Primary prevention and screening during the COVID-19 pandemic: Qualitative findings from the BETTER WISE project

Context: The COVID-19 pandemic challenged healthcare systems worldwide and disrupted primary care through redeployment of healthcare resources to COVID-19 priorities resulting in inaccessible prevention and screening services. The BETTER WISE project involved a comprehensive, evidence-based intervention for patients 40 to 65 years of age to proactively address cancer and chronic disease prevention and screening (CCDPS), including associated lifestyle risks, cancer surveillance and screening for financial difficulty. Patients were invited for a 1-hour prevention visit with a Prevention Practitioner (PP), a member of the primary care team with specialized training in CCDPS and cancer surveillance, to discuss their CCDPS and cancer surveillance status, set S.M.A.R.T goals for their health, and make links to community resources as appropriate.

Objective: To describe how the COVID-19 pandemic impacted implementation of the BETTER WISE intervention.

Methods: Qualitative study - Seventeen focus groups and 48 key informant interviews were conducted with 132 primary care team members (PPs, physicians, allied health professionals, and clinic staff) at three time points in the study. Qualitative data also included 585 written feedback forms from patients, field notes and memos. A thematic analysis using a constant comparative method focused on the impact of the pandemic on BETTER WISE was employed.

Setting: Thirteen primary care settings (urban, rural, and remote) across 3 Canadian Provinces (Alberta, Ontario, and Newfoundland and Labrador).

Results: Four themes emerged from the data regarding how the COVID-19 pandemic impacted the BETTER WISE study: 1) Switch of in-person visits to visits over the phone; 2) Lack of access to preventive care and delays of screening tests; 3) Changes in primary care providers’ availability and priorities; 4) Mental health impacts of the pandemic on patients and primary care providers.

Conclusions: The COVID-19 pandemic significantly impacted primary care as aggressive shifts in priorities were required and non-essential prevention and screening services were made unavailable. Despite structural, procedural, and personal challenges throughout different waves of the pandemic, the primary care clinics participating in BETTER WISE were able to complete the study. Our results underscore the importance of the role of primary care providers in adapting to changing circumstances and support of patients in challenging times.