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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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
Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 20
Rebecca Etz, Advisory Group, Larry A. Green Center
Has primary care bounced back since the start of the pandemic? Some modest gains have happened recently but primary care remains in significant need of support: 35% say revenue and pay are still significantly lower than pre-pandemic levels and net losses threaten current and future viability. Another third of clinicians say the financial picture has been slowing improving but the workforce is fragile and in trouble. And 1 in 5 practices report they have clinicians who have chosen early retirement or left their jobs as a direct result of the pandemic. Series 20 summary. 21 September, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/162575
Original Research: Becoming Don of the Doff: Navigating the Complexity of Donning and Doffing Personal Protective Equipment in the Home
By Dr. Brian Kerley , Dr. Lana Tan , Dr. Denise Marshall , Cindy O'Neill , Anne Bialachowski, Dr. José Pereira
Donning and doffing personal protective equipment (PPE) in home settings is very different from the hospital setting. For example, in hospitals PPE is usually neatly stationed outside the unit or patient room and there are posters on how to safely don and doff. In the home setting where clinicians have to bring their own equipment and there are no set spaces or areas to don and doff PPE. Highlighting the urgent need to address home-based care during the pandemic, this group developed a protocol on how to don and doff PPE in the home using a rapid prototyping approach. 9 September 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/162547
Special Report: Quick COVID-19 Primary Care Survey of Clinicians: Summary of the 6th-11th (May 29-August, 24, 2020) pan-Canadian survey of frontline primary care clinicians’ experience with COVID-19, series 6-11.
Wong, Sabrina RN, PhD; The Primary and Integrated Health Care Innovations Network; The Canadian Institutes for Health Research Strategy for Patient Oriented Research; Nova Scotia Health Authority, Doctors of BC and Doctors Nova Scotia., Advisory Group, Larry A. Green Center
On Friday April 10, the SPOR PIHCI Network, in partnership with the Larry A. Green Center, launched the weekly Canadian Quick COVID-19 Primary Care Survey. Weekly results are available in English and French and an invitation to primary care clinicians across the country to participate opens weekly (http://spor-pihci.com/resources/covid-19/). Series 6-11 results. 8 September, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/156509
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