PRICOV-19 STUDY: A cross-sectional study in 38 countries on the organization of care in general practices during the COVID-19 pandemic

Focus on primary care in times of COVID-19

The COVID-19 pandemic emphasizes the need for strong, well-organized, and integrated health care systems. The PRICOV-19 study was set up to investigate how GP practices reorganized during the COVID-19 pandemic to guarantee safe, effective, patient-centered, and equitable care. Also, the shift in roles and tasks between care providers and the wellbeing of staff is researched. Thanks to its scale and multi-country design, PRICOV-19 also can study which practice- and health care system characteristics are associated with better care and with how GP practices cope with COVID-19 related challenges. 

The results will inform policymakers on which features of health systems and general practice organization must be reinforced to prepare primary care systems across Europe against future pandemics. After all, increased attention to patient safety can limit the transmission not only of COVID-19 but also of other infectious diseases.  

An exceptional collaboration between 48 research institutes

PRICOV-19 was initiated in the summer of 2020. Under the coordination of 'Quality and Safety Ghent,' an interdisciplinary center of expertise for quality and safety in primary care and transdisciplinary care within the Department of Public Health and Primary Care at Ghent University (Belgium), an international consortium of more than 45 research institutes was formed. The study was set up in close collaboration with the 'European Association for Quality and Patient Safety in Primary Care' (EQuiP), one of the WONCA networks. 

PRICOV-19 is the only study at this scale focusing on the organization of primary care in times of COVID-19.  

An online survey to collect data in 38 countries

Data were collected following a cross-sectional study design and using an online questionnaire sent to general practices in 37 European countries and Israel. More than 5.000 practices participated in this study:

card participants

The questionnaire includes 53 items divided into six sections: 

  • patient flow (including appointments, triage, and management for routine care);
  • infection control and prevention; 
  • information processing; 
  • communication; 
  • collaboration and self-care; 
  • practice and participant characteristics.

Questionnaire data are linked with OECD and HSMR data regarding national policy responses to the pandemic and analyzed using multilevel models considering the system- and practice-level. 

More information on the study protocol can be found here.

Progress of the study

Data collection was finished in all countries by December 2021. For each of the following research domains, the data is now being analyzed by interdisciplinary teams of experts from different partner institutions. Reports and publications on the following topics are expected soon: 

  • infection control and prevention; 
  • patient safety incidents; 
  • the use of video consultations; 
  • limitations to the practice infrastructure and building; 
  • care for vulnerable patients; 
  • screening for domestic violence; 
  • change of roles; 
  • wellbeing of GPs; 
  • differences between teaching practices for GP trainees and non-teaching practices; 
  • methodological insights for multi-country studies including differences according to the used sampling procedures. 

Several country-specific reports are in preparation.

Funding

The PRICOV-19 study has almost entirely been funded by in-kind contributions by the partnering institutions. Additional support was received from EGPRN (COVID-19 Grant Funding).

Publications and presentations (dd. 01/09/2024)

Reference to the protocol paper of the PRICOV-19 study: 

  • Van Poel, E., Vanden Bussche, P., Klemenc-Ketis, Z. et al. How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries. BMC Prim. Care 23, 11 (2022). https://doi.org/10.1186/s12875-021-01587-6 

Publication on the international PRICOV-19 database:

