Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Sampling and Study Participants
2.3. Outcome Variables
2.4. Explanatory Variables
2.4.1. Practice Characteristics
2.4.2. Infection Control Infrastructure Equipment
2.4.3. Safeguarding the Well-Being of the Staff Members by the Practice
2.4.4. Adequate Government Support for the Proper Functioning of Practice
2.5. Statistical Analysis
2.6. Ethical Approval
3. Results
3.1. Practice Characteristics
3.1.1. Perceived Governmental Support
3.1.2. Safeguarding the Well-Being of the Staff Members by the Practice
3.2. Perceived Limitations and Needs for Changes in Infrastructure
3.3. Correlation with Practice Characteristics
4. Discussion
4.1. Summary of Main Findings
4.2. Comparison with Existing Literature
4.3. Strengths and Limitations
4.4. Implications for Research, Policy, and Practice
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total | N 4974 | % 100 |
---|---|---|
Location of practice | ||
Big (inner) city | 1613 | 32.4 |
Suburbs | 514 | 10.3 |
(Small) town | 923 | 18.6 |
Mixed urban-rural | 1013 | 20.4 |
Rural Missing value | 898 13 | 18.1 0.3 |
Payment system | ||
Capitation | 2002 | 40.9 |
Fee-for-service | 1957 | 40.0 |
Salary+ mix of salary and other | 507 | 10.4 |
Other Missing value | 426 82 | 8.7 1.6 |
Number of GPs | ||
1 | 1640 | 33.0 |
2-3 | 1320 | 26.5 |
4-5 | 786 | 15.8 |
6+ Missing value | 1167 61 | 23.5 1.2 |
GP trainees | ||
No | 2758 | 55.4 |
Yes Missing value | 2178 38 | 43.8 0.8 |
Number of clinical professions * | ||
1 | 1669 | 33.6 |
2 | 2151 | 43.2 |
3+ Missing value | 1154 0 | 23.2 0 |
Infection equipment indicator | ||
0-4 items | 382 | 7.7 |
5 items | 970 | 19.5 |
6 items | 1627 | 32.7 |
7 items Missing value | 1495 500 | 30.1 10.1 |
Support for Proper Functioning | ||
---|---|---|
Total | N 4974 | % 100 |
Strongly disagree | 823 | 16.5 |
Disagree | 1419 | 28.5 |
Neutral | 1014 | 20.4 |
Agree | 830 | 16.7 |
Strongly agree | 189 | 3.8 |
Missing value | 699 | 14.1 |
Experienced Limitations | Considered Making Adjustments | |||
---|---|---|---|---|
N 4974 | % 100 | N 4974 | % 100 | |
None | 1056 | 21.2 | 1362 | 27.4 |
Hardly | 1028 | 20.7 | 942 | 18.9 |
To a limited extent | 1835 | 36.9 | 1674 | 33.7 |
To a large extent | 1055 | 21.2 | 996 | 20.0 |
Model I | Model II p < 0.001 | Model III p < 0.001 | Model IV p < 0.001 | |
---|---|---|---|---|
OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
Intercept | 1.43 (1.10; 1.87) p = 0.008 | 1.10 (0.80; 1.51) | 0.69 (0.47; 1.03) | 0.42 (0.26; 0.69) p < 0.001 |
Location of practice | (p = 0.673) | (p = 0.455) | (p = 0.607) | |
Big (inner) city | Ref. | Ref. | Ref. | |
Suburbs | 0.90 (0.72; 1.12) | 0.93 (0.73; 1.18) | 0.94 (0.74; 1.20) | |
(Small) town | 0.99 (0.82; 1.19) | 1.06 (0.86; 1.29) | 1.04 (0.85; 1.27) | |
Mixed urban-rural | 1.07 (0.90; 1.29) | 1.15 (0.95; 1.39) | 1.13 (0.93; 1.37) | |
