Paediatric primary care in Germany during the early COVID-19 pandemic: the calm before the storm

Abstract

Globally, the COVID-19 pandemic has a major impact on healthcare provision. The effects in primary care are understudied. This study aimed to explore changes in consultation numbers and patient management during the COVID-19 pandemic, and to identify challenges for patient care.

Design

Survey of paediatric primary care practices on consultation numbers and patient management changes, and semistructured interviews to identify challenges for patient care. Surveys and interviews were partially linked in an explanatory sequential design to identify patient groups perceived to be at higher risk for worse care during the pandemic.

Setting

In and around Düsseldorf, a densely populated area in Western Germany. The primary care facilities are spread over an area with approximately 2 million inhabitants.

Participants

Primary care in Germany is provided through practices run by self-employed specialist physicians that are contracted to offer services to patients under public health insurance which is compulsory to the majority of the population. The sample contained 44 paediatric primary care practices in the area, the response rate was 50%.

Results

Numbers of consultations for scheduled developmental examinations remained unchanged compared with the previous year while emergency visits were strongly reduced (mean 87.3 less/week in March–May 2020 compared with 2019, median reduction 55.0%). Children dependent on developmental therapy and with chronic health conditions were identified as patient groups receiving deteriorated care. High patient numbers, including of mildly symptomatic children presenting for health certificates, in combination with increased organisational demands and expected staff outages are priority concerns for the winter.

Conclusions

Primary care paediatricians offered stable service through the early pandemic but expected strained resources for the upcoming winter. Unambiguous guidance on which children should present to primary care and who should be tested would help to allocate resources appropriately, and this guidance needs to consider age group specific issues including high prevalence of respiratory symptoms, dependency on carers and high contact rates.

SciScore for 10.1101/2020.12.30.20249037: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	IRB: Ethical considerations: The study was approved by the ethics committee of the Medical Faculty of Heinrich Heine University Düsseldorf (study number: 2020-1056). Consent: All participants gave informed consent separately for participation in the survey and the interviews.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	not detected.

Table 2: Resources

Software and Algorithms
Sentences	Resources
After entry of results into Microsoft Excel, data were imported into Stata 14, which was used for all further data management and statistical operations.	Microsoft Excel suggested: (Microsoft Excel, RRID:SCR_016137)

Results…

SciScore for 10.1101/2020.12.30.20249037: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	IRB: Ethical considerations: The study was approved by the ethics committee of the Medical Faculty of Heinrich Heine University Düsseldorf (study number: 2020-1056). Consent: All participants gave informed consent separately for participation in the survey and the interviews.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	not detected.

Table 2: Resources

Software and Algorithms
Sentences	Resources
After entry of results into Microsoft Excel, data were imported into Stata 14, which was used for all further data management and statistical operations.	Microsoft Excel suggested: (Microsoft Excel, RRID:SCR_016137)

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

The main limitation of this study is the small scope with a limited number of surveyed and interviewed care providers in a small geographical area. Yet, the survey had a good response rate among paediatric practices representing a broad spectrum in the Düsseldorf area and the findings are likely to be transferable to other similar settings in Germany and internationally. Population management strategies for COVID-19 have been proposed, but these are not specific for Paediatrics [1]. Paediatric primary care, both in hospital emergency departments and in the community, would benefit from clear testing criteria specific for children and adolescents, that incorporate the considerations most relevant for these age groups. Important criteria that need to be taken into account are:

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

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