Background General practitioners (GPs) face numerous challenges that can contribute to stress. Understanding these factors is crucial for developing interventions to support physician wellbeing and maintain high-quality care.Objectives The study aims to explore the factors associated with perceived stress among European GPs, including attitudes towards person-centred care (PCC), demographics, and professional characteristics.Methods The PACE GP/FP study is an online, cross-sectional, multi-centred survey conducted in 24 European countries between November 2022 and January 2024. The survey tool included the Perceived Stress Scale (PSS), the Patient-Practitioner Orientation Scale (PPOS), and questions on GPs’ demographics and practice characteristics. Linear mixed models analysed the relationship between these variables and perceived stress.Results In total, 3522 GPs were included in the analysis. The mean PSS score indicated moderate levels of stress. Female gender and younger age were associated with increased stress. Also, a higher number of daily patient contacts and a greater perceived responsibility for vulnerable patient populations (e.g. migrants, those with limited social support, or psychiatric vulnerabilities) were significantly associated with higher stress. A stronger patient-centred orientation was associated with lower perceived stress.Conclusion The findings have implications for interventions to reduce GP stress, such as training programs promoting PCC, optimising patient contact rates, and providing targeted support for GPs caring for vulnerable patients. Further research is needed to explore these factors’ complex interplay and impact on GP wellbeing.

BACKGROUND:Many of those affected by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have significant care needs. However, post-exertional malaise, the defining feature of ME/CFS, means that even minor physical, orthostatic, cognitive, or sensory stressors can trigger a disproportionate worsening of health status, condition and symptoms. This results in specific requirements and significant challenges in home care. Nursing care is still provided predominantly by family caregivers, who frequently lack adequate assistance and support. At the same time, there are significant gaps in knowledge, care infrastructure, and professional guidance for the nursing and healthcare professionals, as well as physicians, involved in providing care. OBJECTIVE:The objective of this guide is to structure care measures in a way that prevents overexertion and promotes stability. METHODS:The guide is based on a compilation of practice-oriented measures that have proven effective from the perspective of those affected and family caregivers. These were professionally categorized and further developed by experts in nursing science, physical therapy, general practice and public health. RESULTS:The guide describes how to adjust key dimensions of care - from nutrition and personal hygiene to communication and managing emotional stress - to disease-specific exertion thresholds. Additionally, requirements for the caregiving relationship and the planning of home visits are outlined and the possibilities of palliative care principles are discussed.

Many patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) have significant care needs. However, post-exertional malaise—the defining feature of ME/CFS—means that even minor physical, orthostatic, cognitive, or sensory stressors can trigger a disproportionate worsening of symptoms. This results in specific requirements and significant challenges in home care. Care is still provided predominantly by family caregivers, who frequently lack adequate assistance and support. At the same time, there are significant gaps in knowledge, care infrastructure, and professional guidance for nurses and other healthcare professionals, as well as physicians involved in providing care. The objective of this guide is to structure care measures in a way that prevents overexertion and promotes stability. The guide is based on a compilation of practice-oriented measures that have proven effective from the perspective of patients and family caregivers. These were professionally categorized and further developed by experts in nursing science, physical therapy, general medicine and public health. The guide describes how to adapt key dimensions of care—from nutrition and personal hygiene to communication and managing emotional stress—to disease-specific exertion thresholds. Additionally, it outlines requirements for the caregiving relationship and the planning of home visits and discusses the application of palliative care principles.

OBJECTIVE:To investigate the relationship between patient load or time constraints and attitudes towards person-centered care vs. doctor or disease-centered care within the context of primary care and family medicine in Austria. METHODS:A cross-sectional questionnaire-based study was conducted in Austria as part of the international Person-centered care Attitudes among European General Practitioners/Family Physicians (PACE GP/FP) study [1]. The primary analysis examined the association between continuous patient-practitioner orientation scale (PPOS) scores and self-reported patient load using multivariable linear regression adjusted for age, sex and perceived stress. For a secondary analysis, participants were assigned to one of three care-approach groups, based on PPOS scores (patient-centered, medium patient-centered and doctor/disease-centered) and compared regarding the self-reported number of patients seen per day using a Kruskal-Wallis test. RESULTS:In multivariable linear regression analyses, higher patient load remained independently associated with lower continuous PPOS scores (B = -0.003, 95% CI -0.005 to -0.001, p = 0.002). In our sample, patient load differed significantly across the different care approaches, H(2) = 6.112, p = 0.047, η2 = 0.058. General practitioners (GPs) in the doctor/disease-centered group saw significantly more patients per day (median = 90, interquartile range, IQR = 68) compared to the patient-centered group (median = 50, IQR = 65). Additionally, a high workload, characterized by high clinical demands and time pressure, was the most commonly reported barrier for person-centered care in daily practice. CONCLUSION:Higher patient load was associated with a lower patient-centered orientation among Austrian general practitioners. Our findings suggest the need to address systematic factors contributing to time constraints and emphasize the importance of equipping general practitioners with the resources needed to integrate person-centered care into their practice.

