiatric services is projected by applying activity levels to projected numbers of physicians, which are calculated using a stock and flow model. Outflows are modeled using assumptions derived from past activity patterns and current legislation on retirement. To model inflows, we need to gauge the impact of recent developments: Entrance barriers into medical education were introduced, Austria experienced a surge of medical students coming from Germany, and medical schools implemented quotas for different nationalities. Scenarios take several factors into account, like the shifting sex composition of the medical workforce, re-migration of foreign students, and the impact of entrance barriers on enrolment and drop-out rates. RESULTS: Depending on scenario assumptions, demand for psychiatrists will increase by 8% to 52%. But in all supply scenarios, supply will decline from 2016 onwards, thus widening gaps between supply and demand. Even in the most optimistic scenario, supply will have fallen below current levels by 2030. DISCUSSION: Compared to current rates of service use, a gap between supply and demand will start to widen soon. In the most optimistic combination of scenarios, demand will exceed supply from 2028 onwards, and the projected gap will amount to about 5% of projected demand for services in 2030. LIMITATIONS: Gaps could be miscalculated due to lack of more detailed data, such as retirement patterns of psychiatrists. Shifting responsibilities between psychiatrists and other (mental) health workers as well as changes in psychiatrists' "productivity", e.g. due to more effective medications, were not modeled but would affect results. IMPLICATIONS FOR HEALTH POLICIES: It will be necessary to improve working and training conditions in order to avoid emigration and to attract a sufficient number of young entrants into the profession.

Abundance and diversity of GI microbiota rather than IgG4 levels correlate with abdominal inconvenience and gut permeability in consumers claiming food intolerances.

Food intolerances are an increasing global health problem. Interactions between genetics and environmental changes such as microbial- and stress factors remain poorly understood. Whereas the analyses of IgE mediated allergic responses is based on solid concepts, the roles of microbiota, gut permeability, and IgG antibodies remain widely unclear and are under fierce discussion for scientific relevance. The present pilot study analyzes forty participants, under consultation of nutritional health professionals, for gastrointestinal discomfort and claimed food intolerances. Food frequency questionnaire addresses nutrition, lifestyle and present discomfort. Feces samples are analyzed for dominant microbiota using 16S rDNA based methods and the fecal marker Calprotectin. Blood samples are analyzed for IgG4 levels. The total microbial abundance significantly correlates with claimed discomfort (R=-0.37; p=0.02). The abundance and diversity of microbiota significantly correlates with low Calprotectin values (R=-0.35; p=0.01) and with higher abundance of Faecalibacterium prausnitzii (R=0.78; p<0.01) and Akkermansia (R=0.82; p<0.01). Participants with low discomfort show enhanced Clostridium Cluster XIVa (p=0.008). An increased diversity is also correlating with reduced antibodies against IgG4 of egg white (R=0.68; p<0.01). Data suggest an interaction of low gut permeability and reduced inflammation with an established microbial equilibrium. Self-reported abdominal inconvenience of participants relates mainly to characteristics of microbiota and gut permeability. Anti-inflammatory effects of Faecalibacterium prausnitzii or Lactobacilli and gut barrier functions of Akkermansia may have a key role in food intolerances. The role of IgG4 linking food immune responses with intolerances remains unclear.

Measuring hospital efficiency in Austria--a DEA approach.

We investigate the evolution of efficiency and productivity in the hospital sector of an Austrian province for the time period 1994-1996. We use panel data to design non-parametric frontier models (Data Envelopment Analysis) and compare efficiency scores and time patterns of efficiency across medical fields. As health outcomes hardly can be measured in a direct way we make use of two different approaches for output measurement: In a first approach, we employ the number of case mix-adjusted discharges and of inpatient days, in a second we use credit points, which are calculated in course of the newly introduced diagnosis related group-type financing system. We calculate and compare individual efficiency scores for hospital wards as decision making units (DMU) in specified medical fields. To our knowledge the calculation of ward-specific efficiency scores has not up till now been the unit of non-parametric efficiency analysis. Our two models find different results: Model 1 with conservative output measurement calculates an average efficiency level of 96%, while model 2 with credit points for output measurement puts average efficiency at 70%. Whereas average efficiency in model 1 hardly changes and in model 2 increases modestly in the period 1994-1996, a closer look at single hospitals displays a variety of different efficiency developments over time.