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: Planning and implementing COVID-19 mass vaccination clinics
Shima Shakory, Azza Eissa, Tara Kiran and Andrew D. Pinto
St. Michael's Hospital
The COVID-19 pandemic is an unprecedented global public health crisis. Mass vaccination with safe and effective vaccines to achieve herd immunity requires a whole-of-society approach. Primary care has played a key role in those countries that have succeeded in rapidly vaccinating a large proportion of their populations, particularly those most at risk. In this special report we synthesize existing guidelines and peer-reviewed studies to provide family physicians with practical guidance on planning and implementing COVID-19 mass immunization clinics. PubMed, Ovid, MEDLINE, Epub Ahead of Print, Embase and Google Scholar were used to search for relevant literature using keywords, including “COVID-19”, “mass vaccination”, “campaign”, “standard” and “best practice”. We also identified and analyzed national and international guidelines. Forty-six relevant articles, reports and guidelines were identified and synthesized. Key considerations for COVID-19 mass vaccination clinics include establishing a leadership structure and key roles, identifying optional locations, clinic layout and workflow, day-to-day operations including infection prevention and control, and communication strategies. Ongoing data collection is required to evaluate and continuously improve mass vaccination efforts. Primary care can play a key role in organizing clinics and ensuring populations who have been made vulnerable by social and economic policies are being reached. Planning and implementing a successful COVID-19 mass vaccination campaign requires a number of key steps and considerations. As the COVID-19 vaccine rollout occurs in various countries, research will be required to identify key factors for success in different healthcare systems to inform future pandemic responses. 20 May, 2021. Under review, online-collection only. Permanent URL: http://hdl.handle.net/2027.42/167674
Special Report: Chronic disease patients’ experience with telehealth interventions and self-care strategies during the first wave of the COVID-19 pandemic
Marie-Eve Poitras, Yves Couturier, Mélissa Lavoie, Noémie Bouchard, Megan Pépin, Jessica Bernier, Monica McGraw, Mohamed Ag Ali Ahmed, Vanessa T. Vaillancourt, Caroline Cormier, Gilles Gauthier, Marie-Dominique Poirier, Emmanuelle Doucet
Université de Sherbrooke
Université du Québec à Chicoutimi
Moncton University
Centre intégré universitaire de santé et de services sociaux du Saguenay Lac Saint Jean
During COVID-19 pandemic, Québec (Canada) Public Health Agency asked Family Medicine Group (FMG) to change their practice such as recommending the use of telehealth interventions. However, it is unknown if telehealth meets patients' needs in terms of self-care, especially those suffered from physical and mental chronic condition (PCDs). This study aimed to explore, from a PCD's perspective, the response of FMG about their self-care needs during COVID-19 pandemic. We conducted an exploratory qualitative descriptive study using semi-structured interviews to reach 40 PCDs from three regions of Québec. We explored FMGs' responses, PCDs needs, coping strategies regarding the COVID-19 and the changes in primary care services. We used the transactional theory of stress and coping to inform the data collection and analysis and the COREQ appraisal grid to report this study. PCDs appreciated telehealth and perceived that the accessibility was increased. Moreover, family physicians from FMG conducted the majority of the follow-ups although interdisciplinary teams were available. The coping strategies raised by the PCDs were primarily aimed at maintaining their health status, while some of them aimed to reduce stress levels. PCDs seem to appreciate telehealth but believe it requires improvements, and it is not adequate for all types of follow-ups. PCDs adopt coping strategies to face the pandemic that were not always optimal for their health. We call for a better understanding of PCDs' needs in times of a pandemic in order to offer them the appropriate services an interdisciplinary team can provide. 20 May, 2021. Nonrefereed, online-collection only. Permanent URL: http://hdl.handle.net/2027.42/167663
Original Research: THE IMPACT OF THE COVID-19 PANDEMIC ON PRIMARY HEALTHCARE DISEASE INCIDENCE RATES: 2017 TO 2020
Antoni Sisó-Almirall, Belchin Kostov, Encarna Sánchez, Jaume Benavent-Àreu, Luis González-de-Paz
