Primary Care Research Is Hard to Do During COVID-19: Challenges and Solutions

INTRODUCTION

Research has been difficult during the COVID-19 pandemic and may continue to be hard for quite a while. As researchers who are focused on studying primary care, we wrote this commentary to surface common challenges and present solutions for researchers working in and with primary care practices. Our goal is to normalize what you might be feeling as a researcher: isolated, at odds with reality, overwhelmed at the Sisyphean tasks ahead, and experiencing a sense of failure. Below, we share 3 key challenges that have emerged in our work during COVID-19 and then present observed solutions for coping with this new reality. We pose related questions to help inform how you might advance your work while not burning through your own capacity or your relationships with primary care partners during COVID-19 and beyond. We end with a call to normalize these challenges, practice self-compassion, and embrace pragmatic designs and adaptive solutions moving forward.

COVID-19 AMPLIFIED CHALLENGES

High quality primary care is the bedrock of our health care system and, when available, the result is better health and more equitable outcomes.¹ Yet even prior to COVID-19, primary care was not adequately resourced to meet population needs.^2-4 These structural factors contribute to high levels of burnout (20%-53%) and turnover (30%-50%) in both clinicians and staff members.^4-7 Conducting research in primary care is challenging based on the broad scope of practice, low (and frequently contested) funding to the Agency for Healthcare Research and Quality (AHRQ), and the small percentage of funding from the National Institutes of Health to primary care researchers.⁸

The COVID-19 pandemic illuminated both the critical role and the fragility of the primary care system.^9,10 It has also illustrated the resolve of primary care clinicians and staff who continued to show up each day despite uncertainty and stressors.^11,12 For researchers who engaged in applied, participatory research in these settings, the ongoing environment for primary care during the pandemic has raised questions about what and how to approach practices during this dramatic time of stress and change.

CHALLENGES DURING COVID-19

Based on our individual experiences leading or supporting more than 15 projects engaging primary care clinics during the pandemic, we identified 3 categories of challenge in conducting research during the pandemic.

RECOMMENDATIONS FOR RESEARCH AND ACTION

Given all of this, what is the primary care researcher to do within the current world situation? After all, we do have obligations to our funders, employers, and our fields of discipline to complete the research. In Table 1, we provide options and when these options might be the best choice for a situation. These strategies relate to adjusting project timing, the regions engaged, sample size targets, methods for data collection, and/or project scope. For example, in several of our projects it was reasonable and prudent to hit pause and stop the work temporarily. This included stopping both clinic and patient recruitment for studies as primary care partners worked to respond to the initial outbreak or later surges. This option was helpful for longer study periods, when partners lacked capacity to respond, and when the research team could focus on refining intervention materials or start analyzing existing data. We also saw several studies alter how research is conducted (eg, conducting interviews or the intervention visits by telephone or web conferencing) and expand the scope or realign the intervention to include resources to help with the COVID-19 response (eg, addressing vaccine hesitancy, focusing on emerging behavioral health needs). The examples provided in Table 1 are not meant to be an exhaustive list, rather, one that is pragmatic and useful as considerations.

In these challenges, there are opportunities. For example, one of the strengths of doing primary care research has always been that it can bring funding to practices to do needed work, such as to support population outreach for screening or to support patient navigation to services to address unmet social needs. A key question for primary care research is “How can my work align with these amplified needs during COVID-19?”

There are also some silver linings from the pandemic. For example, telehealth and video conferencing are now widely accepted, which may enable research to be more efficient and less expensive—particularly for rural areas which may require a day’s travel for a 1-hour research meeting. Additionally, COVID-19 vaccine rollout—and the shock of policy makers and health care leaders regarding the challenges with uptake—have drawn greater attention to the need for attending to social and behavioral factors in research.¹⁷ COVID-19 may also serve as a call to remind ourselves of what health care topics and issues we are passionate about and to increase recognition of—and ideally motivate policy makers and funders to address—the structural factors that make primary care delivery and research hard.

Notably, many of the challenges of conducting research in primary care during the pandemic will not end when life “goes back to normal” as COVID-19 infection rates subside.¹⁸ Indeed, we are now starting to witness the ongoing backlash of pandemic stress as primary care clinics, staff, and others working in adjacent roles retire early or opt out as part of the “great resignation” that is being observed nationally.¹⁹ Work is needed to shift policies and invest resources to ensure primary care clinicians and researchers have the bandwidth to meet patient and organizational needs as we recover from the pandemic and face additional regional and global health challenges in the future.