key: cord-1038573-l0oxeqi9 authors: Guha, Anasuya; Plzak, Jan; Schalek, Petr; Chovanec, Martin title: Otorhinolaryngology in the COVID‐19 era: Are there significant differences between hospital‐based and private practices? date: 2021-02-10 journal: Int J Clin Pract DOI: 10.1111/ijcp.14054 sha: 8ab9c65662e59871bda4532c12b721e6175709e1 doc_id: 1038573 cord_uid: l0oxeqi9 OBJECTIVES: The COVID‐19 disease has an incredible impact on both hospital‐based and private practices in the field of otorhinolaryngology and head and neck surgery. Practical issues faced by both types of practices have not been well addressed in most studies. A national survey was conducted in April 2020 to identify the challenges faced by otorhinolaryngologists practicing in the Czech Republic. DESIGN: Prospective questionnaire‐based study SETTING: Online Google questionnaire sent to the members of the Czech Society of Otorhinolaryngology and Head and Neck Surgery PARTICIPANTS: All doctors practicing Otorhinolaryngology in the Czech Republic with access to the online questionnaire between 15th and 26th April 2020. MAIN OUTCOME MEASURES: The primary aims of the study were to evaluate any significant differences between the two types of practice in the field of Otorhinolaryngology. We formulated null hypotheses stating there were no statistical differences in the preparation and availability of personal protective equipment amongst both practices a month after the first case of COVID‐19 in the Czech Republic. Statistical analyses including the Mann‐Whitney U test were performed to test the hypotheses. RESULTS: Analysis and results were based on the completion of the entire questionnaire by the doctors. There were no statistically significant differences between both the practices; however, individual analyses of both the practices showed a different outcome. CONCLUSION: Despite our statistical results, it was observed that private practices faced more deficits and were more financially vulnerable. They were also other issues reported by both practices that could compromise the care of patients, functioning of workplaces and support of doctors. The primary aims of the study were to evaluate any significant differences between the two types of practice in the field of Otorhinolaryngology. We formulated null hypotheses stating there were no statistical differences in the preparation and availability of personal protective equipment amongst both practices a month after the first case of COVID-19 in the Czech Republic. Statistical analyses including the Mann-Whitney U test were performed to test the hypotheses. Results: Analysis and results were based on the completion of the entire questionnaire by the doctors. There were no statistically significant differences between both the practices; however, individual analyses of both the practices showed a different outcome. Conclusion: Despite our statistical results, it was observed that private practices faced more deficits and were more financially vulnerable. They were also other issues reported by both practices that could compromise the care of patients, functioning of workplaces and support of doctors. staff and hospital departments; reallocation of funds; and finally psychosomatic problems from the workplace, 10 Despite the publication of guidelines to protect the ENT workforce, 1,2,4,6,7 it still resulted in COVID-19 related morbidity and mortality within the practice. There was also a lack of literature regarding the effect of COVID-19 on ENT doctors. So in April 2020, we decided to create a national survey in the Czech Republic to determine the response of ENT doctors to the COVID-19 situation. Our results were not only able to identify the strengths and weakness across various ENT practices, 11 but also the psychosomatic problems encountered by the doctors. 12 To the best of our knowledge, we also ascertained that no survey has been performed to compare the differences in clinical practice between private clinics and hospital-based ENT departments. On this basis, we decided to further analyse our data in order to specifically compare the issues between the two types of ENT practices. It is very important to identify any deficits or specific problems faced by both types of practices to ensure that as ENT clinicians, we are well prepared for handling the future problems associated with any pandemic situations. A total of 900 ENT doctors (59.6% females, 40.4% males) were invited to complete a survey via email with an online link to a survey with the help of the Czech Society of Otorhinolaryngology and Head and Neck Surgery. This was carried out in April 2020. 11 Items in the questionnaire that were relevant to this analysis were as follows: gender of the participants; type of practice On the assumption, that private practices would have suffered more than hospital-based practices, two sets of null hypotheses were formulated to compare current workplace provisions across hospital-based and private practices. Whilst addressing the question related to the quality of preparation of practices in response to COVID-19, we formulated the first null hypothesis, h 0 , that there is no statistical difference between the two types of practices. Secondly, when analysing the extent to which the workplaces were equipped with PPE, another null hypothesis, h 0 , was that, there is no statistical difference between both practices. Furthermore, other parameters were also analysed and finally, we performed statistical analysis in excel which included descriptive statistics along with the Mann-Whitney U test. Table 1 . A Mann-Whitney test indicated that there was no difference in the quality of preparation between hospital-based (Median 2) and private practices (Median 2), U = 3539.5, P = 0.0937 The P-value was .0937 during the time of the study in April 2020. This means that if we would reject h 0 , the chance of type I error would be as high as 9.03%. Therefore, it can be shown that no difference was seen between the 2 types of practices. In terms of the provision of PPE during the time of the survey, there was no significant difference between the two types of practices (Median of 4 in both), U = 3651, P-value was .17139 and again null hypothesis has to be accepted since P was not <.05. 