Impact of COVID-19 on Primary Care Practice Sites and Their Vulnerable Patients

Hefner, Jennifer L; Nembhard, Ingrid M.; Singer, Sara J.; Glassman, Jill R.; Glaseroff, Alan; Joseph, Grace; Jauregui, Adam; Mulaney, Bianca; Kelly, Sara; Thomas, Samuel; Vilendrer, Stacie; Tietschert, Maike

doi:10.1108/s1474-823120210000020009

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…An increasing number of papers are being published which analyze how a lack of pandemic preparedness and other challenges mentioned above have been dealt with within European countries and what are the possible directions for a transformation of the primary care system in Europe [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. However, little is known about the preparedness of primary care practices in terms of their infrastructure.…”

Section: Introductionmentioning

confidence: 99%

Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries

Windak

Nessler

Poel

et al. 2022

IJERPH

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COVID-19 proved that primary care (PC) providers have an important role in managing health emergencies, such as epidemics. Little is known about the preparedness of primary care practice infrastructure to continue providing high quality care during this crisis. The aim of this paper is to describe the perceived limitations to the infrastructure of PC practices during COVID-19 and to determine the factors associated with a higher likelihood of infrastructural barriers in providing high quality care. This paper presents the results of an online survey conducted between November 2020 and November 2021 as a part of PRICOV-19 study. Data from 4974 practices in 33 countries regarding perceived limitations and intentions to make future adjustments to practice infrastructure as a result of the COVID-19 pandemic were collected. Approximately 58% of practices experienced limitations to the building or other practice infrastructure to provide high-quality and safe care during the COVID-19 pandemic, and in 54% making adjustments to the building or the infrastructure was considered. Large variations between the countries were found. The results show that infrastructure constraints were directly proportional to the size of the practice. Better pandemic infection control equipment, governmental support, and a fee-for-service payment system were found to be associated with a lower perceived need for infrastructural changes. The results of the study indicate the need for systematic support for the development of practice infrastructure in order to provide high-quality, safe primary care in the event of future crises similar to the COVID-19 pandemic.

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Section: Introductionmentioning

confidence: 99%

Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries

Windak

Nessler

Poel

et al. 2022

IJERPH

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“…As reported by many clinical specialties, the social and clinical changes due to COVID lockdown was significantly disruptive to routine clinical practice for patients and providers. 30 – 32 This sudden change correlated with an adoption of healthcare related technologies, most notably telemedicine. 33 , 34 The emergent nature associated with the COVID-19 outbreak helped with overcoming many of the initial barriers associated with adoption of telehealth tools.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 lockdown on patient-provider electronic communications

et al. 2023

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Background SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature. Methods All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during 12 months before and after lockdown (March 1st, 2020). Logistic regression was utilized to examine the effects of the lockdown on inbox item rate post-COVID-19 lockdown as compared to the pre-lockdown period. Results Before COVID-19 lockdown, 2.07 new inbox items per encounter were received, which increased to 2.83 items after lockdown. However, only patient-initiated electronic messages increased after lockdown and stabilized at a rate higher than the pre-COVID-19 period (aRR 1.27, p-value < 0.001). In contrast, prescription refill requests and telephone calls quickly spiked, then returned to pre-lockdown levels. Conclusion Based on our observations, providers experienced a quick increase in all inbox items. However, only electronic messages had a sustained increase, exacerbating the workload of administrators, staff, and clinical providers. This study directly correlates healthcare technology adoption to a significant disruptive event but also shows additional challenges to the healthcare system that must be considered with these changes.

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“…Several factors made delivery of the intervention directly to PCPs difficult. First, the intervention was conducted during the COVID-19 pandemic, and primary care practice was seriously disrupted 17–20. Many PCP offices decreased hours and either cut back on or lost staff support during this time 21 22.…”

Section: Discussionmentioning

confidence: 99%

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

Baldwin

Katers

Sullivan

et al. 2023

Trauma Surg Acute Care Open

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BackgroundDecreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients.MethodsThis longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP’s identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support.ResultsThe PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP’s office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were.ConclusionsThis level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma.Level of evidenceLevel IV.

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Impact of COVID-19 on Primary Care Practice Sites and Their Vulnerable Patients

Cited by 5 publications

References 27 publications

Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries

Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries

Impact of COVID-19 lockdown on patient-provider electronic communications

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

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