The impact of rurality on the response of general practices to the COVID-19 pandemic : outcomes from the PRICOV-19 study in 38 countries

Background:General practitioners (GPs) played a crucial role in the fight against the COVID-19 pandemic. However, theyhave experienced many barriers to fulfilling this role. The PRICOV-19 study investigates how GP practices inEurope were organized during COVID-19 to guarantee safe, effective, patient-centred, and equitable care.The PRICOV-19 study also aimed to describe the association between response to the pandemic andpractice and health care system characteristics.Research questions:How did degree of rurality impact on the response of general practices to the COVID-19 pandemic?Method:Using a cross-sectional design, data were collected through an online questionnaire sent to GP practices in37 European countries and Israel. The final version of the questionnaire included 53 items coveringdemographic details, management of patient flow, infection prevention and control, information processing,communication, collaboration and self-care.Results:A total of 5,539 GP practices participated in the study: 1,864 PC practices were located in Big (inner) city, 560in Suburbs, 1,039 in (small) towns, 1100 in a mixed urban-rural area, and 976 in a rural area. Statisticallysignificant differences were found between rural, semi-rural and urban practices in the management of patientflow with the urban setting mainly adopting an appointment system while rural practices still operated a walkin system. Significant differences were also found in the perceived limitations related to the building or theinfrastructure of the practice to provide high-quality and safe care.Conclusions:The response to the Covid-19 pandemic in Europe was diverse and heterogeneous across and withincountries. Practice location in terms of the degree of rurality is shown here to be a key factor in how generalpractices across 38 countries responded to the COVID-19 pandemic and on the potential impact on patientsafety and quality of care. Rurality should be a consideration when designing supports for general practiceand family medicine within countries.Background:General practitioners (GPs) played a crucial role in the fight against the COVID-19 pandemic. However, theyhave experienced many barriers to fulfilling this role. The PRICOV-19 study investigates how GP practices inEurope were organized during COVID-19 to guarantee safe, effective, patient-centred, and equitable care.The PRICOV-19 study also aimed to describe the association between response to the pandemic andpractice and health care system characteristics.Research questions:How did degree of rurality impact on the response of general practices to the COVID-19 pandemic?Method:Using a cross-sectional design, data were collected through an online questionnaire sent to GP practices in37 European countries and Israel. The final version of the questionnaire included 53 items coveringdemographic details, management of patient flow, infection prevention and control, information processing,communication, collaboration and self-care.Results:A total of 5,539 GP practices participated in the study: 1,864 PC practices were located in Big (inner) city, 560in Suburbs, 1,039 in (small) towns, 1100 in a mixed urban-rural area, and 976 in a rural area. Statisticallysignificant differences were found between rural, semi-rural and urban practices in the management of patientflow with the urban setting mainly adopting an appointment system while rural practices still operated a walkin system. Significant differences were also found in the perceived limitations related to the building or theinfrastructure of the practice to provide high-quality and safe care.Conclusions:The response to the Covid-19 pandemic in Europe was diverse and heterogeneous across and withincountries. Practice location in terms of the degree of rurality is shown here to be a key factor in how generalpractices across 38 countries responded to the COVID-19 pandemic and on the potential impact on patientsafety and quality of care. Rurality should be a consideration when designing supports for general practiceand family medicine within countries.C