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. 2020 Oct 10;21(1):208.
doi: 10.1186/s12875-020-01278-8.

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

Ermengol Coma  1 , Núria Mora  2   3 , Leonardo Méndez  2 , Mència Benítez  2   4 , Eduardo Hermosilla  2   3 , Mireia Fàbregas  2 , Francesc Fina  2 , Albert Mercadé  2 , Souhel Flayeh  2   5 , Carolina Guiriguet  2   4 , Elisabet Balló  2   6 , Nuria Martinez Leon  7 , Ariadna Mas  7 , Sílvia Cordomí  7 , Yolanda Lejardi  7 , Manuel Medina  2
Affiliations

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

Ermengol Coma et al. BMC Fam Pract. .

Abstract

Background: To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care.

Methods: Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator's percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change.

Results: We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of - 2.69% (95%CI - 3.17% to - 2.23%) in March and - 3.41% (95%CI - 3.82% to - 3.01%) in April; and the control of blood pressure with a reduction of - 2.13% (95%CI - 2.34% to - 1.9%) and - 2.59% (95%CI - 2.8% to - 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of - 2.86% (95%CI - 3.33% to - 2.39%) and - 4.13% (95%CI - 4.55% to - 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome.

Conclusions: The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.

Keywords: COVID-19 [Supplementary Concept].; Chronic disease.; Health Care; Primary health care.; Quality Assurance, Health Care.; Quality Indicators; Quaternary Prevention..

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Monthly result of EQA control indicators during 2019 and 2020. Legend: Short name of each indicator can be found in Additional file 1
Fig. 2
Fig. 2
Monthly result of EQA screening indicators during 2019 and 2020. Legend: Short name of each indicator can be found in Additional file 1
Fig. 3
Fig. 3
Percentage of indicators with significant negative effect according to rurality and socioeconomic status in urban areas. Legend: socioeconomic status in urban areas: 1 U - first quartile urban least deprived; 2 U - second quartile; 3 U - third quartile; 4 U - fourth quartile
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