Background Long Covid-19 (LC) patients have substantial treatment and care needs, yet research has shown that the majority of them experience healthcare access barriers. While qualitative studies indicate socio-economic and demographic access inequalities among LC patients, quantitative evidence remains limited. This study aims to assess socio-economic inequalities in healthcare access among LC patients in Austria, focusing on self-perceived barriers, facilitators and unmet healthcare needs.Methods Retrospective cross-sectional data were collected from adult LC patients through online and paper-based surveys (10-12/2024), following a prior qualitative study. The survey assessed 47 barriers and 10 facilitators based on Levesque's 'access to care' framework, along with unmet healthcare needs overall and related to general practitioner (GP), specialist and hospital care. Overall barrier and facilitator scores were calculated. Inequalities related to gender, age, urbanicity, health-related background through training/employment, complementary private health insurance, and economic situation were examined in linear, logistic and ordered logistic regressions, controlling for clinical and demographic variables.Results Overall, 433 LC patients completed the survey. Participants living in urban areas, with complementary private health insurance, or in a good economic situation reported fewer barriers, reflected in statistically significantly lower overall barrier scores. Income-related inequalities emerged particularly in relation to barriers in GP care, including not being taken seriously, attribution of symptoms to mental health conditions, burdensome costs, short consultation times, and limited availability of telemedicine or home visits. Facilitator scores, in contrast, did not differ by socio-economic factors. Living in a rural area was associated with a higher probability of unmet healthcare needs related to GP and specialist care. A poor economic situation was associated with a higher probability of reporting unmet needs related to specialist and hospital care. No evidence of gender-based inequalities was found.Conclusions Our findings reveal enhanced inequalities in LC healthcare access in an otherwise universal healthcare system. Contrary to prior research, we find income-related inequalities in GP access. Future policy efforts in Austria should consider that central case management through GP care may not be the most optimal set-up, especially without improved information, training, support and specialist referral opportunities.Patient or Public Contribution The design of the survey and the hypotheses on healthcare access barriers and facilitators were directly informed by qualitative interviews from previous work with long Covid-19 (LC) patients, who shared their lived experiences with diagnosis, treatment and navigating the healthcare system. Additionally, LC patients piloted the survey before its launch and provided feedback. Representatives of patient LC groups and individual patients contributed to participant recruitment by sharing study materials within their networks.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, multisystemic disorder mostly triggered by viral infections, with core symptoms including post-exertional malaise (PEM), fatigue, pain, and cognitive dysfunction. Its prevalence has increased significantly in the context of the coronavirus disease 2019 (COVID-19) pandemic. Despite its severity and impact on patients' quality of life, ME/CFS remains poorly understood. On May 12 and 13, 2025, the 3rd International Conference hosted by the Charité Fatigue Center brought together nearly 200 researchers from various disciplines on-site, and around 3,700 participants online to discuss recent advances in ME/CFS research, diagnostics, clinical care, and therapeutic trials. The program featured 33 lectures by international experts on key topics such as post-COVID syndrome (PCS), care structures, and pathophysiological mechanisms including cardiovascular dysregulation, immune dysregulation, autoimmune mechanisms, and metabolic dysfunction. In addition, results from clinical trials addressing disease mechanisms, including those specifically targeting autoantibodies, were presented. While public awareness and funding opportunities have increased in the wake of the pandemic and the emergence of PCS, ME/CFS remains severely underresearched. Sustained and adequately funded research efforts are urgently required to advance understanding, identify diagnostic markers, and develop targeted therapeutic interventions.

