Enhanced crisis resilience of general practitioner-centred care: a retrospective cohort study of patients with coronary artery disease during the COVID-19 pandemic in Germany.

Abstract

Background: Structured, comprehensive provision of primary care services has been shown to provide better outcomes in chronic disease management. In 2004, Germany introduced a programme of general practitioner (GP)-centred healthcare to strengthen the primary care sector. Crises such as pandemics, world conflict and climate events can result in significant challenges for the provision of routine healthcare requiring rapid reorganisation of existing models of care provision. The objective of this study was to assess the impact of the COVID-19 pandemic on the provision of chronic disease surveillance services and the treatment of patients with coronary artery disease (CAD) by GPs in the federal state of Baden-Württemberg, Germany over the years 2019-2020 to examine if the previously demonstrated benefits of GPCC participation were maintained throughout the COVID-19 pandemic.

Methods: Retrospective cohort study monitoring 170,466 CAD patients, conducted using biannually aggregated German insurance claims data (AOK-BaWü), comparing 2019 (pre-pandemic) with 2020 (COVID-19 pandemic), examining access (contacts), therapy (e.g. statin therapy), and clinical outcomes (acute myocardial infarction, angina pectoris, stroke, invasive procedures and pacemaker/defibrillator).

Results: Patients enrolled in the GP-centred care programme (GPCC) had more frequent cohort-specific contacts, increasing during the pandemic, compared to those receiving standard care. Statin prescriptions were higher in the GPCC group and appear to be maintained over the study period. GPCC participation has demonstrated lower risks of all listed clinical outcomes in comparison to standard care and these established advantages of GPCC participation with respect to clinical outcomes were maintained during 2020 despite the challenges of the COVID-19 pandemic.

Conclusion: Structured, comprehensive GP-centred care in Germany demonstrated resilience the challenges of the COVID-19 pandemic and was associated with better continuity of care for patients with coronary artery disease (CAD) and a maintained lower risk of CAD complications. These differences could be explained by the structured and comprehensive provision of primary care services and enhanced coordination with secondary care, allowing practices to maintain care effectively despite the challenges of the COVID-19 pandemic.