A rapidly updated index of open-access COVID-19-related preprint content relevant to primary care. For push notifications when new content is added to this collection, please follow @AnnFamMed on Twitter.

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Special Report: COVID-19 Enhanced Home Care Treatment Model: A Primary Care and Accountable Care Organization Collaboration

Mary Leen, David Dekevich, Raphael Balbino, Terry Hayes, James Clower, Alison Bartfield, Edward Gorak, Kenneth Mayer

COVID-19 caused health systems across the United States to provide innovative care within a short time period. Baptist Health System of Northeast Florida took a proactive, collaborative approach to rapidly develop and implement an enhanced home support model for patients with COVID-19 in partnership with Baptist Primary Care, Baptist Home Health Care, and durable medical equipment companies. The model was evidence-based and protocol-driven allowing patients to be safely cared for in the home setting. It also helped decompress the hospital by preserving finite health system bed and care team capacity, both of which would have otherwise been exceeded during surge peaks. Low rates of emergency department visits and inpatient hospitalizations demonstrated excellent quality of care. Experience gained from building this model allows its replication for chronic, high-risk conditions to align with long-term value-based care strategies. Permanent URL: http://hdl.handle.net/2027.42/169219

Special Report: COVID-19 Patient Primary Care Survey, Series 7 Fielded May 13-26th, 2021

Rebecca Etz, Advisory Group, Larry A. Green Center, Primary Care Collaborative

Not everyone in the US has hit vaccination targets set by the federal government.  Low-income populations and those living in rural areas are 15% less likely to be vaccinated than the general population. Vaccine hesitancy remains a significant obstacle with over 60% of those unvaccinated reporting they are vaccine hesitant or resistant. Vaccine hesitancy was 10% higher among low-income respondents, rural respondents, and parents of children under 18. Among parents surveyed, 60% were vaccine hesitant or resistant. High rates of trust for primary care, as reported by vaccine resistant populations, suggest primary care may be a key asset to overcome vaccination challenges. These are the results from Series 7. 30 August, 2021. Nonrefereed, online collection only. Permanent URL: https://hdl.handle.net/2027.42/169165

Innovation in Primary Care: Addressing COVID-19 Immunization Disparities through Targeted Primary Care Outreach

Emmeline Ha, Grace Yu, Bridget Harrison

The authors describe an innovative approach to increasing COVID-19 vaccination uptake by a primary care provider-led targeted outreach protocol using zip codes, EHR data and phone canvassing. Preliminary findings show that primary care has a critical role in increasing access, equity, and patient uptake of COVID-19 vaccines. 17 Aug, 2021. Under review, online-collection only. Permanent URL: http://hdl.handle.net/2027.42/168565

Special Report: COVID-19 Patient Primary Care Survey, Series 6 Fielded March 19-31, 2021

Rebecca Etz, Advisory Group, Larry A. Green Center, Primary Care Collaborative

In a March 2021 survey fielded during the pandemic, over half of patients report increased anxiety or depression and most report a decrease in their mental health status. Further, low income and rural communities reported poor access to critical services, e.g., low-income respondents had over 50% greater difficulty putting food on the table as compared to the general population. Yet at a time of increased isolation and adversity, two-thirds of those surveyed felt strongly connected to their primary care doctor. Most (78%) have been in contact with their doctor during the pandemic, with over half identifying primary care as the place they called when they needed someone to trust. These are the results from Series 6. 27 July, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/168419

Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 29

Rebecca Etz, Advisory Group, Larry A. Green Center

Four in 10 clinicians worry that primary care will be gone in 5 years and one fifth of respondents expect to leave the profession within the next 3. This just one month after the National Academies of Science, Engineering, and Medicine (NASEM) declared primary care as a common good and in need of coordinated federal support. Pandemic related strain has greatly reduced in practices, but that reduction is not matched by a recovery of the workforce. While nearly 50% report pandemic strain at a 2 or below on a scale of 1 to 5, close to one third report they experience constant lethargy, find it hard to find joy in anything, and often struggle to maintain clear thinking. Respondents identify clear and concrete ways in which the current Administration could strengthen US primary care. Series 29 summary. 27 July, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/168418

Previously Published in the Annals - Telehealth

Initial Implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease 
Nynke D. Scherpbier-de Haan et al,
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

A Web-based consultation system between family physicians and nephrologists reduces the number of referrals and appears to improve treatment appropriateness among patients with chronic kidney disease. The authors assert these findings support the introduction of telenephrology in primary care as a means of delivering higher quality, more convenient care at a lower cost. They conclude that on a broader scale, e-consultation has the potential to break down walls between primary and specialty care.

Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine 
Jocelyn Charles, et al, 
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 

This study assessed the feasibility, cost, and satisfaction of a synchronistic telemedicine model that connected patients with multimorbidities with a primary care team that included primary care physician, telemedicine-trained nurses, specialists from psychiatry and internal medicine, as well as a social worker, pharmacist, home care and community coordinator, and other professionals as appropriate, based on the patient’s needs.  All 74 patient survey respondents indicated the intervention improved their access to interdisciplinary resources, and 97% reported feeling hopeful their conditions would improve as a result. Of 21 PCP survey respondents, 100% reported they would use the model intervention again, and 90% reported improved confidence in managing their patient’s care.

Patient Perceptions of Telehealth Primary Care Video Visits 
Kristin L. Rising, et al,
Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University.

This qualitative study of 19 adult patients interviewed after video visits with their primary care clinician found that patients accept and even prefer video visits to in-person office visits. Participants reported feeling comfortable talking with their clinicians over a video call, and they identified convenience and decreased costs as benefits. Primary concerns with video visits concerned privacy, including potential for work colleagues to overhear conversations, and questioning the ability of the clinician to perform an adequate physical examination.

Expanding Primary Care Access: A Telehealth Success Story 
M.R. Gonçalves, RN,
Universidade Federal do Rio Grande do Sul (UFRGS) School of Medicine, Porto Alegre, Brazil.

The authors describe a telemedicine project in Brazil that included the development of a teleconsulting hotline, increased efficiencies in referral protocolas, and telediagnosis services. They briefly discuss the program's impact on increasing access to specialist consultations, diagnostic testing, and specialized medical advice to physicians.

Family Medicine COVID-19 Front Lines Blog

Please check out our blog for family medicine case notes from the COVID-19 front lines. This is a non-refereed extension of the COVID-19 online collection. Submit your case notes and on-the-ground primary care experiences to our covidcasenotes@umich.edu team.

Published in External Sources

Editorial: An All-Hazards Approach to Pandemic COVID-19: Clarifying Pathogen Transmission Pathways Toward the Public Health Response (Journal of Environmental Health, published May, 2020) by Christopher Eddy, MPH, REHS, CP-FS, Richard Schuster, MMM, MD, FACP, FRCP (Edin), Eriko Sase, PhD
Covid-19: A Remote Assessment in Primary Care (BMJ published online 25 March 2020) - Trisha Greenhalgh, Gerald Choon Huat Koh, Josip Car
Essay: I’m a Family Doctor Fighting Against Fear and Struggling With Distancing While Trying to Keep my Patients Healthy - (The Conversation published 25 March 2020), Tammy Chang, MD, MPH, MS, family physician
COVID-19 Literature Digital Library compiled by Sachin Shah, MD, MPH UCSF @sachinjshah
Essay: Covid-19: Don’t Forget the Impact on US Family Physicians - (BMJ published 26 March 2020), Douglas Kamerow, Robert Graham Center 
Editorial: Covid-19 is Harshly Testing our Capacities as Physicians and Medical Staffers - (Washington Post published 28 Marhc 2020), Ishani Ganguli, MD, MPH @IshaniG
Essay: Medicine: Before COVID-19, and After - (The Lancet published 31 March 2020), Margaret McCartney, General Practioner, @mgtmccartney
Letter: Postacute Care Preparedness for COVID-19: Thinking Ahead - (JAMA published 25 March 2020), David C. Grabowski, PhD and Karen E. Joynt Maddox, MD, MPH
Guidance for Outpatient Management of COVID-19 - (Live Google document), Jill Fenske MD, Jenna B. Greenberg MD, Elizabeth K. Jones MD, Nell Burger Kirst MD, Feranmi Okanlami MD, MS, Daniel S. Oram MD, Jacob Wasag MD, University of Michigan Medical School Department of Family Medicine
Discussion: In the comments: A 20 March 2020 JAMA editorial calls on readers to share their "creative immediate solutions for how to maximize the use of PPE, to conserve the supply of PPE, and to identify new sources of PPE."

Additional Resources

Centers for Disease Control and Prevention (CDC) - Coronavirus (COVID-19)
National Institutes of Health (NIH) - Coronavirus (COVID-19) Resources and Updates
World Health Organization (WHO) - Coronavirus disease (COVID-19) Pandemic
American Academy of Family Physicians (AAFP) - COVID-19: The Latest Updates
Society of Teachers of Family Medicine (STFM) - Medical Education During the COVID-19 Pandemic
American Medical Association (AMA) - COVID-19 (2019 Novel Coronavirus) Resource Center for Physicians
The Hastings Center - Ethics Resources on the Coronavirus (Covid-19)
COVID-19 Health Literacy Project - Downloadable factsheets in 30 languages, developed by Harvard Medical School students, vetted by faculty clinicians, in collaboration with Harvard Health Publishing

Last updated 27 Jul, 2021 10:55 EST