Viele Betroffene von Myalgischer Enzephalomyelitis/Chronischem Fatigue-Syndrom (ME/CFS) sind hochgradig pflegebedürftig. Gleichzeitig bedingt die Post-Exertionelle Malaise (PEM), das Kernmerkmal von ME/CFS, dass bereits geringe körperliche, orthostatische, kognitive oder sensorische Belastungen eine disproportionale Zustandsverschlechterung auslösen können. Dadurch ergeben sich spezifische Anforderungen und erhebliche Herausforderungen in der häuslichen Versorgung. Die pflegerische Versorgung wird bislang überwiegend von Angehörigen getragen, die dabei nur unzureichend Hilfe und Unterstützung finden. Gleichzeitig bestehen erhebliche Defizite in Wissen, Versorgungsstrukturen und professioneller Orientierung für die an der Betreuung beteiligten Pflege- und Gesundheitsberufe sowie Ärzt:innen. Ziel dieses Leitfadens ist es, pflegerische Maßnahmen so auszurichten, dass Überlastungen vermieden und Stabilität unterstützt wird. Der Leitfaden basiert auf einer Zusammenstellung praxisorientierter Maßnahmen, die sich aus Sicht von Betroffenen und pflegenden Angehörigen bewährt haben. Diese wurden durch Expert:innen aus Pflegewissenschaft, Physiotherapie, Allgemeinmedizin und Public Health fachlich eingeordnet und inhaltlich weiterentwickelt. Der Leitfaden beschreibt Anpassungen zentraler Pflegedimensionen – von Ernährung und Körperpflege bis hin zu Kommunikation und Umgang mit emotionalen Belastungen – an krankheitsspezifische Belastungsgrenzen. Ergänzend werden Anforderungen an die Pflegebeziehung und die Planung von Hausbesuchen dargestellt sowie Möglichkeiten palliativer Pflegeprinzipien diskutiert.

Background:Austria's nine federal states are responsible for healthcare provision, particularly hospital services. However, differences in political arrangements between states have resulted in spatial disparities in healthcare. This study evaluated whether the utilisation of primary and secondary healthcare services showed regional differences over time. Methods:This analysis was based on data from the most recent Austrian Health Interview Survey (ATHIS) series conducted in 2014 and 2019, with a total of 31,231 participants. Data on physician density and population numbers were retrieved from the Austrian Medical Chamber and Statistics Austria. Healthcare utilisation behaviour was analysed using descriptive statistics, correlation analysis and multivariable logistic regression models. Results:Highly urbanised regions showed higher rates of ambulatory specialist visits compared with less urbanised regions but lower visit counts of general practitioners (GPs). The reversed utilisation trend was observed for regions of low urbanisation (ambulatory specialist visits: OR 0.79, 95% CI 0.72-0.86, p < 0.01, for regions of low urbanisation). Hence, health service utilisation varied widely across federal states. Overall, physician density in the federal states increased for specialists (i.e., from one specialist per 873 individuals in 2014 to one per 824 in 2019), whereas the density of GPs decreased. Specialist density was correlated with patterns of increasing specialist utilisation (Spearman's rho correlation coefficient: -0.69, p = 0.04). Conclusion:Healthcare utilisation varied according to the degree of urbanisation. The increasing utilisation of specialised care is associated with specialist density. These findings should be emphasised in the context of current health reforms in Austria, especially regarding primary care.

To investigate the relationship between patient load or time constraints and attitudes towards person-centered care vs. doctor or disease-centered care within the context of primary care and family medicine in Austria. A cross-sectional questionnaire-based study was conducted in Austria as part of the international Person-centered care Attitudes among European General Practitioners/Family Physicians (PACE GP/FP) study [1]. The primary analysis examined the association between continuous patient-practitioner orientation scale (PPOS) scores and self-reported patient load using multivariable linear regression adjusted for age, sex and perceived stress. For a secondary analysis, participants were assigned to one of three care-approach groups, based on PPOS scores (patient-centered, medium patient-centered and doctor/disease-centered) and compared regarding the self-reported number of patients seen per day using a Kruskal-Wallis test. In multivariable linear regression analyses, higher patient load remained independently associated with lower continuous PPOS scores (B = −0.003, 95

