INTRODUCTION

During the period of the COVID-19 pandemic there has been a significant overuse of health services in all health systems worldwide, with particular emphasis during the vaccination period on primary care ¹. Telemedicine has been used almost constantly, with a loss of direct professional-user contact that IT technologies cannot replace ². On-demand activities have surpassed any planning that has an impact on the implementation of preventive activities or on the technological accessibility barriers of certain socio-cultural groups ^1,2.

The effectiveness of preventive interventions is enhanced by elements such as empathy, quality of the professional-patient relationship and warmth of clinical communication, aspects that are altered by care through electronic tools ². It also opens opportunities for prevention that allow us to focus health services on the main health problems in the community and to provide the necessary promotion, prevention, treatment and rehabilitation services to solve these problems ³.

On the other hand, the pandemic, of a community nature, has favored the commitment of citizens to co-responsibility and the importance of empowerment in disease control, together with the perception that the health system alone is insufficient to prevent diseases ³. Technological development has great advantages, such as advances in medical records that make it possible to monitor lifestyles and improve people's health information systems, both in their homes and in their social environment, favoring selective and highly targeted interventions to prevent diseases ⁴.

Pandemics can have differential impacts on women and men, ranging from risk of exposure and biological susceptibility to infection to social and economic implications, and people's experiences are likely to vary according to their biological and gender characteristics and their interaction with other social determinants of health ^5,6.

The global response to COVID-19 has been described as "too little, too late", with national and international efforts at an unplanned pace, in the face of many aspects of this situation that remain uncertain ^7,8). However, this should serve to implement global protocols to prepare for future scenarios and enable us to be ready for similar situations. The World Health Organization (WHO) urges its Member States and all global actors to target investments in quality, gender- sensitive research on the adverse health, social and economic impacts of COVID- 19 ^{7)(8)(9)(10)(11)(12)(13)(14)(15)(16}. Advancing proposals for improvement includes further related research such as the one presented in this study that aims to analyze the health perceptions of primary care patients in health department 21 during the epidemic period of COVID-19.

METHODS

RESULTS

The total sample was 243 users, 103 men and 140 women. Ages ranged from 20 to 94, with an average of 64.55 years (SD 19.97). The most frequent type of occupation among women was retired (46%), followed by housewife (18.6%). In men the most frequent occupation was 52.4 % retired, followed by farmers with 12.6 %.

Table 1 shows the socio-demographic characteristics and comorbidity in men and women attended in the basic health area under study. A significant association by sex was observed for body mass index (p<0.001) with higher percentages of overweight and obesity in women. Significant associations were also found for coronary heart disease (p<0.005), lung disease (p<0.027) and smoking (p<0.001).

Table 1. Socio-demographic characteristics and comorbidity. 

^aNo.: number of men in basic health zones;

^bNo.: number of women in basic health zones;

^*Chi-squared test.

p≤ 0.05.

About the referring to questions the perception of health, we highlight the group of women where they report worse health (69%) during the last 12 months and greater problems walking (59.2%). Figure 1 shows the assessment of self- perceived health by sex.

Figure 1. Perceived self-health level by sex. 

With regard to the degree of satisfaction with the health services, 67% of women and 52% of men were satisfactory.

Table 2 below shows the results obtained after the medical consultation in the last 4 weeks. Advice, complementary tests and prescription of medication are the results with the highest percentages derived from the medical consultation.

Table 2. Medical consultation in the last 4 weeks. 

Table 3 below shows the social resources used in the last 12 months. Significant associations were observed for activities of daily living (p<0.001) and telecare (p<0.043).

Table 3. Characteristics of the social resources used at home. 

^aNo.: number of men in basic health zones;

^bNo.: number of women in basic health zones;

^*Chi-squared test.

p≤ 0.05.

DISCUSSION

The aim of this study was to analyze the perception of health in primary care patients in health department 21 during the epidemic period of COVID-19. The following dimensions were analyzed using the Valencian Community Health Survey 2016¹⁷: self-perceived level of health, health consultations and social resources used.

About the characteristics of the participants, we highlight the high average age of participation (65 years), which is in line with life expectancy. Like other studies such as the executive summary of the annual report of the national health system for 2019 ¹⁸, where life expectancy for the Spanish population stands at 83.4 years, with 80.4 years in men and 86.2 years in women, which represents an increase of 4 years since 2001.

In line with other studies ¹⁷, sex has a clear impact on overweight and obesity in women. In our study, a significant association by sex was observed for body mass index. In relation to comorbidities and similar to the results of the 2016 Valencian Community survey, a significant association by sex was observed, with men standing out with higher values obtained for coronary heart disease, lung disease and smoking.

With regard to the health perception dimension, women report worse health and moderate problems with walking. If we compare our results with the health survey of the Valencian Community 2016 ¹⁷, we observe similarities in that men report a better state of health than women. This is similar to other studies such as that of Abufaraj et al., ¹⁹ where Jordanian women experienced worse results in terms of well-being. On the other hand, despite observing low values in health perception, we highlight, as in other studies ^17,20, the good results obtained with respect to satisfaction with health services regardless of age and gender.

We observed an upward trend in the use of health services during the COVID-19 pandemic in terms of health care consultations, where, as a result, prescriptions for medicines, complementary tests and medical advice predominated. Specialized care consultations and emergency services also decreased. This phenomenon could be due to the fear of infection in coronavirus care services during the pandemic. In contrast, compared to other pre-pandemic studies ¹⁷, specialized care and hospital emergency departments were predominant.

The ageing of the population is sometimes associated with the need for support and care at home. With regard to the social resources used at home, our data show a significant association by sex in activities of daily living and telecare. As in other studies, the need for help with activities of daily living, telecare and support for grooming and personal care stand out ^17,21. Other studies also mention social disconnection among older people with increased demand for activities of daily living and telecare as particularly detrimental consequences of the COVID-19 pandemic^22,23.

Among the limitations, we highlight those inherent to the type of study design and the sample corresponding to a single health department. We have not studied the main problem for which they consult, nor the severity. We highlight as possible biases the selection of the sample and the information bias of the interviewers.

CONCLUSION

On a practical level, if we take into account life expectancy in the population, associated comorbidities and health care in the pandemic period, we can say that the perception of health is worse in women. Despite all these factors, satisfaction with health services in the pandemic period is satisfactory.

Finally, it seems necessary to raise awareness among health professionals and implement protocols that prepare for future scenarios and allow us to be ready for similar situations, incorporating a comprehensive approach in their responses to COVID-19. These protocols should ensure that public health policies and measures are able to curb the epidemic taking into account gender and barriers to health access.