The Covid-19 pandemic spread throughout the European countries at the beginning of 2020, and among them, Italy had some of the highest incidence of Covid-19 deaths (1). Several elements affect the impact and spread of infectious diseases in a given population (2).The pandemic has spread differently among European countries, even if comparative analysis presents limited data (3). Healthcare service workers at all levels – primary care, hospital and community care, and highly specialized treatment facilities – have been protagonists in managing the pandemic. Covid-19 has been an enormous challenge for all healthcare systems, bringing to light several national healthcare system strengths and weaknesses (4).
Primary care services (5) have played a key part in managing the pandemic at national and local levels, with general practitioners (GP) being a frontline emergency profession (6). Despite the differences in their role and function in Europe (7; 8;9; 10), GP offer and organization is a crucial aspect of healthcare systems in the context of the World Health Organization’s (WHO’s) policy frame (11; 12).
The key role of primary care in healthcare systems, and therefore also of GPs, is even more crucial in the context of the ageing population (13). Moreover, GPs have been a paramount point of analysis for healthcare policy systems during the Covid-19 pandemic emergency, as confirmed by the message of the WONCA Executive Committee on World Family Doctor Day on 19 May 2020 (14;15).
The importance of GPs in healthcare system organisation is well-known (12). As patients’ first and main point of entry into the healthcare system, GPs play a strategic role in assessing health needs, as well as in coordinating with other health services (16). They also affects healthcare efficiency being a key profession in primary care (17;18): “Strong primary care is associated with better population health and lower rate of unnecessary hospitalizations” (19), considering the key role of GPs as gatekeeper to the rest of healthcare services (4).
Assessing primary care organization and performance has been the focus of a recent study presenting literature review synthesis and the proposal of a theoretical and practical framework (20). Structural aspects, such as the number of GPs, nurses, social workers and pharmacists, are a fundamental aspect of such a framework because they are likely to have a significant impact on the performance of the healthcare systems(21).
This study presents a preliminary analysis on structural data concerning GPs in European comparative perspective, with a specific attention to the Italian case study, and investigates the correlation between number of GPs and Covid-19 mortality rate. The GPs numbers over 100,000 inhabitants (considered together to the degree of ageing population) has been considered as proxy of public health investment in a key aspect of primary care.
Moreover, in recent years, several studies have highlighted the critical flaws and weaknesses of the Italian healthcare system (22; 23; 24, 25). Specific analyses have also investigated and discussed personnel healthcare policy (26; 27). Although several analyses have addressed the effect of the reform process on the Italian national healthcare system, just few has specifically dealt with the GPs sector’s reform in Italy (28; 29; 30).
GPs are the main protagonists of primary care in Italy, due to the limited role of other health and social professionals such as community nurses, pharmacists and social workers. Community / family nurses, in fact, have been not yet fully implemented in Italy (31), as well as specific health care service to manage pandemic at local level (USCA) (32).
Due to the key role of GPs' activities in the Italian context (23), this work intends to fill this gap by investigating GPs' structural data before the arrival of the pandemic, in Italy in a European comparative perspective. Therefore, this study investigates the availability of GP services, in Italy, in terms of number of GPs in the population,as the result of policy-reform processes in the last decades, in a European comparative perspective.
The study has been led by the following three research questions and related hypothesis:
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Is the number of GPsper 100.000 inhabitants increased or decreased in the last 20 years in European countries? According to the literature (19), the main hypothesis is that European health care systems would have increased their investments in GP, increasing their number, coherently with WHO recommendations.
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Has the GPs number per 100.000 inhabitants in Italy been consistent with the rest of the EU countries trend? According to the literature (33), the main hypothesis is that the Italian reform process would have affected the GP numbers in term of reduction.
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Is there any statistically significant correlation between the trend in GPs number and the Covid-19 mortality? According to the literature (22) the main hypothesis would be that countries with an increasing number of GPs would have a lower rate in Covid-19 mortality.