High‐income countries are using migrant care workers to address deficiencies in domestic care, thereby creating new care gaps in their countries of origin. Apart from this, care workers often face challenging working conditions in many countries. This article examines the job profile, needs, and training preferences of migrant live‐in care workers in Austria to inform improvements to their working and living conditions. As part of a transdisciplinary project, an online survey was co‐designed with live‐in care workers and CSOs working with care workers. The survey covered four languages (Slovak, Romanian, Bulgarian, and German). Themes included job profile, training requirements, problems encountered, well‐being, health, work breaks, and social contact in Austria. Descriptive analysis was applied using key figures, including mean values and frequency distributions. The results were interpreted by the project team. Two hundred and twenty‐five live‐in care workers completed the survey. The study found that live‐in carers perform numerous additional tasks, some of which make them feel uncomfortable. Some live‐in carers reported experiencing sexual harassment and physical violence, as well as a deterioration in their physical and mental health, since starting work as a live‐in carer. Participants expressed substantial interest in training opportunities, particularly those dealing with difficult situations in the household. There is great potential to improve conditions for live‐in care workers in Austria by providing services in their native languages. This would benefit both live‐in care workers and care recipients and their families. The expectations regarding what live‐in carers are and are not allowed to do should be communicated much more clearly to clients and their families. Furthermore, dependency on brokering agencies could be reduced by introducing a public health official responsible for administering live‐in arrangements as part of official home care in Austria.

Background: The COVID-19 pandemic has underlined the essential role of primary healthcare (PHC) in epidemiological surveillance and public health decision-making. Across Europe, the integration of electronic health records (EHRs) and the sentinel networks have been pivotal in monitoring COVID-19. However, the lack of standardized PHC indicators for COVID-19 hinders the comparability of data among countries. Objective: To establish a consensus on a set of standardized PHC activity indicators related to the COVID-19 pandemic for 31 countries, enhancing the capability of health authorities to make informed decisions and prepare for future health crises. Methods: A two-round eDelphi study was conducted using a structured web-based survey, following the CREDES guidelines, to achieve consensus among a panel of 164 experts from the Eurodata study. 86 Indicators were selected based on their availability during the current pandemic, with participants rating the relevance and utility of proposed indicators. Results: Of the 22 initial indicators, seven received consensuses for inclusion, while two remained contentious after the second round. The study found significant discrepancies in the awareness of sentinel networks and accessibility to PHC data. The consensus emphasized the necessity for indicators to be standardized, reproducible, and easily extractable from databases, with recommendations for disaggregation by age, sex, and vaccination status. Conclusion: Key COVID-19 indicators for PHC were identified, reflecting a consensus among healthcare professionals. Further cooperation between PHC providers and national public health authorities is warranted both on the national and the international level to harmonized healthcare indicators in response to future health emergencies.

BACKGROUND:This article aims to examine patient safety in general practice during COVID-19. METHODS:In total, 5489 GP practices from 37 European countries and Israel filled in the online self-reported PRICOV-19 survey between November 2020 and December 2021. The outcome measures include 30 patient safety indicators on structure, process, and outcome. RESULTS:The data showed that structural problems often impeded patient safety during COVID-19, as 58.6% of practices (3209/5479) reported limitations related to their building or infrastructure. Nevertheless, GP practices rapidly changed their processes, including the appointment systems. Implementation proved challenging as, although 76.1% of practices (3751/4932) developed a protocol to answer calls from potential COVID patients, only 34.4% (1252/3643) always used it. The proportion of practices reported having sufficient protected time in general practitioners' schedules to review guidelines remained consistent when comparing the pre-COVID (34.2%,1647/4813) with the COVID period (33.2%,1600/4813). Overall, 42.8% of practices (1966/4590) always informed home care services when patients were diagnosed with COVID-19, while this decreased to 30.1% for other major infectious diseases (1341/4458). Most practices reported at least one incident of delayed care in patients with an urgent condition, most often because the patient did not come to the practice sooner (60.4%, 2561/4237). Moreover, 31.1% of practices (1349/4199) always organized a team discussion when incidents happened. Overall, large variations were found across countries and patient safety indicators. CONCLUSIONS:The results demonstrated that European GP practices adopted numerous measures to deliver safe care during COVID-19. However, multilayered interventions are needed to improve infection control and GP practice accessibility in future pandemics.

BACKGROUND:Person-centred care (PCC) is a fundamental principle in general practice, emphasising practices tailored to individual patient preferences, needs, and values. Despite the importance of PCC, general practitioners (GPs) face obstacles in effectively implementing it, with associated factors remaining unclear. OBJECTIVES:The PACE GP/FP study aims to explore GPs' attitudes towards PCC and the factors facilitating or hindering its implementation in daily practice across European countries. This paper outlines the PACE GP/FP study protocol. METHODS:The cross-sectional design with data collection via an online survey distribution to GPs in 24 European countries. Study instruments include two validated questionnaires (Perceived Stress Scale (PSS) and Patient Physician Orientation Scale (PPOS)) and additional items covering general information about the doctor and their practice, as well as facilitators and barriers to PCC. These additional items were specifically developed for the study, translated using the forward-backward method, evaluated through cognitive debriefing, and integrated into the REDCap platform to create language and country-specific survey links. The STROBE checklist guides the reporting of the manuscript. CONCLUSION:The PACE GP/FP study will provide a comprehensive exploration of GPs' attitudes towards PCC and the factors shaping its practice in Europe. The findings from the PACE GP/FP study will provide evidence for designing future implementation strategies and guide targeted interventions to promote PCC in primary care across Europe.

