More room for telemedicine after COVID-19: lessons for primary care?
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EDITORIAL
More room for telemedicine after COVID‑19: lessons for primary care? Livio Garattini1 · Marco Badinella Martini1 · Michele Zanetti1 Accepted: 11 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Background The COVID-19 pandemic has put under pressure all the European health care systems, regardless of their type and structure. Telemedicine (TM) has been an almost unavoidable answer for primary care (PC) services to contain contagion during the first period of this catastrophic event. Starting from general practice, the pandemic has dramatically undermined the traditional face-to-face contact of the patient–physician relationship and brought TM to the forefront of PC on a broad scale, as never before [1]. Here, first, we briefly summarize the main features of PC in Europe. Then, we look over the vast literature on TM and discuss the major concerns which have limited its widespread adoption before the pandemic. Finally, we depict a radically different post COVID-19 scenario for PC in Europe, in which TM could be exploited to the utmost.
Primary care PC includes all the health services that are the first level of contact for individuals and families, and from then on a source of continuous, comprehensive and coordinated regular care to meet their health needs [2]. In terms of health policy, the most important function of PC is the coordination of care within the whole spectrum of healthcare services [3]. Beyond general practice, the services included in PC range widely from a European country to another, depending on national wealth and type of health system. For instance, in the Italian National Health Service (NHS) infant vaccinations, population screenings, outpatient consultations, counseling for family planning, home care and rehabilitation services are all part of PC [4].
* Livio Garattini [email protected] 1
Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
Regardless of the different health frameworks, general practitioners (GPs) are the pivotal providers of PC throughout Europe, as they are the front-line health professionals to whom patients turn for any health-related concerns. GPs are also considered crucial ‘gate-keepers’ for filtering secondary care induced by specialist consultants [4]. This is their traditional role in the ‘Beveridgian’ public health systems (like the British and Italian NHSs), more recently played by GPs also in ‘Bismarckian’ social health insurance systems (like the Belgian and Dutch ones) [5]. Although GPs’ costs are mainly covered by public services or social insurances in all European nations, they are still officially self-employed physicians (in Italy and the UK too). For historical reasons, GPs are a sort of ‘small businessmen’ inside the health care systems [6], differently from their colleagues in hospitals who are usually employees in their workplace. Finally, out-of-hours and timely access to PC have become common issues in this era of ageing populations [7, 8], further amplified by the increasing
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