Perceived risk and pandemic response awareness in low-capacity public primary health care in Greece

Background: Primary health care (PHC), known as the cornerstone of thehealth systems, has an important role in infectious diseases control. The COVID-19 pandemic has put a burden on health systems worldwide and especially on healthcare workers at the first line delivering their services in remote areas of the country.
Aim: This study investigates primary healthcare    workers’ (PHCWs) preparedness and awareness level and their risk perception in managing the pandemic during its initial phase.
Methods: A cross-sectional survey was conducted in public PHC units in Greece. A web-based 14-items questionnaire, tested in a pilot study, was administered by a pre-existing panel of the Education and Research Network in PHC of Aristotle University of Thessaloniki, Greece. Associations were assessed between epidemic response awareness, risk perception, participants demographics and work settings. Participants were grouped by profession in 1st line Physicians (General Practitioners, Internal Medicine Specialists, Pediatricians), 1st line non-physicians (nurses, health visitors,paramedics) and 2nd line PHCWs (dentists, microbiologists, administrators, midwifes, laboratory technicians, nutritionists and social workers). Univariate logistic regression and multivariable analysis were performed and linear regression was performed to examine the effect of participants’ awareness of the preparedness plan to their working area characteristics.
Results: 441 PHCWs participated in the survey. Risks were perceived at a lower level by 2nd line PHCW than 1st line PHCW (b=-0.78, 95%CI: -1.49,-0.08; p=0.028). Older PHCWs had less concerns than younger PHCWs (b=-0.04, 95%CI: -0.08,-0.01; p=0.025) and more experienced participants had more concerns than less experienced (b=0.04, 95%CI: 0.00,0.07; p=0.050). PHCWs in rural settings presented with more preparedness awareness, compared to PHCWs in urban areas (b=1.10, 95% confidence interval [CI]: 0.28,1.92; p=0.008), while PHCW living with high risk individuals showed less situation awareness (-0.55, 95%CI: -0.95, -0.16; p=0.006).
Conclusions: Primary health care workers in rural areas revealed a rather high awareness of the response measures and management protocol requirements that were in place in contrast with their colleagues in urban areas. As expected 1st line PHCW directly exposed to emergencies, expressed more concerns than 2nd line PHCW. Learning from the challenges occurring during the initial phase of the pandemic, could help PHC facilities address COVID-19 effectively and PHCWs' sense of security and confidence could augment, even when working in remote areas of the country. When planning trainings, distributing equipment and proposing protocols, the characteristics of the area and the needs of the PHCW and population, should be cautiously considered.