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: Quick COVID-19 Primary Care Weekly Survey, Telemedicine/Health Equity Series 2

Rebecca Etz, Advisory Group, Larry A. Green Center

One of America’s largest and growing public health concerns is the increasing disparities in health care. Telehealth has been broadly recognized as an effective strategy to bridge gaps in health care by reducing barriers to accessing care. Responses from primary care clinicians provide a first-hand account of how telemedicine has affected patient access and which patients are more and less likely to use telemedicine. Series 2 summary, 9 Nov, 2021. Nonrefereed, online collection only. Permanent URL: https://hdl.handle.net/2027.42/170911

Special Report: Quick COVID-19 Primary Care Weekly Survey, Telemedicine/Health Equity Series 1

Rebecca Etz, Advisory Group, Larry A. Green Center

The number of Americans without a regular source of primary care continues to increase in spite of growing health care costs and expanded coverage under the Affordable Care Act. Prior to the pandemic, a study released in the Journal of the American Medical Association reported a 2% decrease in the proportion of the U.S. population with an identified source of primary care. Given the importance of primary care in enabling timely, high quality care, along with the dramatic increase in the use of telemedicine, it is essential to understand how telemedicine is being used. Series 1 Summary, 9 Nov, 2021. Nonrefereed, online collection only. Permanent URL: https://hdl.handle.net/2027.42/170910

Innovation: Response To The Pandemic: Housing For Health In The Va Tent Community

Tiffany Owens, Daniel Ewing, Melissa Devera, Sandesh Shrestha, Peter Capone- Newton, Kristin Kopelson, Lisa Altman, Lillian Gelberg

In response to the COVID-19 pandemic, an innovative approach to providing integrated primary care services was initiated in the Veterans Administration Greater Los Angeles Healthcare System (Figure 1). The Care, Treatment and Rehabilitation Services, a unique street medicine program, was placed within an encampment that is supported by the West Los Angeles VA health care services including onsite provision of 24/7 security, stability of tent sites, 3 meals a day, unlimited water, hygiene stations, face masks, showers and housing placement services. 29 Oct, 2021. Non-refereed, under review. Permanent URL: https://hdl.handle.net/2027.42/170780

Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 31

Rebecca Etz, Advisory Group, Larry A. Green Center

Nine in ten primary care clinicians agree – the size of the primary care workforce and current payment models are not sufficient to meet the COVID-19 related needs of our population. While details regarding long-haul COVID-19 remain unclear, people with extended COVID-19 symptoms will require regular clinical management over time, most likely to occur in primary care settings. COVID surges and worsening population health challenge the resilience of primary care, even as it braces for the long-lasting impact of the pandemic. Nearly half of surveyed clinicians report both that the health of their patients is worse and that hospital and specialty care in their area is limited. Primary care is filling gaps in access even while their workforce has shrunk during the pandemic. Series 31 summary. 25 Oct, 2021. Nonrefereed, online collection only. Permanent URL: https://hdl.handle.net/2027.42/170757

Special Report: Improving Conversations with COVID-19 Vaccine Hesitant Patients: Action research to support family physicians

Myles Leslie, Raad Fadaak, Nicole Pinto

Societal and operational challenges familiar to family medicine have been given new form and urgency by the COVID-19 pandemic. Vaccination delivery and efforts to counter vaccine hesitancy have become focal issues for family medicine teams. Conducting action research, our team developed an interactive web-based Guide to improve clinical conversations around a broad range of vaccine hesitancies as presented by patients. The Guide was co-designed with family physicians in a process that included validation interviews and role-play interviews. The validation interviews sought to understand the pragmatic realities of vaccine hesitancy in family medicine clinical practice relative to relevant psychological theories. The role-play interviews drew out conversational strategies and advice from family physicians. The principles of Motivational Interviewing - an evidence-based approach to vaccine hesitancy conversations that supplements information deficit approaches - were then used to co-design the content and presentation of the Guide. User counts, stakeholder engagement, and web-based analytics indicate the Guide is being used extensively by family physicians. Formal evaluation of the Guide is presently underway. 1 Oct, 2021. Non-refereed, under review. Permanent URL: https://hdl.handle.net/2027.42/170143

Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 30

Rebecca Etz, Advisory Group, Larry A. Green Center

The primary care platform is resilient but has weakened, with patient needs exceeding pre-pandemic levels. For nearly two thirds of primary care clinicians (64%), telemedicine has been key to maintaining patient access to care. If pre-pandemic regulations are restored, 41% of clinicians worry their practice will no longer be able to support telemedicine. The potential loss of this adaptive tool is yet another challenge for an overstretched workforce in which more than half report mental exhaustion is a constant worry as both COVID-19 and patient needs surge. Seven in ten say patient visits now take more time, 65% say mental health concerns are increasing among children, and the majority are managing the care of people with long haul COVID-19, despite limited guidance on how to do so (58%). Series 30 summary. 30 Sept, 2021. Nonrefereed, online collection only. Permanent URL: https://hdl.handle.net/2027.42/170402

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. 3 Sept, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/169219

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