Table 2 Overview of main themes and related findings, incorporating pre-, during, and post-pandemic reflections, reported by general practitioners and medical assistants (n = 14, interviews pre-pandemic; and n = 22, interviews during the pandemic)
Theme | Findings and reflections pre-, during, and post-pandemic |
|---|---|
Internal professional factors | |
Risk perception and IPC awareness | Pre-pandemic Relatively low perceived risk of infectiona for both patients and HCWs in general practices During the pandemic Increased perceived risk of infection for patients and awareness of the importance of IPC Relatively low perceived risk of infection for HCWs themselves Future expectation (post-pandemic) Diverse future expectations: one group expected IPC awareness to remain heightened post-pandemic, while others expected IPC awareness to decline once COVID-19 infection rates decrease (lower perceived severity of the disease) |
Attitudes towards IPC and professional responsibilityb | Pre-pandemic IPC part of professional responsibility (protect patients from avoidable infections) IPC has to be practical, of added value, and evidence-based IPC takes a lot of time (perceived time investment) Balancing IPC with other aspects of patient care and professional roles Autonomy in making IPC-related decisions During the pandemic IPC part of professional responsibility (protect patients from avoidable infections) Doubts about the effectiveness of certain IPC measures IPC takes a lot of time (perceived time investment) Balancing IPC with other aspects of patient care and professional roles Autonomy in making IPC-related decisions |
Decision-making process and risk considerations for IPC adherence | During the pandemic Main reasons for HCWs to adhere to IPC: (1) protect the patient (with extra vigilance for vulnerable groups such as the elderly population and immunocompromised patients), (2) protect themselves to prevent staff absenteeism (and ensure continuity of care), and (3) protect their household and relatives The decision to adhere to IPC was influenced by multiple factors and risk assessments:  • the nature of the consultation (duration, level of physical contact, and setting, i.e., home visit or consultation at GP practice);  • the type/risk indication of the patient (respiratory symptoms/COVID-19 suspicion and vulnerability of the patient group);  • the season (e.g., flu season), community prevalence or incidence;  • the pathogenicity of the virus;  • ability to provide good patient care (including effective communication);  • sustainability considerations Decision-making and considerations to upscale IPC measures were influenced by:  • Internal factors (within GP practice): increasing infections among the patient population and among staff (to prevent further personnel shortages);  • External factors (outside GP practice): guidelines and recommendations from the government, the professional association (NHG), and public health services; increasing infection rates and community incidence; increasing disease burden (based on pathogenicity of the virus), and rising hospital occupancy |
External factors | |
Social norm and social influence in GP practice team | Pre-pandemic Social norms (injunctive norm, descriptive norm), exemplary behaviour, and internal change coaches reinforce IPC behaviour During the pandemic IPC discussed in team meetings, shared decision-making, and mutual agreement in team |
Environmental context and IPC resource availability in GP practice | Pre-pandemic  • Resources and materials: limited availability and access to IPC materials and equipment  • Lack of organisational commitment to IPC (IPC generally only received attention in light of accreditation requirements or quality assurance) During the pandemic  • GP practice building and layout: inadequate practice building or layout affecting patient flow, physical distancing and adequate ventilation  • Resources and materials: limited IPC resource and material availability (PPE and tests), particularly during the first waves of the pandemic  • Other barriers include the large size of the GP practice (e.g., health centres) |