We analyzed variations in the annual incidence of the main cardiovascular risk factors, prevalent chronic diseases, common mental health disorders and neoplasms in 2020 compared with 2017-2019. In 2020, there was a significant decrease in the incidence of hypertension, hypercholesterolemia, type 2 diabetes mellitus, chronic kidney disease, ischemic heart disease, benign prostatic hypertrophy, osteoporosis, hypothyroidism, chronic obstructive pulmonary disease, alcohol use disorder, benign tumors, and melanomas. Only anxiety disorders increased significantly (IRR 1.16; 95% CI 1.07-1.24). Prioritization of COVID-19 care has changed the doctor-patient relationship to the detriment of face-to-face scheduled visits of chronic disease detection and monitoring protocols.12 May, 2021. Under Review, online-collection only. Permanent URL: http://hdl.handle.net/2027.42/167403
Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 28
Rebecca Etz, Advisory Group, Larry A. Green Center
Seven in 10 primary care clinicians report that mental exhaustion, both personally and in their practice, has reached all-time highs. Nearly 2 in 5 clinicians have required mental health support as a result of the pandemic, while 4 in 5 report fielding weekly calls from colleagues or patients in the midst of a mental health crisis. There is also evidence to suggest that these levels are underreported (see below). Many clinicians have recalibrated their expectations during the pandemic with close to 40% reporting that stress is the same or worse, but “sadly, we’ve gotten used to it.” Series 28 summary. 21 April, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/167180
Essay: Everyone Can Use Ramps, So Don't Forget These "Steps": Disability Accessibility at COVID-19 Vaccination Sites
Michael McKee, Oluwaferanmi Okanlami, Philip Zazove
The COVID-19 pandemic affected everyone around the globe, but for some the impact was drastic and even more life-threatening. People with disabilities historically struggle with health inequities and inaccessible health care, but many of these disparities are now magnified due to the pandemic. Most of the safeguards put in place by health care systems to manage the pandemic were implemented without any input or consideration from individuals with disabilities. With the arrival of COVID vaccines, health care systems and vaccine administrators have the opportunity to ensure a more inclusive and accessible vaccine rollout plan to prevent further marginalization of our largest minority group. We present our story and list simple steps to ensure that the "shots in arms" get into everyone, not just the most "able bodied." 20 April, 2021. Non-refereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/167171
Original Research: Trust in Healthcare and Trust in Science Predict Readiness to Receive the COVID-19 Vaccine in Appalachia
Michelle Rockwell, Jeffrey Stein, Julie Gerdes, Jeremiah Brown, Adrienne Holz Ivory, John Epling
Virginia Tech Carilion School of Medicine
The Appalachian Region faces multiple barriers to widespread COVID-19 vaccination. The purpose of this research study was to explore the role of trust in healthcare and science on Appalachian residents' readiness to receive the COVID-19 vaccine and to describe trusted health influencers and information sources. A cross sectional survey study of Appalachia residents (n=1048) was completed between February 25 and March 6, 2021. Findings suggest that trust in healthcare and science are prospective foci for improving vaccine acceptance in Appalachia. As highly trusted influencers, primary care providers should be leveraged and supported in COVID-19 vaccine education and distribution. 6 April, 2021. Non-refereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/167136
Special Report: The Impact of Race and History on COVID Vaccination Acceptance
Amanda Olagunju
Langley Air Force Base Hospital
This article delves into cultural and historical factors that negatively impact minority patient coronavirus vaccination acceptance. It provides a basic review of past transgressions committed against minority communities by American medical and scientific research fields. This article then discusses how medical providers can potentially address or mitigate minority patient fears about vaccination. 5 April, 2021. Non-refereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/167014
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 7 Apr, 2021 10:20 CST