Abstract
BackgroundPrimary 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.MethodsWe 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.ResultsPractices 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.ConclusionOur 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.
Highlights
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 experiences of primary care practices as they adapted during the early stages of the pandemic, with respect to the rapid shift to telehealth, the care and management of patients with chronic disease, routine screening and preventive care of all patients, and the significance of these factors on access to care and equity
We were able to report primary care provider and staff perspectives on: the nature and benefits associated with the rapid shift to telehealth; the adaptations made with respect to the care and management of patients with chronic disease as well as with routine screening and preventive care of all patients; the significance of these factors on access to care and equity; and the future potential of emerging service delivery adaptations post-pandemic among the highperforming practices in our study
Summary
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. Throughout the US, telehealth was successfully used for a variety of core primary care functions related to chronic disease management and preventive care during the early pandemic period. Practices established processes to remotely monitor high-risk patients (e.g., use of a registry to identify patients in need of a virtual appointment to manage hypertension) [11]. They offered virtual group visits on healthy lifestyle changes for patients with diabetes [12]. Practices modified screening prevention practices such as using a medication refill request to schedule a virtual visit and assess medication adherence [13] and conducted pre-visit screening virtually in preparation for in-person visits [10]
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