Where is Primary Health Care (PHC) open data during COVID-19 pandemic in Europe? A mixed- methods study protocol to build a European PHC indicators dashboard for future pandemics
Authors: Ares-Blanco Sara , Guisado-Clavero Marina , Lygidakis Charilaos , Fernández-García María , Petek Davorina , Vinker Shlomo , Li Donald , Stadval Anna , Solves José Joaquin Mira , Rio Lourdes Ramos Del , Larrondo Ileana Gefaell , Fitzgerald Louise , Adler Limor , Assenova Radost , Bakola Maria , Bayen Sabine , Brutskaya-Stempkovskaya Elena , Busneag Iliana-Carmen , Divjak Asja Ćosić , Peña Maryher Delphin , Domeyer Philippe-Richard , Gjorgjievski Dragan , Gómez-Johansson Mila , Hanževački Miroslav , Hoffmann Kathryn , Ільков Оксана , Ivanna Shushman , Jandrić-Kočić Marijana , Karathanos Vasilis Trifon , Kirkovski Aleksandar , Knežević Snežana , Kor Büsra Çimen , Kostić Milena , Krztoń-Królewiecka Anna , Heleno Bruno , Nessler Katarzyna , Lingner Heidrun , Murauskienė Liubovė , Neves Ana Luisa , López Naldy Parodi , Perjés Ábel , Petrazzuoli Ferdinando , Petricek Goranka , Sattler Martin , Saurek-Aleksandrovska Natalija , Seifert Bohumil , Serafini Alicia , Sentker Theresa , Tiili Paula , Torzsa Péter , Valtonen Kirsi , Vaes Bert , Pottebergh Gijs , Gómez-Bravo Raquel , Astier-Peña Maria Pilar 
Published: November 2023

Abstract
- Background
Primary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: 1) Describe PHC's clinical pathways for acute COVID-19 cases, including long-term care facilities (LTCF), 2) Explain PHC's role in vaccination strategies, 3) Develop COVID-19 PHC activity indicators, and 4) Create a PHC contingency plan for future pandemics.
- Methods:
A mixed-method study will employ two online questionnaires to gather retrospective data on COVID-19 management in PHC and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and Public Health (PH) will be devised to address future pandemic scenarios. Analysis: Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving 28 European countries support the development.
- Discussion:
While PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC's role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants' involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments’ daily dashboards in Europe, often overlooked in media and public debates.