  • Collins, C., Clays, E., Van Poel, E., Cholewa, J., Tripkovic, K., Nessler, K., de Rouffignac, S., Šantrić Milićević, M., Bukumiric, Z., Adler, L., Ponsar, C., Murauskiene, L., Ožvačić, Z., Windak, A., Asenova, R., and Willems, S. (2022). Distress and wellbeing among general practitioners in 33 countries during COVID-19: results from the cross-sectional PRICOV-19 study to inform health system interventions. International journal of environmental research and public health, 19(9), 5675.https://doi.org/10.3390/ijerph19095675
  • De Sá e Silva, B., Ožvačić Adžić, Z., Vanden Bussche, P., Van Poel, E., Seifert, B., Heaster, C., … Willems, S. (2022). Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study. International Journal of Environmental Research and Public Health, 19(17), 10151. https://doi.org/10.3390/ijerph191710515
  • Collins, C., Van Poel, E., Šantrić Milićević, M., Tripkovic, K., Adler, L., Bjerve Eide, T., ... & Willems, S. (2022). Practice and System Factors Impact on Infection Prevention and Control in General Practice during COVID-19 across 33 Countries: Results of the PRICOV Cross-Sectional Survey. International Journal of Environmental Research and Public Health, 19(13), 7830. https://doi.org/10.3390/ijerph19137830  
  • Groenewegen, P., Van Poel, E., Spreeuwenberg, P., Batenburg, R., Mallen, C., Murauskiene, L., … Willems, S. (2022). Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19). International Journal of Environmental Research and Public Health, 19(22), 15329. https://doi.org/10.3390/ijerph192215329  
  • Windak, A., Nessler, K., Van Poel, E., Collins, C., Wójtowicz, E., Murauskiene, L., … Willems, S. (2022). Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries. International Journal of Environmental Research and Public Health, 19(24), 17015. https://doi.org/10.3390/ijerph192417015
  • Van Poel, E., Collins, C., Groenewegen, P., Spreeuwenberg, P., Bojaj, G., Gabrani, J., … Willems, S. (2023). The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries. International Journal of Environmental Research and Public Health, 20(4), 3165. https://doi.org/10.3390/ijerph20043165
  • Fomenko, L., Keygnaert, I., Van Poel, E., Collins, C., Gómez Bravo, R., Korhonen, P., … Willems, S. (2023). Screening for and Disclosure of Domestic Violence during the COVID-19 Pandemic: Results of the PRICOV-19 Cross-Sectional Study in 33 Countries. International Journal of Environmental Research and Public Health, 20(4), 3519. https://doi.org/10.3390/ijerph20043519
  • Petrazzuoli, F., Collins, C., Van Poel, E., Tatsioni, A., Streit, S., Bojaj, G., … , Willems, S. (2023). The impact of rurality on the response of general practices to the COVID-19 pandemic: outcomes from the PRICOV-19 study in 38 countries. International Journal of Environmental Research and Public Health ,20(4), 3674. https://doi.org/10.3390/ijerph20043674
  • Tatsioni, A., Groenewegen, P., Van Poel, E., Vafeidou, K., Assenova, R., Hoffmann, K., … Willems, S. (2024). Recruitment, data collection, participation rate, and representativeness of the international cross-sectional PRICOV-19 study across 38 countries. BMC Primary Care, 24(Supplement1). https://doi.org/10.1186/s12875-024-02438-w
  • Kirkove, D., Willems, S., Van Poel, E., Dardenne, N., Donneau, A.-F., Perrin, E., … Pétré, B. (2024). Characteristics of primary care practices associated with patient education during COVID-19: results of the cross-sectional PRICOV-19 study in 38 countries. BMC Primary Care, 24(Supplement1). https://doi.org/10.1186/s12875-024-02348-x
  • Willems, S., Vanden Bussche, P., Van Poel, E., Collins, C., & Klemenc-Ketis, Z. (2024). Moving forward after the COVID-19 pandemic : lessons learned in primary care from the multi-country PRICOV-19 study. EUROPEAN JOURNAL OF GENERAL PRACTICE, 30(1). https://doi.org/10.1080/13814788.2024.2328716
  • Eriksson, M., Blomberg, K., Arvidsson, E., Van Poel, E., Ares-Blanco, S., Astier-Peña, M. P., … Willems, S. (2024). Did the organization of primary care practices during the COVID-19 pandemic influence quality and safety? An international survey. BMC HEALTH SERVICES RESEARCH, 24(1). https://doi.org/10.1186/s12913-024-11173-y
  • Delvento, G., Schindler, C., Rotaru, C., Curteanu, A., Curochicin, G., Prytherch, H., … Collins, C. (2024). Follow-up of patients with chronic conditions within primary care practices during COVID-19: Results from 7 Central and Eastern-European countries from the cross-sectional PRICOV-19 study. European Journal of General Practice, 30(1). https://doi.org/10.1080/13814788.2024.2391468
  • Keenan, I., Van Poel, E., Clays, E., …, Collins, C. (2024). Resilience in Crisis: Insights into General Practitioners’ Self-Care Across 38 Countries During the Pandemic. Manuscript under review.
  • Bak Kirk, U., Gomez Pellin, M., Stummer, F., … Collins, C. (2024). Video Consultation Trends in General Practice during COVID-19: Impact of Practice and Country Characteristics. Manuscript under review.

