How Austrian primary care physicians evaluated their available resources and quality of care during the first year of COVID-19: a repeated cross-sectional survey study.

backgroundIn March 2020, Austria was among the first European countries to declare a national lockdown, responding to SARS-CoV-2 infections with a stringent ringfencing policy for inpatient beds. These interventions altered access to the Austrian healthcare system. This study aims to understand demand- and supply-side factors influencing Austrian Primary Care Physicians' (PCPs') assessment of their care quality during the first ten months of the COVID-19 pandemic.

methodsThe study deployed a cross-section design based on stratified random sampling, where all Austrian PCPs (split into three disjointed random samples) were invited to participate in an online questionnaire (in May, September and November 2020, respectively). A multinomial logit model was used to analyse the three sets of cross-sectional survey data. The study subjects are all 6,679 Austrian PCP (2020) with a registered practice. The total sample size was 403 (corresponding to a net response rate of 6.3%).

resultsThe primary outcome was the PCPs' evaluation of their care quality. Secondary outcomes were "patient behaviour and wellbeing" (five questions), with Cronbach's alpha of 0.74, and the PCPs' "pandemic preparedness" (five questions) with a smaller internal consistency (0.69). 47% of the PCPs rated their care quality during the first ten months of the pandemic as worse than before the outbreak of COVID-19. The overall assessment correlates to the pandemic stage, lack of preventive care and mediocre information exchange/cooperation within the medical profession. Towards the end of the first lockdown, PCPs' care quality perception was exclusively shaped by the availability of SARS-CoV-2 tests at the practice.

conclusionsPCP quality assessments can serve as a real-time indicator, helping to anticipate the need for epidemiologic and diagnostic procedures. In Austria, supply-side factors, such as protective equipment and tests, were generally provided quickly by the public authorities. Findings suggest that perceptions of quality have changed considerably over time. Our results show that the understanding of quality changes during the first year. At the beginning, lack of resources or supply-side factors are the main driver for the assessment, while at the end of the first year, demand-side factors drive the quality assessment. In particular, the strong silo mentality and the separation between the care sectors have impacted the quality assessment of PCP.