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Office-based physicians have not been as visible in COVID-19 news coverage as hospital staff, although outpatient clinicians clearly are affected by similar safety and volume issues, all without the support structure a hospital provides. How are they faring? A survey that was sent in February and March 2020 to 450 Italian primary care physicians affiliated with a single hospital in Lombardy (the hardest hit region of Italy) provides a glimpse.
Of 272 respondents (60% response rate) who were providing care to an estimated 400,000 patients, about half reported at least one known contact with a SARS-CoV-2 patient. Almost all had tried to prevent overcrowding in the office, and about 90% had modified their practice to include phone-based care or telemedicine. Most had purchased their own personal protective equipment (PPE), less than half had received PPE from the Ministry of Health (the employer of Italian physicians), and less than 20% had provided PPE for use by waiting patients.
About 40% reported that they themselves had experienced cough, fever, or gastrointestinal symptoms during the preceding 4 weeks; symptoms lasted for longer than 1 week in about half who were ill. Only 18 respondents were tested for SARS-CoV-2; only 2 tests were positive.
Fiorino G et al. Clinician education and adoption of preventive measures for COVID-19: A survey of a convenience sample of general practitioners in Lombardy, Italy. Ann Intern Med 2020 Apr 15; [e-pub]. (https://doi.org/10.7326/M20-1447)
Comment
These data (skewed, of course, to a set of primary care doctors with the time and, presumably, the health to respond a survey) are notable for high rates of preparation and very low rates of testing, despite a sizable prevalence of suggestive symptoms. The authors note that, when they wrote this report, 20 primary care physicians in the region had died of COVID-19.