Publications on the national PRICOV-19 databases: 

  • Paper on the results in Austria: Stummer, F.O., Voggenberger, L., Gomez Pellin, M.d. et al. Insights into the use of telemedicine in primary care in times of the SARS-CoV-2 pandemic - a cross-sectional analysis based on the international PRICOV-19 study in Austria. BMC Prim. Care 24 (Suppl 1), 218 (2023). https://doi.org/10.1186/s12875-023-02113-6
  • Paper on the results in Austria: Hoffmann, K., Stummer, F.O., Van Poel, E., Wojczewski, S. (2023). Distress and factors for good mental health among general practitioners during the SARS-CoV-2 pandemic Results from the cross-sectional PRICOV-19 study in Austria. Manuscript under review.
  • Paper on the results in Belgium: Van Poel, E., Vanden Bussche, P., Pétré, B., Ponsar, C., Collins, C., De Jonghe, M., … Willems, S. (2024). Quality of care in Belgian general practices during the COVID-19 pandemic : results of the cross-sectional PRICOV-19 study. BMC PRIMARY CARE, 24(Supplement 1). https://doi.org/10.1186/s12875-024-02305-8
  • Paper on the results in Belgium: Vanden Bossche, D., Van Poel, E., Vanden Bussche, P., Petré, B., Ponsar, C., Decat, P., & Willems, S. (2024). Outreach work in Belgian primary care practices during COVID-19: results from the cross-sectional PRICOV-19 study. BMC Primary Care, 24(Supplement 1). https://doi.org/10.1186/s12875-024-02323-6
  • Paper on the results in Belgium: Cholewa, J., Ponsar, C., de Rouffignac, S., Pétré, B., Van Poel, E., Willems, S., & De Jonghe, M. (2024). General practitioners’ well-being in Belgium: results from the cross-sectional PRICOV-19 study. BMC Primary Care, 24(Supplement 1). https://doi.org/10.1186/s12875-024-02341-4
  • Paper on the results in Germany: Stark, S., Schaubroeck, E., Kluge, M. et al. “The measures taken by the government overburdened the daily practice” – insights of the PRICOV-19 study on German general practitioners in times of COVID-19. BMC Prim. Care 24 (Suppl 1), 207 (2023). https://doi.org/10.1186/s12875-023-02115-4
  • Paper on the results in France: Viegas, L., Dupie, I., Rigal, L., Van Poel, E., Willems, S., Beaupin, A., & Falcoff, H. (2023). Triage des patients et consultations à distance dans les structures de soins primaires pendant la pandémie de Covid-19 en France (étude PRICOV-19). SANTE PUBLIQUE, 35(4), 393–403. https://doi.org/10.3917/spub.234.0393
  • Paper on the results in Germany: Stark, S., Kluge, M., Schaubroeck, E., Van Poel, E., Willems, S., Kühlein, T. Roos, M., Burggraf, L. (2022). “What else to say?” – Primary health care in times of COVID19 from the perspective of German general practitioners: An exploratory analysis of the open text field in the PRICOV-19 study. Manuscript accepted for publication.
  • Paper on the results in Greece: Tsampouri, E., Kapetaniou, K., Missiou, A., Bakola, M., Willems, S., Van Poel, E., & Tatsioni, A. (2024). Measures during the COVID-19 pandemic in public primary health care in Greece : is there still a missing link to universal health coverage? BMC PRIMARY CARE, 24(Supplement 1). https://doi.org/10.1186/s12875-024-02392-7
  • Paper on the results in Hungary: Lakó-Futó, Z., Vörös, K., Van Poel, E., Willems, S., Torzsa, P. (2023). Assessing the Performance of Hungary's Primary Health Care System during the COVID-19 Pandemic: Findings from the Cross-Sectional PRICOV-19 Study. Manuscript under review.
  • Paper on the results in Ireland: Garzón-Orjuela, N., Collins, C., Willems, S., Van Poel, E., & Vellinga, A. (2024). Patient safety incidents in Irish general practice during the COVID-19 pandemic : an exploratory practice level analysis. BMC PRIMARY CARE, 24(Supplement 1). https://doi.org/10.1186/s12875-024-02439-9