Background: The COVID-19 pandemic has had a significant negative impact on the physical and mental health of healthcare workers worldwide. The aim of the paper is to measure the frequency of distress and wellbeing among general practitioners (GPs) in Austria during the pandemic and to identify key levers that could mitigate the risks of distress. Methods: Data were collected as part of the international PRICOV-19 study. In Austria, 500 GPs were randomly selected for participation in a survey between December 2020 and July 2021. For analysis, all dependent and independent variables were described using descriptive statistical methods. Subgroup analyses were conducted using cross-tables and Fisher’s exact tests. A binary logistic regression model was also applied. Open text question was analysed via content analysis. Results: In total, 130 GPs completed the relevant questions for this analysis of the online survey. More than 40% of GPs felt burned out or stated that their work schedules did not leave enough time for personal/ family life. Half of the GPs were found to be in distress, with 14.3% in (very) strong distress. More than 40% of the respondents thought that government support was insufficient for the proper functioning of their practice. Working in rural areas was a protective factor against distress, as were sport and exercise, particularly outdoor activity. Connecting with family and friends and adjustments to the work environment to reduce workload were shown to be important. Discussion: Our results show that GPs in Austria suffered from distress during the first two years of the pandemic. To protect GPs as our firstline healthcare workers in pandemic or high-stress situations, several factors are required for a functioning healthcare system: support of GPs regarding work-life balance, support in terms of collaboration between colleagues and the team and easy access to green outdoor spaces for sports and exercise. By identifying key factors that promote good mental health among GPs, healthcare organizations and policymakers can take targeted action to alleviate the negative impact of stress and burnout on this critical sector of the healthcare workforce.

Remote consultation and teleconsultation have the potential to transform healthcare delivery by improving patient outcomes, reducing healthcare costs, and increasing patient access to care. However, teleconsultation uptake by Austrian general practitioners (GPs) is low, even during the SARS-CoV-2 pandemic. Therefore, the aim of this study was to explore the factors behind this rare uptake by understanding the experiences, perspectives, challenges, and fears of GPs in terms of teleconsultations in general and video consultations in particular. Semi-structured interviews were conducted with 30 GPs working in different organizational primary care areas in the public sector. We followed the qualitative content analysis approach for data analysis. Five super-categories and 19 related subcategories were identified from the interviews. The five super-categories involve aspects regarding methods of remote communication and consultation, topics for remote communication, concerns about telemedicine, and expectations regarding the support needed and potential/expectations of teleconsultations. The most noteworthy finding is that GPs overwhelmingly refer to telephone consultations when talking about remote/teleconsultations. Respondents only mentioned video consultations as a means of remote consultation upon prompting. Moreover, the lack of institutional support and infrastructure for video consultation implementation was a recurring theme, emphasizing the need for investments and resources. However, despite these barriers, GPs see the opportunities for teleconsultations in their daily work. As GPs were at the forefront of healthcare provision during the pandemic, their insights shed important light on real-life challenges and opportunities regarding teleconsultations. It became clear that a safe, focused, and supportive environment is needed to implement new technologies such as video consultations, especially in a healthcare system where GPs are responsible for implementation as entrepreneurs themselves. Above all, clinicians and patients need to be involved in creating the necessary e-health strategy and related software development from the beginning.

This study comprehensively analyses healthcare access barriers and facilitators encountered by long COVID-19 patients in a universal healthcare system, including the potential role of central coordination units in alleviating the patient burden. Retrospective cross-sectional long COVID-19 patient questionnaire survey. Data collection took place 10–12/2024 in Austria (n = 433). Conceptualized along the five steps of the ‘access to care’ framework, the questionnaire covered 47 barriers and 10 facilitators derived from a previous qualitative study. Descriptive statistics, Whitney-Mann-U and t-tests, as well as linear and ordered logistic regressions were used in the statistical analysis. Barriers were encountered in all access steps with the mean number of barriers considered problematic being 31.9 (SD 8.4) out of 47. The most common barriers were lacking information and the burden of self-organising one’s treatment (perceived as problematic by over 90

