This study enabled to identify the initial risk perceptions and the feeling of preparedness among primary care physicians from Belgium, France, and Spain when COVID-19 pandemic emerged in Europe and when only isolated cases were observed in those three countries.
At the beginning of the COVID-19 pandemic, between mid-February and the beginning of March 2020, the majority of primary care physicians investigated were little to moderately worried about the disease. As suggested by the results of the study, this could be explained by a low perceived risk of handling infected patients, the feeling to be well-informed and the trust in health authorities’ ability to implement appropriate measures to limit the spread of the disease. Moreover, as the pandemic was still emerging in Europe, it appeared that the general population was not yet really concerned about its evolution and severity. About 20% of the patients followed by the physicians surveyed in the three countries were very worried about the COVID-19 pandemic, whereas this rate was around 30% among the general population over the pandemic course [16]. The global feeling of low to moderate anxiety, both for health professionals and the general population, could appear to be contradictory with the predominant feeling of the physicians of being insufficiently prepared to face the COVID-19 pandemic, as they were not directly involved in the management of this growing epidemic. Regarding the dramatic evolution of the pandemic in Europe in the weeks following the study, it appears that the scientific data available at this time and transmitted to the physicians could have given a wrong assessment of the spread and the severity of the disease [17, 18]. A previous study had highlighted that making available an internal information channel to ensure factual, accurate, and reliable information while preventing information overload represents a key measure in increasing infectious disease preparedness [19]. With the current hindsight on the pandemic, it seems essential to better integrate the primary care physicians into the information, training and protection channels for this kind of health risk, which may be lacking at this level, unlike the hospital level, and this is could be managed by the health authorities [20].
Differences between countries concerning the level of anxiety and the feeling of preparedness were observed, with Spanish physicians feeling more anxious (even more anxious than their patients) but more prepared, while Belgian and French physicians were little worried and moderately prepared. Such variations have been previously studied across countries, with Asian countries feeling more prepared than European or Northern American countries to face emerging diseases [13, 21]. However, no comparison between European countries has been undertaken. The national epidemic context was rather similar over the study period in the three countries involved in the study: 6 COVID-19 cases and 2 related-deaths were reported in France; 134 cases and no deaths in Spain; no cases or deaths in Belgium [2]. The main difference is that the study started in Spain later than in France, and was ended up one week later than in Belgium and France. The anxiety of the Spanish GPs could have been higher, as the European situation was complicated at that time (i.e. Italian situation). This contradictory feeling of anxiety and preparedness among Spanish physicians could be explained also by differences in organization and structure of the primary care services. In Spain, the primary care physicians are included in a complex structure of the public health system (including health administrative services, hospitals and primary care) that were contacted and informed periodically by the health authorities. While these contacts may have helped Spanish primary care professionals feel prepared, they may also have made the physicians anxious about the pandemic. Thus, communication regarding the epidemiological context could have been emphasized in Spain compared to Belgium and France, as well as the preparation of the health services, which could contribute to the higher feeling of preparedness of the Spanish GPs. A comparison could be of interest in adapting one country’s most effective public health measures in terms of information and communication to the other countries [21,22,23]
This study has some limitations. Physicians included are part of sentinel surveillance networks, which generate inherent biases (these professionals are more interested in research, well-informed and specially concerned with advances in clinical practice), making the results not representative of the primary care physicians in these countries. In France, the réseau Sentinelles representativeness has been previously studied, showing no particular differences regarding age and professional activities [10]. In Belgium, the Sentinel GPs have been selected to cover the whole country and form a representative sample of GPs in the country regarding age, sex and geographical distribution [11]. In Spain, Red Centinela Sanitaria evaluates representativeness yearly using cluster analysis and principal components analysis to ensure a good representation [12]. Even if the representativeness of the physicians participating in these three sentinel networks tries to be reached as much as possible, selection biases inherent to the present study could have occurred, linked in particular to the data collection process. Indeed, inclusion was made on a voluntary basis. However, this had no impact on the representativeness of the Belgian and Spanish physicians in terms of age, sex and location of practice. Regarding the differences observed in France in terms of age and location of practice, this does not seem to have influenced physicians’ feeling of preparedness or anxiety. Indeed, the perceptions of French participating GPs were similar to the ones of Belgian GPs. Finally, this cross-sectional study lacks a follow-up during this COVID-19 pandemic, which could have been particularly interesting to evaluate and adapt the guidelines and information campaigns. Repeating this study through the course of the COVID-19 pandemic, under different conditions of the epidemic and of awareness, could help identify critical aspects to be further improved.