  • Paper on the results in Israel: Adler, L., Vinker, S., D. Heymann, A., Van Poel, E., Willems, S., & Zacay, G. (2022). The effect of the COVID-19 pandemic on primary care physicians in Israel, with comparison to an international cohort: a cross-sectional study. Israel Journal of Health Policy Research, 11(1). https://doi.org/10.1186/s13584-022-00543-8
  • Paper on the results in Kosovo*: Bojaj, G., Tahirbegolli, B., Beqiri, P., Alloqi Tahirbegolli, I., Van Poel, E., Willems, S., … Hoxha, I. (2023). Health Service Management and Patient Safety in Primary Care during the COVID-19 Pandemic in Kosovo. International Journal of Environmental Research and Public Health, 20(4), 3768. https://doi.org/10.3390/ijerph20043768
  • Paper on the results in the Republic of Moldova: Delvento, G., Curteanu, A., Rotaru, C., Van Poel, E., Willems, S., Prytherch, H., & Curocichin, G. (2023). The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova : results from the PRICOV-19 survey. BMC PRIMARY CARE, 24(Supplement 1). https://doi.org/10.1186/s12875-023-02116-3
  • Paper on the results in the Netherlands: Groenewegen, P., Vanden Muijsenbergh, M., Batenburg, R., Van Poel, E., van den Broek, S., Vanden Bussche, P., & Willems, S. (2022). Snelle aanpassing praktijkorganisatie tijdens de coronapandemie. Huisarts En Wetenschap. https://doi.org/10.1007/s12445-022-1439-5
  • Paper on the results in the Netherlands: Groenewegen, P.P., van den Muijsenbergh, M., Batenburg, R. et al. Quick adaptation of the organisation of general practices during the COVID-19 pandemic in the Netherlands. BMC Prim. Care 24 (Suppl 1), 170 (2023). https://doi.org/10.1186/s12875-023-02114-5
  • Paper on the results in Norway: Eide, T.B., van Poel, E., Willems, S. et al. Changes in work tasks and organization of general practice in Norway during the COVID-19 pandemic: results from a comparative international study. BMC Prim. Care 24 (Suppl 1), 227 (2023). https://doi.org/10.1186/s12875-023-02146-x
  • Paper on the results in Poland: Nessler, K., Van Poel, E., Willems, S., Wójtowicz, E., Mann, M., & Windak, A. (2022). The response of primary care practices in rural and urban settings in Poland to the challenges of the COVID-19 pandemic. Annals of Agricultural and Environmental Medicine. https://doi.org/10.26444/aaem/155906
  • Paper on the results in Poland: Nessler, K., Studziński, K., Van Poel, E., Willems, S., Wójtowicz, E., Kryj – Radziszewska, E., Windak, A. (2024). The well-being of Polish GPs during the COVID-19 pandemic-cross-sectional questionnaire-based study. Manuscript under review.
  • • Paper on the results of Serbia: Milicevic, M.S., Tripkovic, K., Bjelica, N., Dinic, M., Jeremic, D., Van Poel, E., Willems, S., Bukumiric, Z. (2024). Assessing the Appropriateness of the Mayo Clinic Mental Well-Being Index for General Practitioners During Crises: Results of the PRICOV-19 Study in Serbia. Manuscript under review.
  • Paper on the results in Slovenia: Gomezelj, M. C., Miroševič, Š., Tajki, A. V., Bunc, K. T., Van Poel, E., Willems, S., & Klemenc-Ketiš, Z. (2023). The safety of patient management in family medicine in Slovenia during Covid-19 : a cross-sectional study. BMC PRIMARY CARE, 24(Supplement 1). https://doi.org/10.1186/s12875-023-02209-z
  • Paper on the results in Slovenia: Tajki, A. V., Miroševič, Š., Gomezelj, M. C., Bunc, K. T., Van Poel, E., Willems, S., & Klemenc-Ketiš, Z. (2024). Well-being of family physicians during COVID-19 pandemic in Slovenia. BMC PRIMARY CARE, 24(Supplement 1). https://doi.org/10.1186/s12875-024-02416-2
  • Paper on the results in Spain: Gallego-Royo, A., Sebastián Sánchez, I., Sanz-Astier, L.-A., Peris-Grao, A., Freixenet-Guitart, N., Maderuelo-Fernández, J. A., … Astier-Peña, M. P. (2024). Quality and safety actions in primary care practices in COVID-19 pandemic : the PRICOV-19 study in Spain. BMC PRIMARY CARE, 24(Supplement 1). https://doi.org/10.1186/s12875-024-02391-8

