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.
Last updated 31 July 2020 9:33 CST
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Latest Works
Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 23
Rebecca Etz, Advisory Group, Larry A. Green Center
As we begin month 9 of the pandemic, primary care is weaker, patients are sicker, and the pandemic is raging more fiercely. For months, medical groups have raised alarms about the escalating consequences on patients of failing to adequately support primary care during the pandemic: excess mortality, preventable worsening of non-COVID related health conditions, high levels of mental anguish, growing social needs, and surging pandemic misinformation. The impact of inaction is clear. More than half of clinicians report severe/near severe levels of practice stress and growing patient health burden due to delayed or inaccessible care. Nine months in, COVID-19 is again surging, 63% of practices have staff out due to illness or quarantine, 1 in 5 lack sufficient testing supplies, and over half report increased patient distrust of medical information from public leaders. Series 23 summary. 13 November, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/163524
Special Report: Renaissance of family medicine in Romania during Covid-19 era
By Elena Popa, Teodota Tetia, Adorata Coman
n this paper, we would like to share the experience we had in Romania during the pandemic and how we reacted locally to the challenges induced by this tragic, difficult to control period. We are located in a large urban area and the office is part of a polyclinic. The number of patients registered is over 2600, with a relatively equal distribution by age categories. 17 November 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/163516
Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 22
Rebecca Etz, Advisory Group, Larry A. Green Center
Seven months into the pandemic, patients are exhibiting the effects of delayed or inaccessible care. Over half (56%) of primary care clinicians have seen an increase in negative impact on patients’ health. With COVID-19 now surging beyond Spring 2020 levels, practices continue to face unresolved pressure points from the first wave, such as inability to fill open staff positions (35%), persistent challenges with COVID-19 testing (61%), and difficulty with PPE (37%). Despite this, practices are showing remarkable adaptiveness by significantly increasing their outreach to community organizations and adopting wise and flexible use of telehealth despite payment concerns. Series 22 summary. 13 November, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/163512
Special Report: Hand in hand towards a better care: an experience of patient-professional collaboration during COVID-19 pandemic
By Esperanza Martin Correa, Gemma Torrell Vallespin
The difficulties that the health system has had in providing an adequate response and care for people with Long covid, united by the uncertainty of facing an unknown disease, has led them to share their experiences through social networks and to organize themselves in groups. Some primary care (PC) professionals have collaborated with these groups. The coordinated work of professionals and patients has made it possible to develop a joint care proposal for people affected with Long covid in PC that facilitates the construction of joint knowledge through observation, monitoring and the study of all of those involved. 11 November 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/163507
Essay: Cherry Blossoms, COVID-19, and the Opportunity for a Healthy Life
Dr. Marshall Chin
To date short-term funding and policy fixes for the COVID-19 pandemic have focused on saving the current health care system; policies have not maximized the population's health, prioritized the safety net, or addressed our most vulnerable neighbors. We need to plan reforms now. The author discusses three lessons that could guide these reforms. Accepted 7/17/20. In Press. Permanent URL: http://hdl.handle.net/2027.42/163332
Essay: Access, Equity, and Neutral Space: Telehealth beyond the Pandemic
Benjamin Kaplan
A fourth year medical school student discusses telehealth's utility during a viral pandemic, but also its potential as a powerful tool for expanding access to care and promoting health equity over the coming years. The limitations of telehealth, including the challenge of performing a physical exam and maintaining emotional connection across physical distance, are further challenged by inconsistent availability of Broadband internet, as well as a lack of standardized reimbursement procedures for telehealth visits. Accepted 8/5/20, In-Press. Permanent URL: http://hdl.handle.net/2027.42/163333
Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 21
Rebecca Etz, Advisory Group, Larry A. Green Center
Population health is in decline, primary care is under water, and major disruptions to medical supply chains all signal that our health system is buckling. The health of the population has weakened during the pandemic with half of clinicians noting that overall physical health of the population has declined. In addition, 41% say the health of those with chronic conditions is noticeably worse, and 86% report a pandemic-specific decline in the population’s mental health. At the same time, only 1 in 5 surveyed clinicians report their fee-for-service volume is within 10% of pre-pandemic levels and nearly half (47%) endorsed the statement that despite a somewhat rosier economic picture, their clinical workforce is fragile. Heading into flu season, shortages of PPE (33%) and flu vaccine (13%) are now a major concern. Series 21 summary. 2 October, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/162822
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, MD, 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, MD, MScCH, 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, MD, MSHP, 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, et al, 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
Introducing our new 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