Objectives Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. Design Cross-sectional survey study. Setting General practice in low-income neighbourhoods in the Netherlands. Participants Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. Main outcome measures Need for GP contact, decision to contact a GP practice, and GP service utilisation. Results Forty-five percent (N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)) . Moreover, 56% (N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). Conclusion Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis.

Background Worldwide the Covid-19 pandemic resulted in drastic behavioral measures and lockdowns. Vaccination is widely regarded as the true and only global exit strategy; however, a high vaccination coverage is needed to contain the spread of the virus. Vaccination rates among young people are currently lacking. We therefore studied the experienced motivations and barriers regarding vaccination in young people with the use of the health belief model. Methods We conducted a correlational study, based on a convenience sample. At the vaccination location, directly after vaccination, 194participants(16–30 years) who decided to get vaccinated at a pop-up location several weeks after receiving a formal invitation, filled out a questionnaire regarding their attitudes towards vaccination based on concepts defined in the health belief model. We used these concepts to predict vaccination hesitancy. Results Younger participants and participants with lower educational levels report higher levels of hesitancy regarding vaccination (low education level = 38.9%, high education level = 25.4%). Perceived severity (Mhesitancy = .23, Mno hesitancy = .37) and susceptibility (Mhesitancy = .38, Mno hesitancy = .69) were not associated with hesitancy. Health related and idealistic benefits of vaccination were negatively associated with experienced hesitancy (Mhesitancy = .68, Mno hesitancy = -.37), while individualistic and practical benefits were not associated with hesitancy (Mhesitancy = -.09, Mno hesitancy = .05). Practical barriers were not associated with hesitancy (Mhesitancy = .05, Mno hesitancy = -.01), while fear related barriers were strongly associated with hesitancy (Mhesitancy = -.60, Mno hesitancy = .29). Conclusions Health related, and idealistic beliefs are negatively associated with experienced hesitancy about vaccination, while fear related barriers is positively associated with experienced hesitancy. Future interventions should focus on these considerations, since they can facilitate or stand in the way of vaccination in young people who are doubting vaccination, while not principally opposed to it.

SamenvattingVaccine hesitancy vormt een grote bedreiging voor de wereldwijde gezondheid. Tijdens de COVID-19-pandemie en de bijbehorende grootschalige vaccinatiecampagnes kwam dit in vele landen, inclusief Nederland, duidelijk naar voren. Medisch professionals hebben een relatief groot vertrouwen van de bevolking en lijken daarmee een belangrijke rol bij de informatievoorziening rond COVID-19-vaccinaties te spelen. Daarom heeft het Erasmus MC, samen met de regionale huisartsenkringen en vier andere universitaire centra, in november 2021 de Vaccinatie Twijfeltelefoon geïnitieerd om persoonlijke voorlichting en medisch advies over de COVID-19-vaccinaties laagdrempelig beschikbaar te maken. Het aantal telefoontjes geeft de potentie weer van deze vorm van informatievoorziening, en de grote reikwijdte en het laagdrempelige en onafhankelijke karakter vormen het fundament van deze landelijke telefoonlijn. Onze ervaringen met de Vaccinatie Twijfeltelefoon tijdens de COVID-19-pandemie lijkt erop te wijzen dat deze vorm van informatievoorzienig in de toekomst mogelijk ook breder ingezet kan worden voor andere grote medische vraagstukken.

SamenvattingDe COVID-19-vaccinatiegraad in Nederland is niet gelijk verdeeld: in sommige wijken blijft de vaccinatiegraad achter. Dat leidt tot individuele gezondheidsrisico’s en belasting van de zorgketen. Een verklaring hiervoor is dat een gelijke aanpak (equality-aanpak) niet altijd tot gelijke uitkomsten leidt, terwijl er op landelijk niveau wel gekozen is voor een algemene voorlichtingscampagne. Wij bepleiten daarom het inzetten van de equity-aanpak, zoals door de WHO gedefinieerd, gericht op het behalen van gelijke resultaten door in te spelen op de specifieke behoeften van kwetsbare groepen. Als voorbeeld beschrijven we een Rotterdamse interventie, waarbij Rotterdamse (huis)artsen het initiatief namen informatie over vaccins en vaccinatie aan te bieden op de drukbezochte markten van Rotterdam. Aan de hand van interviews met betrokken medische vrijwilligers schetsen wij daarnaast enkele randvoorwaarden voor het succesvol inzetten van een dergelijke op outreach gebaseerde aanpak en doen we enkele praktische aanbevelingen.