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Resilience of primary healthcare facilities : Experiences from 16 European countries during the COVID-19 pandemic. A mixed-methods study conducted by EURIPA

Petrazzuoli, Ferdinando LU orcid ; Gokdemir, Ozden ; Antonopoulou, Maria ; Blahová, Beata ; Mrduljaš-Đujić, Natasa ; Dumitra, Gindrovel G. ; Falanga, Rosario ; Ferreira, Mercedes ; Gintere, Sandra and Hatipoglu, Sehnaz , et al. (2025) In Advances in Clinical and Experimental Medicine 34(4). p.487-505
Abstract

Background. The role of primary healthcare (PHC) during a pandemic varies across European countries. The coronavirus disease 2019 (COVID-19) pandemic has altered the working practices of family medicine doctors and impacted the resilience of healthcare systems. Objectives. This study aimed to examine European healthcare system responses to the pandemic, focusing on rural and urban differences. Materials and methods. This cross-sectional, mixed-methods study used a semi-structured online questionnaire with 68 questions, including 21 free-text comments. Data were collected from May 2020 to January 2021. Key informants from 16 European Rural and Isolated Practitioners Association (EURIPA) member countries distributed questionnaires to 406... (More)

Background. The role of primary healthcare (PHC) during a pandemic varies across European countries. The coronavirus disease 2019 (COVID-19) pandemic has altered the working practices of family medicine doctors and impacted the resilience of healthcare systems. Objectives. This study aimed to examine European healthcare system responses to the pandemic, focusing on rural and urban differences. Materials and methods. This cross-sectional, mixed-methods study used a semi-structured online questionnaire with 68 questions, including 21 free-text comments. Data were collected from May 2020 to January 2021. Key informants from 16 European Rural and Isolated Practitioners Association (EURIPA) member countries distributed questionnaires to 406 PHC doctors. Data were analyzed using descriptive statistics and nonparametric tests (χ2, Kruskal–Wallis, Mann–Whitney U) with a significance threshold of 0.05. Results. A statistically significant difference was found between rural (36.4%, 55/151), semirural (19.4%, 24/124) and urban populations (29.8%, 39/131) regarding medicine shortages (χ2 = 9.91, degrees of freedom (df) = 4, p = 0.042). The semirural setting showed a statistically significant difference from the other settings (p = 0.004 in post hoc χ2 test). Significant differences were found between countries in resilience features including, effectiveness of triage, adapting to the rapidly changing requirements, government help, existence of a community resilience group, improved interprofessional collaboration, medicine shortage, and general practitioners (GPs) involvement in palliative care. Conclusions. Medicine shortage was more prevalent in rural and urban areas compared to semirural areas. Differences were observed between countries in their responses to the pandemic, particularly in adapting to the rapidly changing requirements, effectiveness of triage, government help, and the existence of a community resilience group. These differences were confirmed with qualitative analysis. The results emphasize the need for tailored approaches considering diverse contexts in shaping effective healthcare system resilience.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
COVID-19, primary care, resilience, rural health
in
Advances in Clinical and Experimental Medicine
volume
34
issue
4
pages
19 pages
publisher
Wroclaw Medical University
external identifiers
  • pmid:39679655
  • scopus:105004283305
ISSN
1899-5276
DOI
10.17219/acem/194212
language
English
LU publication?
yes
id
e42ba6e3-60a0-436a-be08-46a476c4d3a4
date added to LUP
2025-08-13 10:35:14
date last changed
2025-08-14 15:03:21
@article{e42ba6e3-60a0-436a-be08-46a476c4d3a4,
  abstract     = {{<p>Background. The role of primary healthcare (PHC) during a pandemic varies across European countries. The coronavirus disease 2019 (COVID-19) pandemic has altered the working practices of family medicine doctors and impacted the resilience of healthcare systems. Objectives. This study aimed to examine European healthcare system responses to the pandemic, focusing on rural and urban differences. Materials and methods. This cross-sectional, mixed-methods study used a semi-structured online questionnaire with 68 questions, including 21 free-text comments. Data were collected from May 2020 to January 2021. Key informants from 16 European Rural and Isolated Practitioners Association (EURIPA) member countries distributed questionnaires to 406 PHC doctors. Data were analyzed using descriptive statistics and nonparametric tests (χ<sup>2</sup>, Kruskal–Wallis, Mann–Whitney U) with a significance threshold of 0.05. Results. A statistically significant difference was found between rural (36.4%, 55/151), semirural (19.4%, 24/124) and urban populations (29.8%, 39/131) regarding medicine shortages (χ<sup>2</sup> = 9.91, degrees of freedom (df) = 4, p = 0.042). The semirural setting showed a statistically significant difference from the other settings (p = 0.004 in post hoc χ<sup>2</sup> test). Significant differences were found between countries in resilience features including, effectiveness of triage, adapting to the rapidly changing requirements, government help, existence of a community resilience group, improved interprofessional collaboration, medicine shortage, and general practitioners (GPs) involvement in palliative care. Conclusions. Medicine shortage was more prevalent in rural and urban areas compared to semirural areas. Differences were observed between countries in their responses to the pandemic, particularly in adapting to the rapidly changing requirements, effectiveness of triage, government help, and the existence of a community resilience group. These differences were confirmed with qualitative analysis. The results emphasize the need for tailored approaches considering diverse contexts in shaping effective healthcare system resilience.</p>}},
  author       = {{Petrazzuoli, Ferdinando and Gokdemir, Ozden and Antonopoulou, Maria and Blahová, Beata and Mrduljaš-Đujić, Natasa and Dumitra, Gindrovel G. and Falanga, Rosario and Ferreira, Mercedes and Gintere, Sandra and Hatipoglu, Sehnaz and Jacquet, Jean Pierre and Javorská, Kateřina and Kareli, Ana and Mohos, András and Naimer, Sody and Tkachenko, Victoria and Tomacinschii, Angela and Randall-Smith, Jane and Kujawa, Krzysztof and Kurpas, Donata}},
  issn         = {{1899-5276}},
  keywords     = {{COVID-19; primary care; resilience; rural health}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{487--505}},
  publisher    = {{Wroclaw Medical University}},
  series       = {{Advances in Clinical and Experimental Medicine}},
  title        = {{Resilience of primary healthcare facilities : Experiences from 16 European countries during the COVID-19 pandemic. A mixed-methods study conducted by EURIPA}},
  url          = {{http://dx.doi.org/10.17219/acem/194212}},
  doi          = {{10.17219/acem/194212}},
  volume       = {{34}},
  year         = {{2025}},
}