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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Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 26
Rebecca Etz, Advisory Group, Larry A. Green Center
Though primary care is able to reach, educate, and advocate for the majority of the population with regard to vaccine administration, they have not yet been leveraged. Two months after the first vaccine was given in the US, practices are still struggling to access vaccines for their patients. Although 89% of primary care clinicians want their practices to be a vaccination site, only 22% are considered as such by their health department, local hospital, or health system. Primary care is overlooked as an outlet for equitable vaccine distribution even as it has the ability to target those most vulnerable and in need. Over 60% of clinicians surveyed have already created eligibility groups and proactive outreach campaigns to educate their patients. Series 26 summary. 2 March, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166450
Original Research: Counterproductive Messaging About COVID-19 Safety Measures in Cancer Screening Outreach: Results of a Pragmatic Randomized Trial
By Kristin Gagliardi, Sara Coleman Hernandez, Gina Intinarelli, Kevin Grumbach
University of California, San Francisco
COVID-19 has caused patients to defer preventive services. We conducted a pragmatic randomized trial of incorporating a message about COVID-19 safety measures into an automated telephonic outreach program targeting primary care patients overdue for cancer screening. Contrary to our hypothesis, the COVID-19 safety measure messaging resulted in significantly fewer patients in the intervention group requesting scheduling of preventive services (135 of 196 patients reached (68.9%)), compared with the standard call script group (165 of 207 patients (79.7%)), (p=0.01). Messages intended to reassure patients about the safety of obtaining in-person preventive services during the coronavirus pandemic may have unintended consequences. 1 March, 2021. Under review, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166320
Original Research: BUILDING AND SUSTAINING VIRTUAL PATIENT MEDICAL HOMES DURING THE COVID-19 PANDEMIC
By Christopher Cameron, Kathleen Douglas-England, Courtenay Bolton, Samantha Sexsmith Chadwick
The purpose of this study was to evaluate the [redacted] Primary Care Network’s ([redacted] PCN) ability to support 61 primary care practices in building and sustaining virtual Patient Medical Homes (PMHs) during the COVID-19 pandemic. A mixed methods evaluation determined that the [redacted] PCN achieved this mandate. The organization provided physician members with access to allied health care team members using virtual platforms. Care coordinators continued to optimize the use of Electronic Medical Records (EMRs) from their home offices. Patient care remained of high quality, revealed through the analysis of patient experience data collected both before and during the pandemic. Despite a new requirement to work remotely, healthcare teams remained collaborative. The number of clinics that the PCN supported in improvement work remained steady as the pandemic progressed in March and thereafter. 23 February, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166317
Guidelines for Accessible COVID-19 Testing & Vaccination Sites
By Michael McKee, Oluwaferanmi Okanlami, Philip Zazove
Over 20% of individuals report a disability. These people often struggle with health inequities and poor health care access. Many of these barriers are addressable through simple steps. Providing an avenue for patients to communicate accessibility challenges and request accommodations prior to their appointment will help these individuals obtain their COVID-19 tests and vaccines equitably upon arrival. 17 February, 2021. Under review, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166308
Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 25
Rebecca Etz, Advisory Group, Larry A. Green Center
COVID-19 vaccines are now available, yet primary care remains a largely untapped resource in vaccine administration. 99% of clinician respondents believe primary care should be helping with vaccine distribution, yet only 1 in 5 are currently involved. 6 in 10 practices are willing and ready to assist with vaccine distribution but face obstacles, such as lack of storage, staffing, or PPE required. This despite the fact that primary care can help reach vulnerable and at-risk patients and has vast vaccine experience. Among respondents, 20% were practicing in rural communities, and 17% were caring for almost exclusively Medicaid covered patients, and 6 in 10 had patient panels in which at least 75% patients have multiple chronic conditions. Series 25 summary. 10 February, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166302
Original Research: Primary Care's Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs
By John Westfall, Elizabeth Wilkinson, Anuradha Jetty, Stephen Petterson, Yalda Jabbarpour,
Robert Graham Center for Policy Studies in Family Medicine and Primary Care
COVID-19 pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination. With the advent of several COVID-19 vaccines, the dissemination and delivery of COVID-19 immunization across the nation is of concern. A study of the delivery of vaccinations, using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey at the service, physician, and visit level show that Primary Care Physicians have played a crucial role in delivery of vaccinations to the U.S. population, including the elderly, between 2012-2017. These findings indicate primary care practices may be a crucial element of vaccine counseling and delivery in the upcoming COVID-19 recovery and immunization efforts in the United States. 29 January, 2021. In-press, accepted 1/28/2021. Permanent URL: http://hdl.handle.net/2027.42/166088
Special Report: Health and healthcare disparities associated with the digital divide
By Esli Osmanlliu, Ramesh Johari, and David Scheinker
The prioritization of telehealth in response to the COVID-19 pandemic may accelerate progress to virtual integrated care at scale. However, disparities in healthcare and health outcomes may widen if telehealth is not accessible to the underserved communities that are most in need. Providers faced with practical constraints have already defaulted into a two-tiered system of telehealth: technology-driven, integrated care for those with the requisite resources; and phone-based, ad-hoc care, possibly less effective, for those without. Insights based on data from federal organizations offer a starting point for primary care providers to understand common structural barriers to telehealth access, identify interventions they can implement to increase equity in their virtual care practice, and advocate for their patients. 27 January, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166083
Special Report: A prioritization algorithm for healthcare personnel for the CDC's COVID-19 Phase 1a vaccine distribution plan
By Grace Flood, Alison Meier, Matthew Anderson, Dr. William Ehlenbach, Shiva Bidar-Sielaff, Sang Thao, Maureen Smith
We developed an algorithm that can be used to equitably distribute COVID-19 vaccinations to healthcare personnel (HCP) during Phase 1a of the Center for Disease Control and Prevention’s (CDC) coronavirus vaccine distribution plan, if not enough vaccine is available to immunize an entire group of employees with similar job-related risk exposure. The algorithm prioritizes individuals with the highest risk of mortality using Social Vulnerability Index (SVI) and age. 30 December, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/163774
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
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