Adjustments in family medicine practice organization and patient care in Croatia during the COVID-19 pandemic: results from the cross-sectional PRICOV-19 study

Aim: To describe the organization of care in family medicine (FM) practices in Croatia during the COVID-19 pandemic from the perspective of six dimensions of care quality (equity, patient-centeredness, safety, effectiveness, timeliness, and efficiency) and practice collaboration, to investigate the differences in terms of quality of care and practice collaboration between urban and rural practices. Patients and methods:This study was a part of the international cross-sectional PRICOV-19 study. A translated version of the online questionnaire was distributed to a convenient sample of 1270 FM practices in Croatia from March to June 2021. Data on physician and practice characteristics, practice collaboration and six dimensions of quality of care were analyzed. Differences between urban and rural practices were assessed using chi-square test. Results: A total of 148 questionnaires (response rate 11.7%) was included in the analysis. FM practices used appointment systems and performed triage before patients entered the practice (98.4%), using protocols (97.3%) and providing a family physician (FP) as a backup when non-FP practice staff performed the triage (100.0%). Limitations to the practice building/infrastructure and considering making future adjustements was reported by 67.6% and 71.0% of FM practices, respectively. Most practices (66.1%) actively reached out to vulnerable patients. Family physicians from rural areas more often actively reached out to patients who might postpone health care (p=0.028). Some type of patient safety incident related to a delayed care process was reported by 9.6% to 28.2% of the responding FPs. In case of a staff member’s absence due to COVID-19, 69.4% of practices could count on the help from the neighboring FM practices. Conclusions: Croatian FM practices made important organizational changes to deliver high-quality care during the COVID-19 pandemic. Further research is needed to understand which practice and healthcare system characteristics contribute to the improvement of health care quality in primary care during pandemics.