The overview of the publications will be regularly updated on this website.

PRICOV-19 Research Consortium Position Paper on Moving Forward After the COVID-19 Pandemic: Lessons Learned in Primary Care

A position paper has been written by the PRICOV-19 Consortium and is based on the published and upcoming scientific PRICOV-19 publications. The PRICOV-19 Consortium has validated this position statement. The EQuiP Council endorsed it following a discussion by conference attendees at the 62nd EQuiP conference in Dublin on 12th May 2023. In   the meanwhile, also WONCA Europe has endorsed the position statements.

All credit for this position statement belongs to the 48 partnering institutions of the PRICOV-19 Research Consortium and the individual PRICOV-19 consortium researchers. The Consortium wishes to express its deep gratitude to EQuiP for their support of PRICOV-19, and for their efforts to validate and disseminate the lessons learned. 
Click here to access full statement in pdf format.

The position statements are embedded in the following manuscript:

  • Willems, S., Vanden Bussche, P., Van Poel, E., Collins, C., & Klemenc-Ketis, Z. (2024). Moving forward after the COVID-19 pandemic : lessons learned in primary care from the multi-country PRICOV-19 study. EUROPEAN JOURNAL OF GENERAL PRACTICE, 30(1). https://doi.org/10.1080/13814788.2024.2328716

Conferences 

Results of PROCOV-19 were presented at the following conferences: 