Rural | 1.02 (0.84; 1.23) | 1.09 (0.89; 1.34) | 1.09 (0.88; 1.34) | |
Payment system | (p = 0.019) | (p = 0.006) | (p = 0.008) | |
Capitation | Ref. | Ref. | Ref. | |
Fee-for-service | 0.78 (0.62; 0.98) p = 0.037 | 0.74 (0.58; 0.94) p = 0.014 | 0.73 (0.57; 0.94) p = 0.014 | |
Salary+ mix of salary and other | 1.28 (0.68; 2.43) | 1.45 (0.75; 2.78) | 1.37 (0.71; 2.63) | |
Other | 1.27 (0.92; 1.75) | 1.27 (0.91; 1.78) | 1.26 (0.90; 1.77) | |
Number of GPs | (p < 0.001) | (p < 0.001) | (p < 0.001) | |
1 | Ref. | Ref. | Ref. | |
2–3 | 1.57 (1.31; 1.87) p < 0.001 | 1.54 (1.28; 1.85) p < 0.001 | 1.53 (1.27; 1.85) p < 0.001 | |
4–5 | 1.46 (1.18; 1.81) p < 0.001 | 1.38 (1.09; 1.74) p = 0.006 | 1.39 (1.10; 1.76) p = 0.005 | |
6+ | 1.88 (1.49; 2.39) p < 0.001 | 1.77 (1.38; 2.28) p < 0.001 | 1.86 (1.44; 2.40) p < 0.001 | |
Clinical professions (1–7)/multidisciplinary team | 0.96 (0.90; 1.02) p = 0.203 | 0.96 (0.90; 1.03) p = 0.231 | 0.94 (0.87; 1.02) p = 0.141 | |
GP trainees | ||||
No | Ref. | Ref. | Ref. | |
Yes | 1.16 (1.01; 1.34) p = 0.035 | 1.16 (0.997; 1.34) p = 0.055 | 1.19 (1.02; 1.38) p = 0.027 | |
Infection equipment indicator | p = 0.055 | p = 0.107 | ||
7 items | Ref. | Ref. | ||
6 items | 1.10 (0.94; 1.30) | 1.08 (0.92; 1.27) | ||
5 items | 1.20 (0.999; 1.45) p = 0.051 | 1.17 (0.97; 1.42) | ||
0–4 items | 1.41 (1.07; 1.85) p = 0.013 | 1.38 (1.05; 1.83) p = 0.023 | ||
Safeguarding the well-being (score 0–9) | 1.06 (1.02; 1.11) p = 0.002 | 1.07 (1.02; 1.11) p = 0.002 | ||
Adequate government support | p < 0.001 | |||
Strongly agree | Ref. | |||
Agree | 1.23 (0.87; 1.73) | |||
Neutral | 1.30 (0.92; 1.83) | |||
Disagree | 1.88 (1.33; 2.64) p < 0.001 | |||
Strongly disagree | 2.15 (1.50; 3.07) p < 0.001 | |||
Intercept variance (s.e.) | 0.56 (0.15) p < 0.001 | 0.44 (0.13) p < 0.001 | 0.40 (0.12) p < 0.001 | 0.35 (0.10 p < 0.001 |
Model information | ||||
Akaike’s Information Criterion (AIC) | 21,827.13 | 21,178.64 | 18,596.34 | 18,277.96 |
−2 Log Likelihood | 21,825.13 | 21,176.64 | 18,594.34 | 18,275.96 |
Likelihood ratio test | 652.49 (df = 17) p < 0.001 | 2582.30 (df = 12) p < 0.001 | 318.38 (df = 4) p < 0.001 |
Model I | Model II (p < 0.000) | Model III (p = 0.000) | Model IV (p = 0.000) | |
---|---|---|---|---|
OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
Intercept | 1.28 (1.01; 1.62) p = 0.044 | 0.76 (0.56; 1.03) p = 0.080 | 0.36 (0.24; 0.53) p < 0.001 | 0.32 (0.19; 0.53) p < 0.001 |
Location of practice | (p = 0.063) | (p = 0.017) | (p = 0.024) | |
Big (inner) city | Ref. | Ref. | Ref. | |
Suburbs | 0.98 (0.78; 1.22) | 0.94 (0.75; 1.20) | 0.95 (0.75; 1.21) | |
(Small) town | 0.93 (0.77; 1.11) | 0.92 (0.76; 1.12) | 0.90 (0.74; 1.10) | |
Mixed urban-rural | 1.14 (0.95; 1.36) | 1.16 (0.96; 1.41) | 1.14 (0.94; 1.38) | |
Rural | 1.21 (1.002; 1.46) p = 0.048 | 1.28 (1.04; 1.56) p = 0.019 | 1.25 (1.02; 1.54) p = 0.031 | |
Payment system | (p = 0.204) | (p = 0.093) | (p = 0.043) | |
