Primary care physicians during the COVID-19 epidemic

July 22, 2020

From March 2020, when COVID-19 spread throughout Europe, GPs had to rely on clinical information collected in hospitals, the only official information available, when dealing with potential infections. "However, we also heard, from colleagues or even through social media, of other and unconfirmed information that reported very different clinical pictures encountered by GPs," explains Dr Hubert Maisonneuve, a lecturer and researcher in the research group led by Professor Dagmar Haller at the Primary Care Unit of the UNIGE Faculty of Medicine, and a GP in the Lyon region. "Since it was extremely difficult to test our patients, we decided, with a few colleagues and in collaboration with two ambulatory laboratories, to set up studies that would allow us to better understand the symptomatology of COVID-19 in its mild forms, and potentially develop a clinical evaluation tool." To this end, clinical data from more than 1,500 patients who underwent a PCR test were collected between March 24 and May 7, 16% of whom tested positive for COVID-19.

Significantly different symptoms

The medical researchers were able to establish a clinical picture for these patients that was significantly different from that described in the hospital setting, but consistent with the informal information collected previously. "Very early on, we detected that loss of taste and smell were among the most predictive symptoms of the disease, unlike fever or cough, which are not specific enough," explains Dr. Benoît Tudrej, a general practitioner and member of the Collège universitaire de médecine générale at the Claude Bernard University in Lyon, who participated in this work. In addition, rarer symptoms that were thought to be strongly related to COVID-19, such as shortness of breath, were found to have very little correlation with a positive test. Because the ambulatory population is different from the population arriving at the hospital, the clinical picture is also different. "However, this is a good indication that you cannot base an entire public health policy in managing an epidemic on hospital data alone, especially when there is a lack of tests to screen for people with light symptoms,» adds Dr. Tudrej.

A poor clinical prediction score

Many research teams have sought to develop a clinical prediction score, a technique commonly used that, by combining various clinical signs and symptoms, allows a statistical estimate of a patient's risk for a particular disease. "We thus tested the model published by an Anglo-American team in Nature Medicine based on data collected through an application," explains Dr Maisonneuve. "But on our data, this score doesn't work. Why? Probably because of a selection bias in the Anglo-American study, where respondents - mostly young women - did not have the same demographic profile as our patients.»

The clinical prediction score does indeed seem to work better for a subgroup, women in their 40s to 60s, whose symptoms seem more pronounced, and therefore easier to detect. "However, this aspect of our work needs to be confirmed on larger samples or with more powerful analysis tools," adds Dr. Paul Sebo of UIGP, who was in charge of this part of the study.

GPs are essential to an efficient health policy

These studies carried out in the urgency of an exceptional situation highlight two important points: firstly, the fact that GPs often remain on the sidelines of political decisions, to the detriment of a large part of the population for whom their usual doctor remains the sole contact person for health matters. In a situation where triage of patients is problematic, but where the threat is spreading rapidly, this can lead to a delay in care or a lack of subtlety in analysing the situation. "This is especially true when, as it is currently the case, the aim is to identify new clusters as quickly as possible in order to contain the spread of the virus", the authors point out. Secondly, research in primary care is still underdeveloped. It is through such work, which is based on strong evidence, that it will be able to take its full place in the construction of academic and medical knowledge.

Université de Genève

Related Primary Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Continuity of English primary care has worsened with GP expansions
A new study published by the British Journal of General Practice has found that patients' abilities to see their preferred GP has fallen greater in English practices that have expanded, compared with those that stayed about the same size.

Primary care office-based vs telemedicine care visits during COVID-19 pandemic
This observational study quantified national changes in the volume, type and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based visits compared with telemedicine encounters.

Expenditures for primary care may affect how primary care is delivered
This study looks at trends in out-of-pocket and total visit expenditures for visits to primary care physicians.

Primary care clinicians drove increasing use of Medicare's chronic care management codes
To address the problem of care fragmentation for Medicare recipients with multiple chronic conditions, Medicare introduced Chronic Care Management (CCM) in 2015 to reimburse clinicians for care management and coordination.

Primary care at a crossroads: Experts call for change
Primary care providers have experienced a rise in responsibilities with little or no increase in the time they have to get it all done, or reduction in the number of patients assigned to them.

Primary care physicians during the COVID-19 epidemic
Scientists from the University of Geneva has analysed clinical data from more than 1,500 ambulatory patients tested for COVID-19.

The five phases of pandemic care for primary care
The authors present a roadmap for necessary primary care practice transformations to care for patients and communities during the COVID-19 pandemic.

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

Read More: Primary Care News and Primary Care Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to