1. Otorhinolaryngology is a very vulnerable specialty with respect to COVID-19 2. Adequate preparation of practices is of paramount importance so that the care of non-COVID-19 patients with urgent or serious chronic illnesses is not A large population of our study group comprised of female practitioners, most of whom are associated with private practices. Amongst all the respondents, 71.7% were either employed by a private practice or a hospital. Age predilection, although difficult, it can be assumed that 15% of doctors that are practicing for more than 35 years are definitely 60 years patients. 13, 14 In the Czech Republic, doctors above 65 years of age and or those with chronic illnesses working in hospitals had the possibility of working from home with suitable compensation; however, it was not made mandatory; these guidelines were not reinforced by the general medical council or ministry of health. And, moreover, in this specialty, this would be difficult to achieve, since most patients present with symptoms similar to those encountered in any pandemic associated with a respiratory virus, and have to be considered as potentially positive until and unless proven otherwise. Our hypotheses were proved wrong. In terms of the current preparation of practice and availability of PPE amongst otorhinolaryngology practices in response to COVID-19, no significant differences were observed amongst both types of practices. Furthermore, majority of practitioners reported moderately to well-prepared workplaces. Although 53% of all doctors from both clinical settings reported having adequate PPE, nevertheless during the overall analysis of the items deficient in both practices, two major shortfalls were still seen; PPE and disposable aids. Deficits in PPE have been well published, 13 thus practices should maintain an inventory in helping health establishments estimate provisions. Furthermore, private clinics also suffered significantly from the shortage of disinfection and sterilisation products. Financial losses were encountered by both practices, but owners of private practices were more vulnerable. In a survey carried out in April 2020 with 724 physician respondents, 97% of medical practices had been negatively affected by the COVID-19 situation leading to 22% layoffs with projected layoffs of up to 36% within May 2020. 15 This further reiterates the importance of financial support in order to maintain a private practice. Although several European countries have agreed to provide incentives and also been promised supplementary funds, very few have made agreements with private practices. 16 In the Czech Republic, no such provisions have been made. where there are no hospitals with ENT departments and patients are dependent on private clinics, reduced accessibility to such practices will also cause significant problems for debilitated patients and those with chronic illnesses. They will have to travel long distances. Amongst elderly or disabled patients, this is a very important factor and they may not be able to cope with this. As a result, this will delay treatment and lead to the deterioration of their health. We would recommend a more detailed follow-up survey to fully explore all the practical problems that are currently being faced during the second and more severe phase of COVID-19 within the otorhinolaryngology practice. The authors have no conflicts of interest Research involving human participants and/or animals: Formal ethical approval was not required for this survey since it was questionnaire-based. Protocol followed in studies involving human subjects was in compliance with the Helsinki declaration and further in accordance with local ethical guidelines of the institutional ethical committee of the 3 rd Faculty of Medicine, Charles University, Guidance for ENT during the COVID-19 pandemic COVID-19: protecting our ENT workforce COVID-19 in otolaryngologist practice: a review of current knowledge cal-guide -surgi cal-prior itisa tion-durin g-coron aviru s-pande mic-ent-specific Tracheostomy in the COVID-19 era: global and multidisciplinary guidance COVID-19 and ENT Pediatric otolaryngology during the COVID-19 pandemic. Guidelines of the French Association of Pediatric Otorhinolaryngology (AFOP) and French Society of Otorhinolaryngology (SFORL) Ethical questions related to Covid-19 and ENT practice Effectiveness of masks and respirators against respiratory infections in healthcare workers: a systematic review and meta-analysis PPE guidance for covid-19: be honest about resource shortages A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak Face to face with COVID-19: highlights of challenges encountered in various ENT practices across the Czech Republic (a national survey) Extremely wicked, shockingly evil and undoubtedly COVID-19: the silent serial killer [published online ahead of print Protect our healthcare workers Keep older healthcare workers off the covid-19 front line COVID -Finan cial-Impac t-One-Pager -8-5x11-MW-2.pdf. aspx?lang=en-US&ext= Strengthening the health financing response to COVID-19 in Europe