The primary care COVID-19 integrated pathway: a rapid response to health and social impacts of COVID-19

Abstract

Background The first wave of COVID-19 in Calgary, Alberta accelerated the integration of primary care with the province’s centrally managed health system. This integration aimed to deliver wraparound in-community patient care through two interventions that combined to create the COVID-19 Integrated Pathway (CIP). The CIP’s interventions were: 1) a data sharing platform that ensured COVID-19 test results were directly available to family physicians (FPs), and 2) a clinical algorithm that supported FPs in delivering in-community follow up to improve patient outcomes. We describe the CIP function and its capacity to facilitate FP follow-up with COVID-19 patients and evaluate its impact on Emergency Department (ED) visits and hospitalization. Method We generated descriptive statistics by analyzing data from a Calgary Zone hub clinic called the Calgary COVID-19 Care Clinic (C4), provincially maintained records of hospitalization, ED visits, and physician claims. Results Between Apr. 16 and Sep. 27, 2020, 7289 patients were referred by the Calgary Public Health team to the C4 clinic. Of those, 48.6% were female, the median age was 37.4 y. 97% of patients had at least one visit with a healthcare professional, where follow-up was conducted using the CIP’s algorithm. 5.1% of patients visited an ED and 1.9% were hospitalized within 30 days of diagnosis. 75% of patients had a median of 4 visits with their FP. Discussion Our data suggest that information exchange between Primary Care (PC) and central systems facilitates primary care-based management of patients with COVID-19 in the community and has potential to reduce acute care visits.

Thinking and Enacting the Patient Medical Home under Pandemic Conditions: A qualitative study from primary care in Alberta, Canada

“…In March 2020, when Alberta's rst C19 case was identi ed, as with other PHC organizations, [11][12][13][14] PCNs pivoted to managing patients in the community. 13,14 They brought to this pandemic response work not just their resources, but their mandated commitment to the PMH.…”

Thinking and Enacting the Patient Medical Home Under Pandemic Conditions: A Qualitative Study From Primary Care in Alberta, Canada

“… 3 - 7 Striving to deliver Primary Health Care (PHC) broadly and holistically conceived, 8 , 9 those teams have protected the capacity of acute care facilities 10 and integrated with other elements of the health system helping to achieve resilience. 11 - 14 The shock of the pandemic to PHC provision has been unique in its sustained severity, 15 , 16 highlighting and exacerbating longstanding challenges to the provision of PHC including burnout amongst existing clinicians 17 - 19 ; threats to the financial viability of practices 20 , 21 ; and a decreased flow of new physicians into the practice of family medicine. 22 - 24 In this context of new and old challenges, the pandemic’s effects on the delivery of PHC-focused care models are not well understood.…”

“…Actions taken by AHS units that were aimed at rapidly deploying mass C-19 testing across the province initially did not include provision for test result notifications to be shared with PCPs. 14 This emergent integration challenge 15 was met with parties in the 2 siloes building a data bridge between C-19 clinics run by the PCNs and the AHS public health and testing units generating the results. 13 The integration enabling data bridge solution ensured PCPs knew about C-19 positive patients, and that those patients received in-community follow-up.…”

“…Emergency Departments in AHS hospital facilities were made aware of the follow up strategy, and knowing it was in place altered their threshold for admission allowed them to discharge “borderline” patients knowing they would be followed for deterioration. 14 The pandemic, then, was a generative moment in the integration history of the primary and acute care elements of Alberta’s system. It provided the impetus for overcoming persistent barriers to integration, and, as we will show, the enactment of the province’s PHC goals through its specific commitment to the PMH.…”

“…In March 2020, when Alberta’s first C19 case was identified, as with other PHC organizations, 11 - 14 PCNs pivoted to managing patients in the community. 13 , 14 They brought to this pandemic response work not just their resources, but their mandated commitment to the PMH.…”