A qualitative study of high-performing primary care practices during the COVID-19 pandemic

Abstract

Background Primary care practices have remained on the frontline of health care service delivery throughout the COVID-19 pandemic. The purpose of our study was to understand the early pandemic experience of primary care practices, how they adapted care processes for chronic disease management and preventive care, and the future potential of these practices’ service delivery adaptations. Methods We interviewed 44 providers and staff at 22 high-performing primary care practices located throughout the United States between March and May 2020. Interviews were transcribed and coded using a modified rapid assessment process due to the time-sensitive nature of the study. Results Practices reported employing a variety of adaptations to care during the COVID-19 pandemic including maintaining safe and socially distanced access through increased use of telehealth visits, using disease registries to identify and proactively outreach to patients, providing remote patient education, and incorporating more home-based monitoring into care. Routine screening and testing slowed considerably, resulting in concerns about delayed detection. Patients with fewer resources, lower health literacy, and older adults were the most difficult to reach and manage during this time. Conclusion Our findings indicate that primary care structures and processes developed for remote chronic disease management and preventive care are evolving rapidly. Emerging adapted care processes, most notably remote provision of care, are promising and may endure beyond the pandemic, but issues of equity must be addressed (e.g., through payment reform) to ensure vulnerable populations receive the same benefit.

The role of primary care in informing and supporting people with limited health literacy in the Netherlands during the COVID-19 pandemic: a qualitative interview study

“…Also, with respect to general health issues, primary care has been reported to be an important information provider for individuals with limited HL, especially among the elderly and chronically ill [ 25 ]. However, as was reported by an interview study among primary care professionals in the USA [ 26 ], these individuals are the most difficult to reach and manage during a pandemic (e.g., due to difficulty with digital consultations), which stresses the needed attention for accessibility we described. In line with our findings, it has been recommended to prioritize and proactively contact vulnerable patients in primary care during a pandemic [ 27 ].…”

Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors

“…Staff was reduced due to infection and mandatory isolation [ 4 , 5 ]. In-person consultations were restricted to prevent virus spread and telehealth was boosted [ 4 , 6 ]. GPs were diverted to COVID-19-related work, further reducing accessibility in primary care [ 5 ].…”

Evaluating the Impact of the COVID-19 Pandemic on Monthly Trends in Primary Care

“…Between March 2020 and May 2020, primary care providers expressed concern about meeting quality of care for their patients who could not access home-based monitoring for hypertension and diabetes. In addition, the providers had difficulty ordering routine labs to monitor lipid levels and diabetes and ensuring proper referrals for diabetes [ 8 ]. Pharmaceutical dispensing data indicate concerning drops, particularly in April, May, July, and August of 2020.…”