Work climate in pandemic times: which burdens do German physicians in primary care report?

BACKGROUND: In Germany, general practitioners (GPs) provide basic and primary care in the ambulatory sector and refer patients to other specialists when necessary. Often, GPs present the first point of contact for patients in the German healthcare system. During the COVID-19 pandemic, GPs and other medical specialists in the ambulatory setting suddenly were confronted with unprecedented challenges. OBJECTIVE: To answer the following research questions: How did COVID-19-related challenges affect the work climate? Do physicians with deteriorated work climate simultaneously report a worsened provision of patient care? Which challenges were the most burdening? METHODS: In the course of the project COVID-GAMS more than 18 000 physicians of various specialties had been invited to a quantitative cross-sectional online survey (in Summer 2020). Analyses were conducted separately for the groups of GPs and other medical specialists. Group differences were analysed statistically and burdening factors were identified. RESULTS: 1703 participants were included in the analysis. 22.2% of GPs (other medical specialists: 19.9%) stated, their work climate had deteriorated. Physicians with a deteriorated work climate showed a tendency towards poorer personal provision of patient care (M = 3.75, SD = 0.98 versus M = 3.93, SD = 0.99) compared to unchanged or improved work climate. The lack of protective material in March/April 2020, changes in practice management and possible economic impacts on the practice were the most burdening factors reported by GPs. CONCLUSION: GPs who reported a negative impact on the work climate in the course of the first pandemic lockdown also tend to see own deficits in the provision of patient care.

Use of telemedicine in the outpatient sector during the COVID-19 pandemic: a cross-sectional survey of German physicians.

BACKGROUND: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany. METHODS: The anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians. RESULTS: The use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients. CONCLUSION: The COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician's and patient's barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.

Stockpiled personal protective equipment and knowledge of pandemic plans as predictors of perceived pandemic preparedness among German general practitioners.

BACKGROUND: The COVID-19 pandemic significantly changed the work of general practitioners (GPs). At the onset of the pandemic in March 2020, German outpatient practices had to adapt quickly. Pandemic preparedness (PP) of GPs may play a vital role in their management of a pandemic. OBJECTIVES: The study aimed to examine the association in the stock of seven personal protective equipment (PPE) items and knowledge of pandemic plans on perceived PP among GPs. METHODS: Three multivariable linear regression models were developed based on an online cross-sectional survey for the period March-April 2020 (the onset of the pandemic in Germany). Data were collected using self-developed items on self-assessed PP and knowledge of a pandemic plan and its utility. The stock of seven PPE items was queried. For PPE items, three different PPE scores were compared. Control variables for all models were gender and age. RESULTS: In total, 508 GPs were included in the study; 65.16% believed that they were very poorly or poorly prepared. Furthermore, 13.83% of GPs were aware of a pandemic plan; 40% rated those plans as beneficial. The stock of FFP-2/3 masks, protective suits, face shields, safety glasses, and medical face masks were mostly considered completely insufficient or insufficient, whereas disposable gloves and disinfectants were considered sufficient or completely sufficient. The stock of PPE was significantly positively associated with PP and had the largest effect on PP; the association of the knowledge of a pandemic plan was significant but small. PPE scores did not vary considerably in their explanatory power. The assessment of a pandemic plan as beneficial did not significantly affect PP. CONCLUSION: The stock of PPE seems to be the determining factor for PP among German GPs; for COVID-19, sufficient masks are the determining factor. Knowledge of a pandemic plans play a secondary role in PP.