Background: Due to additional responsibilities and uncertainties during the COVID-19 pandemic, primary healthcare (PHC) workers are at increased risk of burnout. Aim: To determine and compare the burnout levels and related factors in PHC nurses and family physicians (FPs) during the COVID-19 pandemic. Methods: An online survey was delivered to PHC workers. Non-random sampling method was used. To evaluate burnout, the Maslach Burnout Inventory was used, which investigates burnout in three categories: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Multivariate linear regression was used to analyze factors associated with burnout for FPs and nurses separately. Findings: Among the participants, 55.7% were nurses, the mean age was 42.34. FPs and nurses experienced similar levels of burnout in terms of EE. Family physicians had higher levels of low PA and DP. Based on the results of the multivariate analysis, while higher EE levels were significantly associated with unequal distribution of workload and communication problems within the Family Health Center for physicians, the unequal distribution of PPE, lack of appreciation by patients or colleagues and restrictions on work-related rights were relevant factors for nurses. Lack of appreciation and restrictions of the rights were associated with increased DP scores in both groups. Unequal distribution of workload was also associated with reduced PA among FPs. Conclusion: PHC physicians and nurses are affected by burnout in different ways under the conditions of the COVID-19 pandemic based on gender, socioeconomic status and working conditions. To protect the mental health of PHC workers in the next public health emergency, clarification in the organization of services, empowering PHC workers in emergency risk communication and provision of timely, adequate and free PPE is essential. It is also crucial to ensure the rights of health workers through macro policy changes especially during emergencies.

Background: Patient activation (PA), which is known to improve health outcomes, describes the knowledge, skills and confidence a person has in managing their own health care. We investigated the extent of PA and associated factors in adults with diabetes (DM) and/or hypertension (HT). This study is the first in Turkey evaluating PA, using the Patient Activation Measure (PAM) scale. The results of the study provide practitioners with information on the characteristics of patients who need support to increase their activation. Methods: We conducted this cross-sectional study in 14 Family Health Centers in Istanbul. The participants were DM and/or HT patients. A questionnaire including the PAM, questions on patient characteristics, life style behaviors, healthcare utilization and health status was applied to 431 patients. Based on PAM score, patients were classified into two activation levels: level 1-2 (poor activation) and level 3-4 (good activation). χ2, t-test and logistic regression (LR) analysis were used. LR analysis was performed for all participants and for women and men separately. Results: Of 431 patients (mean age: 63.6), 65% were women; 45% had a poor activation level (PAL). Based on LR analysis; low socioeconomic status (SES) (OR = 1.6; 95% CI:1.01-2.5), being illiterate (OR = 3.9, 95% CI: 1.5-10.7), being primary school graduate (OR = 2.1, 95% CI:1.1-4.2), lack of adult vaccination (OR = 1.9, 95% CI:1.1-3.1), higher BMI (OR = 1.1, 95% CI: 1.09-1.13) and worse self-reported health (OR = 1.2, 95% CI: 1.1-1.3) were factors associated with low PAL. The latter was associated with low PAL for both sexes; high BMI was an associated factor only among women, while low SES and lack of vaccination were factors only in men. Conclusions: Almost half of the patients had low activation level in our sample. Associated factors may serve as the basis for the development of interventions needed to enhance activation for patients with DM/HT. Key messages: Low patient activation is associated with low level of education, low SES, high BMI, lack of vaccination and worse self-reported health. The factors associated with patient activation vary by gender. A qualitative study with patients having different levels of activation would be useful to understand the underlying motivations.

Background and objectives: An important Non-Communicable Disease risk factor, hypertension (HT), is highly prevalent and controlled HT rates are not sufficient which increases the risk of developing premature deaths. The purpose of the study is to evaluate differences in all-cause and cardiovascular-related mortality according to HT status by using national data from Chronic Diseases and Risk Factors Survey in Turkey (2011–2017). Materials and Methods: Cox regression models were used to estimate hazard ratios (HR) for predicting the all-cause and cardiovascular system-related mortalities. Median follow-up period was 6.2 years. Results: Among individuals with HT, 41.8% was untreated, 30.1% received treatment and had controlled blood pressure, and 28.1% were under treatment but had uncontrolled BP levels. The hazard for mortality among treated & uncontrolled hypertensive participants was significantly higher for all-cause (HR = 1.32, 95% CI = 1.06–1.65), cardiovascular (HR = 2.11, 95% CI = 1.46–3.06), heart disease (HR = 2.24, 95% CI = 1.46–3.43), and Coronary Heart Disease mortality (HR = 2.66, 95% CI = 1.56–4.53) compared to normotensive participants. Conclusions: Individuals with HT who were treated but do not have controlled blood pressure in Turkey had a significantly increased risk of Cardiovascular Disease and all-cause mortality. Along with studies investigating the causes of uncontrolled blood pressure despite initiation of treatment, support should be provided to patients in cases of non-adherence to antihypertensive medication or life change recommendations.