“There is a lot of personal damage, or loss, or grief, we cannot mention right now.” (focus group participant)

The rapid and ongoing spread of covid-19 across the world has taken everyone by surprise. Many healthcare systems are struggling to cope with an unprecedented influx of patients and the crisis has changed our lives overnight. Covid-19 is having knock-on effects on our wider health and wellbeing and has taken a toll on other healthcare services. Nevertheless, we cannot yet grasp the full scale of the problem. In light of this situation, the European Forum for Primary Care (EFPC) launched four interdisciplinary online focus group discussions with primary care professionals (PCPs) about the “collateral damage” caused by health systems responding to covid-19. After a general approach to the issue, the groups then focused on the impact of the pandemic on the mental health of older people. Fourteen health professionals representing nine countries took part in the discussions. Their worries and experiences had a lot in common. 

“Older people receive the bare minimum of care.” (focus group participant)

This quotation summarizes many worries from primary care professionals, that the reduction of contact and access to health and social care has led to undertreatment, especially of older people and people with chronic conditions. Policies and recommendations to reduce care to only absolutely essential treatments and appointments have had widespread consequences. “There is anxiety about the safety of hospital and in general healthcare structures. […] probably […] they refrain from accessing healthcare.”

Such worries are not limited to patients, but also extend to providers. Home care nurses are worried about acting as super-spreaders by visiting a high number of high-risk patients within a short time, often with limited protective equipment. This can lead to more strain on informal caregivers and concerns have been raised that this might lead to more emergency admissions as informal caregivers are overburdened. 

The needs of older people are not simply limited to formal or informal care; “the human desire for contact is also vital.” There is a conflict about protective shielding of older people and withdrawal of contact to family; loneliness and stress again lead to frailty and depression. A delicate balance needs to be struck between protective isolation and contact under appropriate safety measures. 

The impact of covid-19 on older members of society extends to younger members as well. Children and adolescents are at risk of domestic violence and abuse. [4] The responsibility of care that social workers have is not restricted to the settings they normally work in, instead it extends to the households of those they care for, and their local community.

There is already a rise in mental health problems like depression as well as increased rates of suicide worldwide, associated with isolation, financial concerns, and uncertainty of future perspectives. The delay of treatment for existing patients with mental health problems, combined with this increased anxiety, and systems which are not able to provide the support that is needed, exacerbates the situation. “People with suicidal thoughts are intensifying. To wait two or three weeks […]” for “better times” is not an option. [5-10] 

So, what are we going to take away from this? Primary care providers usually know which of their patients are most vulnerable; we must actively get in touch with them. We need to strengthen our patient-centred approach, improving the ability of people to self-manage their chronic conditions and decrease their dependency on health services, but without asking too much of them. 

All the contributions and lessons-learned during this crisis should not be a one-way trip. The EFPC is gathering and sharing experiences among its members so they can learn from one another, regardless of national or professional borders. A strong primary care community is now more vital than ever. 

Sarah Burgmann, Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Advisory Board Member European Forum for Primary Care, no conflicts of interest.

Tom Carter, Junior Coordinator European Forum for Primary Care, Netherlands institute for health services research), no conflicts of interest.

Diederik Aarendonk, coordinator European Forum for Primary Care, no conflict of interest.

Judith De Jong, member executive board European Forum for Primary Care, Professor at Maastricht University, programme coordinator at the Netherlands institute for health services research, no conflicts of interest.

References:

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