Background The COVID-19 pandemic has significantly impacted global healthcare systems, leading to challenges in managing Long COVID. Variations in definitions and diagnostic criteria across Europe hinder recognition and treatment efforts. This study aims to analyse and compare the definitions of Long COVID used in 34 European countries.Methods A retrospective descriptive study was conducted involving key informants from 34 European countries, utilising an online questionnaire to gather data on Long COVID definitions. Quantitative and qualitative analyses were employed to assess the variability of definitions and challenges in managing Long COVID.Results The study found significant variation in Long COVID definitions among the participating countries; the most frequent definition was the other definition (n: 17, 50.0%), followed by the World Health Organisation’s definition (n: 16, 47.0%) and the CDC definition (n: 11, 32.3%). Half of the countries reported using multiple definitions simultaneously, indicating a lack of standardisation. Qualitative analyses highlighted challenges such as difficulties in standardising terminology, variability in clinical criteria, and issues with implementing diagnostic codes.Conclusion The findings underscore the need for a unified, yet adaptable, definition of Long COVID. Such a definition would support general practitioners (GPs) by simplifying diagnostic processes, improving continuity of care, and facilitating equitable patient access to multidisciplinary resources. The current lack of consensus complicates patient care, data collection, and resource allocation, impacting health policy development. Future efforts should focus on achieving agreement on definitions to ensure equitable treatment and effective healthcare responses to Long COVID.

BACKGROUND:The COVID-19 pandemic accelerated the use of telemedicine, specifically video consultations as they provide healthcare access in challenging situations where face-to-face encounters are not possible. Nevertheless, it remains largely unknown to what extent the organisation of general practice and national digital infrastructures have impacted the uptake and use of video consultations. OBJECTIVE:This study examined the variation in use of video consultations in general practice across Europe during the COVID-19 pandemic and explored associations with practice- and country-level characteristics. METHODS:This study is part of the international PRICOV-19 project, using data from an online survey and additional questions from national leads. First, we conducted a rapid literature search to support an evidence-based selection of the PRICOV-19 main survey items and additional questions aligned with our aims. Then, we included five practice-level and nine country-level characteristics, as well as COVID-19 intensity characteristics, as independent variables in the analysis. Finally, we conducted a linear mixed model analysis at the country-level, examining five models incrementally within a one-level random intercept regression model. RESULTS:Data from 5,065 general practices in 38 countries revealed that fewer than half (47.5%) utilized video consultations during the COVID-19 pandemic. Usage was highest in the United Kingdom, Luxembourg, Scandinavia, and France (82.6-94.4%) and the lowest in Portugal, Spain, Serbia, Bosnia and Herzegovina, Switzerland, and the Czech Republic (11.1-23.1%). At practice-level, key factors associated with higher usage included having more patients than average with a history of migration and difficulty speaking the local language, being a self-employed general practitioner, having a higher number of registered patients, and being urban-based. At country level, only accessible and affordable internet was statistically significantly associated with use of video consultations. CONCLUSIONS:The study corroborates some established trends in telemedicine adoption while also providing new insights into specific practice-level factors that facilitated the use of video consultations in general practice across European countries during COVID-19. While some factors are universally influential, particularly internet access and affordability, others are more context-dependent. TRIAL REGISTRATION:Not applicable.

BackgroundExperts estimate that in up to 10% of the infected, SARS-CoV-2 would cause persistent symptoms, activity limitations and reduced quality of life. Referred to as long COVID, these conditions might, in the future, specifically impact German-speaking countries due to their higher rates of unvaccinated people compared to other Western countries. Accurate measurement of symptom burden and its consequences is needed to manage conditions such as long COVID, and several tools have been developed to do so. However, no patient-reported instrument existed in the German language at the time of writing.ObjectiveThis study, therefore, aimed to develop a German version of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS).MethodsWe conducted a translation and qualitative evaluation, including cultural adaptation, of the C19-YRS and assessed its face validity. After creating a preliminary version, 26 individuals (14 women [53%]) participated in cognitive interviews (January 2022 to March 2022). Using cognitive debriefing interviews, we ensured the content’s comprehensibility. The matrix-framework method guided the qualitative data analysis.ResultsCompared to the original English version, adaptations were necessary, resulting in changes to the introductory text, while the items for recording persistent symptoms were hardly changed.ConclusionThe German version of the C19-YRS is expected to support standardized long COVID care.

BackgroundLong COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access.MethodsApplying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive 'access to health care' model.ResultsBased on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas.ConclusionsThe findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research.