  • Willems, S., Van Poel, E., Vanden Bussche, P., Collins, C., Eide, T., Jacobsen, F. F., … van den Muijsenbergh, M. (2021). COVID-19 : threat or opportunity for quality improvement (QI) in primary care? In EFPC 2021 16th Conference, Abstracts. Virtual. 
  •  Willems, S., Van Poel, E., Vanden Bussche, P., & Klemenc-Ketiš, Z. (2021). COVID-19 : threat or opportunity for quality improvement in primary care in Europe. In 12th International Symposium on Health Sciences, Abstracts. Virtual. 
  •  Willems, S., Van Poel, E., Vanden Bussche, P., Klemenc-Ketiš, Z., Rochfort, A., & Zwart, D. (2021). COVID-19 : threat or opportunity for quality improvement in general practice? In 26th WONCA Europe Conference, Abstracts. Virtual.  
  • Willems, S., Van Poel, E., Vanden Bussche, P., Klemenc-Ketiš, Z., Rochfort, A., & Zwart, D. (2021). COVID-19 : threat or opportunity for quality improvement in general practice? In 26th WONCA Europe Conference, Abstracts. Virtual. 
  •  Collins, C., Clays, E., Van Poel, E., Cholewa, J., Ponsar, C., Murauskiene, L., … Willems, S. (2022). Distress and wellbeing among general practitioners during COVID- 19 : supports required based on the results from the cross-sectional PRICOV-19 study. 60th EQuiP Virtual Conference, Abstracts. • De Sá e Silva, B., Ozvacic Adzic, Z., Vanden Bussche, P., Van Poel, E., & Willems, S. (2022). Effect of being a training practice on outcomes related to the safety culture of primary care practices in the PRICOV-19 study. 60th EQuiP Virtual Conference, Abstracts. 
  •  Groenewegen, P., Van Poel, E., Spreeuwenberg, P., Batenburg, R., Murauskiene, L., Mallen, C., … Willems, S. (2022). Has the Covid-19 pandemic lead to changes in the tasks of the primary care workforce? An international survey among general practices. 60th EQuiP Virtual Conference, Abstracts. 
  • Willems, S., Vanden Bussche, P., Van Poel, E., & Klemenc-Ketiš, Z. (2022). How did general practices organize care during the COVID-19 pandemic : the cross-sectional PRICOV-19 study in 38 countries. 60th EQuiP Virtual Conference, Abstracts. 
  •  Fomenko, L., Keygnaert, I., Van Poel, E., Collins, C., Gómez Bravo, R., Korhonen, P., … Willems, S. (2022). To ask or not to ask ? What factors were associated with a pro-active communication of general practitioners and their patients concerning domestic violence during the COVID-19-pandemic. 60th EQuiP Virtual Conference, Abstracts. 
  •  Van Poel, E., Collins, C., Vanden Muijsenbergh, M., Groenewegen, P., Schaubroeck, E., Stark, S., … Willems, S. (2022). Active outreach to vulnerable patients during COVID-19 : a common practice or exception in primary health care? 60th EQuiP Virtual Conference, Abstracts. • Collins, C., Clays, E., Van Poel, E., Cholewa, J., Ponsar, C., Murauskiene, L., … Willems, S. (2022). Distress and wellbeing among general practitioners during COVID-19 : results from the cross-sectional PRICOV-19 study. 76–76. Istanbul. 
  •  Collins, C., Van Poel, E., Glynn, L., Lineen-Curtis, N., Cowley, J., Quinlan, D., & Willems, S. (2022). Policy dialogue to inform a solutions-based research agenda on rural general practice. Presented at the WONCA World Rural Health Conference, Limerick, Ireland. 
  •  Willems, S., Vanden Bussche, P., Van Poel, E., Collins, C., Klemenc-Ketis, Z., Kluge, M., … Vanden Muijsenbergh, M. (2022). Family medicine – jewel in the crown of equitable covid-19 care. Presented at the 27th WONCA Europe Conference, London 
  • Cholewa, J., de Rouffignac, S., Ponsar, C., Pétré, B., Van Poel, E., and Willems, S. (2022). General practitioners in Belgium and wellbeing: beyond the COVID-19 pandemic. presented at the 17th EFPC Conference, Ghent 
  •  Peris-Grao, A., Freixenet, N., Brugués-Brugués, A., Garcia-Gimeno, O., Van Poel, E., and Willems, S. (2022). Team reorganization after COVID pandemic. Differences between PRICOV results and current data. presented at the 17th EFPC Conference, Ghent, 2022.
  • Bjerve Eide, T., Van Poel, E., Willems, S., & Fadnes Jacobsen, F. (2023). Changes in work tasks and organization of general practice in Norway during the COVID-19 pandemic : results from the Pricov-19 study. 96th EGPRN Meeting, Abstracts. Presented at the 96th EGPRN Meeting, Split, Croatia. 
  • Delvento, G., Curteanu, A., Rotaru, C., Van Poel, E., & Willems, S. (2023). The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova : results from the PRICOV-19 Survey. 28th WONCA Europe Conference, Abstracts. Presented at the 28th WONCA Europe Conference, Brussels, Belgium. 
  • Kirk, U. B., Van Poel, E., Schaubroeck, E., Vanden Bussche, P., Collins, C., & Willems, S. (2023). Lessons learned : how did the pandemic initiated innovations in family medicine to ensure high-quality care? 28th WONCA Europe Conference, Abstracts. Presented at the 28th WONCA Europe Conference, Brussels, Belgium.

More information

Please contact the Ghent University PRICOV-19 team: 

Partnering institutions

More information