Capitation | Ref. | Ref. | Ref. | |
Fee-for-service | 0.83 (0.66; 1.04) | 0.79 (0.62; 1.01) p = 0.063 | 0.75 (0.59; 0.97) p = 0.025 | |
Salary+ mix of salary and other | 0.87 (0.49; 1.57) | 0.76 (0.40; 1.44) | 0.71 (0.37; 1.36) | |
Other | 1.16 (0.85; 1.59) | 1.22 (0.87; 1.70) | 1.20 (0.86; 1.69) | |
Number of GPs | (p = 0.008) | (p = 0.027) | (p = 0.023) | |
1 | Ref. | Ref. | Ref. | |
2–3 | 1.27 (1.07; 1.52) p = 0.007 | 1.30 (1.08; 1.57) p = 0.006 | 1.31 (1.09; 1.59) p = 0.005 | |
4–5 | 1.27 (1.02; 1.57) p = 0.033 | 1.18 (0.94; 1.49 | 1.21 (0.96; 1.53) | |
6+ | 1.47 (1.16; 1.85) p = 0.001 | 1.36 (1.05; 1.74) p = 0.018 | 1.38 (1.07; 1.77) p = 0.013 | |
Clinical_professions (1–7)/multidisciplinary team | 1.11 (1.04; 1.18) p < 0.001 | 1.08 (1.01; 1.16) p = 0.023 | 1.10 (1.01; 1.19) p = 0.022 | |
GP trainees | ||||
No | Ref. | Ref. | Ref. | |
Yes | 1.27 (1.11; 1.46) p < 0.001 | 1.25 (1.08; 1.45) p = 0.003 | 1.27 (1.09; 1.48) p = 0.002 | |
Infection equipment indicator | (p = 0.005) | (p = 0.006) | ||
7 items | Ref. | Ref. | ||
6 items | 1.07 (0.92; 1.26) | 1.06 (0.90; 1.25) | ||
5 items | 1.30 (1.08; 1.57) p = 0.006 | 1.30 (1.07; 1.57) p = 0.007 | ||
0–4 items | 0.85 (0.65; 1.10) | 0.84 (0.64; 1.10) | ||
Safeguarding the well-being (score 0–9) | 1.16 (1.11; 1.20) p < 0.001 | 1.16 (1.12; 1.21) p < 0.001 | ||
Adequate government support | (p < 0.001) | |||
Strongly agree | Ref. | |||
Agree | 1.08 (0.76; 1.53) | |||
Neutral | 1.05 (0.74; 1.48) | |||
Disagree | 1.46 (1.04; 2.06) p = 0.029 | |||
Strongly disagree | 1.51 (1.05; 2.16) p = 0.024 | |||
Intercept variance (s.e.) | 0.44 (0.12) p < 0.001 | 0.41 (0.12) p < 0.001 | 0.42 (0.12) p < 0.001 | 0.40 (0.12) p < 0.001 |
Model Information | ||||
AIC | 21,588.44 | 20,952.08 | 18,480.54 | 18,149.25 |
−2 Log Likelihood | 21,586.44 | 20,950.08 | 18,478.54 | 18,147.25 |
Likelihood ratio test | 636.36 (df = 17) p < 0.001 | 2471.54 (df = 12) p < 0.001 | 331.29 (df = 4) p < 0.001 |
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Windak, A.; Nessler, K.; Van Poel, E.; Collins, C.; Wójtowicz, E.; Murauskiene, L.; Hoffmann, K.; Willems, S. Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries. Int. J. Environ. Res. Public Health 2022, 19, 17015. https://doi.org/10.3390/ijerph192417015
Windak A, Nessler K, Van Poel E, Collins C, Wójtowicz E, Murauskiene L, Hoffmann K, Willems S. Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries. International Journal of Environmental Research and Public Health. 2022; 19(24):17015. https://doi.org/10.3390/ijerph192417015
Chicago/Turabian StyleWindak, Adam, Katarzyna Nessler, Esther Van Poel, Claire Collins, Ewa Wójtowicz, Liubove Murauskiene, Kathryn Hoffmann, and Sara Willems. 2022. "Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries" International Journal of Environmental Research and Public Health 19, no. 24: 17015. https://doi.org/10.3390/ijerph192417015