Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

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Omran’s widely acclaimed and equally widely critiqued theory of epidemiological transition postulates that economic development and technological progress improve overall health outcomes for populations and eradicate communicable diseases, shifting the burden of mortality and morbidity to non-communicable diseases (NCDs). However, the COVID-19 pandemic has been ravaging across the world for a year and a half and has arguable made devastating impact on peoples’ lives, health and economies beyond any other disease across Global North and Global South. So is this the last nail in the coffin of Omran’s theory? Is the double burden of CDs and NCDs expanding from Global South into Global North? Do we need a new theory of epidemiological transition to explain global trends? Does the risk of other communicable diseases like COVID-19 remain? Do healthcare systems and pharmaceutical industries need to be reorientated to combat potential future outbreaks?

The aim of this interactive workshop is to explore the importance of communicable and non-communicable diseases and priorities for health systems around the world. The main objective is to learn lessons from a global response to the pandemic and share views about the role of family doctors in combatting the spread of communicable diseases while providing care to patients with NCDs and increasing multimorbidity.

Methods and timetable: the workshop will involve a short 10min initial presentation to set the scene, to be followed by Mentimeter polls and WhiteBoard collaborations for the audience, including an interactive discussions and sharing views on the questions mentioned above.

Consensus or divergence of participant views on these questions will constitute the results and conclusions.

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Background. National responses to the pandemic varied in the degree to which a strong primary health care approach, which coordinates primary care with public health functions as espoused in the Astana Declaration of 2018, was stressed.

Aim and learning objectives. To understand and compare pandemic responses and exchange lessons learned across countries. The Workshop will enlighten participants on the experiences discovered through the survey findings and will facilitate a discourse on how primary care may be better integrated with public health functions.

Methods and timetable. An international survey of primary care experts, conducted in April and May 2020, solicited perceptions of their respective countries’ primary care strength, pandemic plan implementation, public health measures, and policy decision-making. The responses were then correlated against COVID-19 mortality rates. Bivariate analyses were conducted on 38 countries with five or more responses and qualitative analysis on open text responses.

Results / Conclusions. The outcomes of the pandemic are still being revealed, however, the lack of implementing a coordinated primary health care approach in most countries has already been made clear. Having a strong primary care system, as in the United Kingdom or Italy, did not contribute to a strong response. In other countries, such as Germany and Cyprus, transparent communication and leadership were key to enlisting the population to make necessary personal sacrifices. In addition, technological innovations such as e-consultations were viewed as having a positive impact in most countries. Overall, our findings underscore the challenge of determining specific drivers of success in mitigating the pandemic.

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Background and purpose - In the context of 2020 SARS-CoV-2 pandemic, healthcare services had to get reorganized and resorted to teleconsultation in their clinical practice. This study’s main goal is to know the portuguese Family Doctors’ perspective over the utility of teleconsultation in their future clinical practice. Secondarily, it also sought to recognize advantages and disadvantages of teleconsultation, identify possible difficulties and under what circumstances it may represent an added value.

Methods - A cross-sectional study was realized between September 2020 and January 2021 through the application of an online questionnaire. The target population were Family Medicine physicians and residents, who worked in primary healthcare belonging to portuguese National Health Service.

Results - 377 responses were received. 83,6% of participants consider that teleconsultation represents a valuable asset to the future of medicine. The main identified advantage was the greater accessibility by patients to healthcare (68,7%) and the main disadvantage was the impossibility to perform a proper physical examination (81,2%). The lack of appropriate resources, like phone line, camera, internet connection and suitable software was considered the major barrier (70%). 47,8% of the participants answered that the relative time needed for a teleconsultation should be the same as for an usual consultation of the same typology. The type of consultation considered to be the most appropriate to telemedicine was Adult Health (68,7%).

Conclusions - In the portuguese Family Doctors’ perspective, teleconsultation will become essential to the future of Primary Care, even though a long way has to go in order to understand its best applicability.

