The PUPPY Study – Protocol for a Longitudinal Mixed Methods Study Exploring Problems Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year

Abstract

Background: The COVID-19 pandemic significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible, pharmacies remaining open with restrictions on patient interactions, rapid uptake of virtual care, and reduced referrals for lab tests, diagnostics, and specialist care. The PUPPY Study seeks to understand the impact of COVID-19 across the quadruple aim of primary care, with particular focus on the impacts on patients without attachment to a regular provider and those with chronic health conditions. Methods: The PUPPY study builds on an existing research program exploring patient access and attachment to primary care, pivoted to adapt to the emerging COVID-19 context. We will undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, comparing data pre- and post-pandemic in three Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used including: a policy review; qualitative interviews with primary care policymakers, providers (i.e., family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescribing and healthcare billings. The findings will inform the strengthening of primary care during and beyond the COVID-19 pandemic. Interpretation: This is the first study of its kind exploring the impacts of COVID-19 on primary care systems, with particular focus on the issues of patient's attachment and access to primary care. Our multi-stakeholder, cross-jurisdictional team will collaborate to rapidly disseminate findings and share implications for future policy and practice.

Chronic conditions patient’s perception of post-COVID-19 pandemic teleconsulting continuation in primary care clinics: a qualitative descriptive study

“…The telephone often served as the teleconsultation technology, which fell far short of the capabilities of the best available technology devices. 56 A postpandemic routinisation will therefore need to go beyond the telephone mode and rely on technological development commensurate with scientific and patient recommendations. We assume that the technological delay has had an impact on the adoption of good practices.…”

“…In addition, technologies used were not always mature enough to support intelligent teleconsultation, such as appointment scheduling, clinical record information and teleconsultation itself. The telephone often served as the teleconsultation technology, which fell far short of the capabilities of the best available technology devices 56. A postpandemic routinisation will therefore need to go beyond the telephone mode and rely on technological development commensurate with scientific and patient recommendations.…”