Most COVID-19 patients were treated in primary health care (PHC) in Europe.To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient’...

Background and aim: Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic. Methods: Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care. Results: Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom’s follow-up was performed mainly by PHC. Conclusion: PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.

The COVID-19 pandemic has significantly impacted global healthcare systems, leading to challenges in managing Long COVID. Variations in definitions and diagnostic criteria across Europe hinder recognition and treatment efforts. This study aims to analyse and compare the definitions of Long COVID used in 34 European countries. A retrospective descriptive study was conducted involving key informants from 34 European countries, utilising an online questionnaire to gather data on Long COVID definitions. Quantitative and qualitative analyses were employed to assess the variability of definitions and challenges in managing Long COVID. The study found significant variation in Long COVID definitions among the participating countries; the most frequent definition was the other definition (n: 17, 50.0%), followed by the World Health Organisation's definition (n: 16, 47.0%) and the CDC definition (n: 11, 32.3%). Half of the countries reported using multiple definitions simultaneously, indicating a lack of standardisation. Qualitative analyses highlighted challenges such as difficulties in standardising terminology, variability in clinical criteria, and issues with implementing diagnostic codes. The findings underscore the need for a unified, yet adaptable, definition of Long COVID. Such a definition would support general practitioners (GPs) by simplifying diagnostic processes, improving continuity of care, and facilitating equitable patient access to multidisciplinary resources. The current lack of consensus complicates patient care, data collection, and resource allocation, impacting health policy development. Future efforts should focus on achieving agreement on definitions to ensure equitable treatment and effective healthcare responses to Long COVID.

Strengthening Primary Health Care (PHC) is essential for building resilient and equitable health systems, but PHC faces barriers in implementation, resource allocation, and political prioritisation. This study aimed to develop a strategic roadmap to enhance PHC by identifying core values, priorities, and actionable strategies through expert consensus. A two-round Delphi study was conducted with 210 stakeholders from 35 countries, including PHC professionals, policymakers, and public health experts. Participants evaluated the importance, feasibility, and policy prioritisation of key PHC values. Quantitative data were analysed using descriptive statistics. The response rate was 81.4% (171/210) in round one and 73.5% (97/132) in round two. The majority of participants (89%) had a background in medicine. A consensus (>80% agreement) was reached in the first round regarding PHC values. Key recommendations included increasing investment in PHC workforce development, particularly in underserved areas; strengthening health information systems and integrating telehealth solutions; enhancing PHC governance models to support multidisciplinary collaboration and citizen-centred care; and adapting processes to improve chronic care management, end-of-life support, and standardised assessment frameworks. In the second round, when participants assessed the feasibility of these recommendations, agreement levels ranged from 61 to 92%. When asked about the policy prioritisation of these measures, agreement dropped, ranging from 22 to 51%. This study highlights that PHC stakeholders perceive a critical need to align health policies with the core values of PHC, while addressing systemic barriers to implementation. Future efforts should focus on bridging the perceived gap between expert recommendations and political prioritisation to achieve sustainable PHC improvements.

Background: The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. Objective: To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. Methodology: Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. Main outcome measures: Patient’s first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. Results: Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania’s apps considered social needs. Conclusions: COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases.

Refugees are more likely to experience higher rates of depression and anxiety. Since the start of the full-scale invasion of Ukraine in 2022, large numbers of Ukrainians have been forced to leave their country or become internally displaced. This study investigated the levels of depression and anxiety symptoms in Ukrainian refugees, both outside and inside Ukraine. A descriptive, mixed-methods study of Ukrainians aged > 18 who became refugees during or following February 2022, currently living in Belgium, Greece, Israel, Latvia, North Macedonia, Slovenia, Spain, Türkiye and Ukraine. We asked about previous episodes of depression and/or anxiety and used the PHQ-9 and GAD-7 questionnaires to assess current prevalence of depression and anxiety symptoms (score ≥ 15, categorised as moderate-severe symptoms of depression, and ≥ 10 categorised as moderate-severe symptoms of anxiety, respectively). Participants' current place of residence was categorised as 'Outside Ukraine' or 'Inside Ukraine'. An open-ended question asked: "What life events/circumstances have affected your psychological state now?" Participant recruitment was through convenience sampling during 2023-2024. We used descriptive statistics, with bivariate, logistic regression of quantitative variables, and thematic analysis of the free-text answers. Four hundred sixty two respondents met the inclusion criteria, mean age 41 (SD:12.5); 422 (91.7%) were women. Before 2022, 64 (13.9%) had been diagnosed with depression and/or anxiety, and 36 (7.8%) had received treatment for these conditions. The current prevalence of moderate-severe symptoms of depression was 37.0% (95% CI: 32.6-41.6) and of moderate-severe symptoms of anxiety was 51.5% (95% CI: 46.9-56.2). After adjusting for age, the odds ratio for refugees outside Ukraine compared with those remaining in Ukraine was 1.86 (95% CI:1.18-2.93) for moderate-severe symptoms of depression, and 1.70 (1.11-2.58) for moderate-severe symptoms of anxiety. Thematic analysis revealed six themes: impact of war, disrupted networks, economic burdens, health-related problems, barriers to local integration, using tools, and resources for a better adaptation. The prevalence of moderate-severe symptoms of depression and anxiety in Ukrainian war refugees was high, with those in Europe being more likely to have symptoms than those internally displaced. We found a wide range of circumstances that had affected respondents' psychological states.