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Background:

The future of clinical care will be shaped by the introduction of artificial intelligence (AI) into the workflow of general practitioners (GPs). Digital competencies will be fundamental to develop an Exponential Medicine that could help to improve care quality and patient safety. Understanding the importance of clinical data management and its applications could enhance medical performance.

Aim and learning objectives:

To learn the overview of the application of AI in clinical practice, introducing concepts and specific terms related to this topic.

Methods and timetable:

60 minutes version:

5 min: Team presentation.

25 min: Introduction to eHealth and Artificial Intelligence. Concepts: data quality. Interoperability. Medical ontologies. BigData analysis. Clinical Decisions Support Systems. Exponential and Personalized Medicine. Bioethics, challenges and opportunities of AI for healthcare. Clinical research in times of AI.

25 min: Interactive exercises. Brainstorming. Digital competencies for physicians in times of AI.

5 min: Take-Home messages.

The 90-minute version is possible by dedicating 30 minutes to degreasing the topics of "Bioethics, challenges and opportunities of AI for healthcare" and "Clinical research in times of AI", 15 minutes each.

Proposed results:

To develop digital competencies and skills of Family Doctors.

To understand the role of AI in different steps of clinical care and clinical research.

To raise awareness of the importance of AI-based tools to power clinical care.

To inspire innovation based on AI-based tools to improve clinical care.

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Background and purpose: Persistent somatic symptoms (PSS) are highly prevalent in primary care and are a burden to both the patient and healthcare. Data-based identification of patients with PSS could foster various improvements in care. However, identification is currently hampered by unambiguous registration of PSS. The present study aims to explore different theory-driven methods for data-based identification of patients with PSS.

Methods: A cross-sectional study was performed on routine primary care data from 169,138 patients in the Netherlands. Identification of PSS was based on (A) PSS-related syndrome codes, (B) PSS-related terminology, (C) PSS-related symptom codes, and (D) 4-dimensional symptom questionnaire (4DSQ) scores. Sample size, demographics, chronic conditions, and health care utilization (HCU) as extracted via the four methods were explored. Sensitivity between methods was examined.

Results: The percentage of cases identified varied between 0.3% and 7.0% across the methods. Over 58.1% of cases had comorbid chronic physical condition(s) and over 33.8% had comorbid chronic mental condition(s). HCU was generally higher for cases selected by any method compared to the total cohort. HCU was relatively higher for method B compared to the other methods. In 26.7% of cases, cases were selected by multiple methods. Sensitivity between methods was generally low.

Conclusions: The different methods yielded different patient samples within our cohort. Therefore, for the most comprehensive data-based selection of PSS cases, a combination of methods A, C, and D would be recommended. Additionally, advanced (data-driven) methods are needed to create a more sensitive algorithm for identifying the full spectrum of PSS.

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Background and purpose: Loss experiences are common in later life and have been associated with negative effects on mental health. Older adults and their needs seem to be underserved both in the non-digital and in the digital sector of mental health care. The objective of the pilot study was to assess usability and acceptability of an internet-based self-management intervention for older adults with prolonged grief symptoms.

Methods: The pilot study comprised a survey with N=15 older adults (60+) with loss experiences. Participants were recruited through health care providers and support groups. Participants received login data to access the eHealth intervention (trauer@ktiv.de), which has been developed at the University of Leipzig by mental health care professionals. Data were collected at baseline (before access to the intervention). At two months follow-up still N=12 persons took part in the study (response rate 80%).

Results: Participants were on average 66.5 years old and predominantly female (86.7%). Loss experiences comprised mostly the loss of a spouse (57%) or other relatives (28.5%). Overall, nine out of 12 participants at follow-up (75%) accessed the eHealth intervention. Participants rated the intervention as satisfactory or very satisfactory. The intervention achieved good/excellent usability with a score of 82% (USE-Questionnaire).

Conclusions: Results show good usability and high user acceptance for the eHealth intervention targeting older adults with grief symptoms. Recruitment of the target group and uptake of the intervention need age- and symptom-specific approaches. The pilot study precedes a randomized controlled trial assessing the effectiveness of the intervention.