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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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. 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
Innovation: Community Collaboration to Implement a Vaccination Clinic in Rural Areas
Roger Garvin, Ryan Norton, Joe Skariah, Sonja Likumahuwa-Ackman, Jennifer DeVoe, Stein Berger, Megan McGhean, Suzanne Sullivan, Deborah Cohen, Brian Garvey
Oregon Health & Science University
Primary care has delivered more vaccinations to people in the US than any other healthcare organization or entity. Patients seek vaccine advice from their primary care clinician, and this is no different for the COVID-19 vaccine. While mass COVID-19 vaccination sites are a critical piece of the greater public health strategy to immunize our communities, reaching older, underserved, and vaccine adverse communities will require engaging primary care and leveraging the trusting relationships practices establish with communities. Oregon Health & Science University Family Medicine Health Center, Scappoose, OR, collaborated with our rural county health department to establish a mass vaccination site at our clinic building. Based on our experience, we also developed a toolkit for decision-makers and implementers of vaccine clinics, designed to be a “vaccination clinic in a box,” that could be replicated in, and tailored to, many types of settings. 31 March, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/167008
Special Report: Quick COVID-19 Primary Care Weekly Survey, Series 27
Rebecca Etz, Advisory Group, Larry A. Green Center
Despite significant strain, primary care continues to address growing patient needs, with 4 in 10 clinicians increasing support for patients with food, housing, or financial insecurities during the pandemic. Although expanding services, as well as their capacity to provide mental health support, practices remain financially fragile. Eight in 10 report practice revenue is more than 10% below pre-pandemic levels. Based on pandemic experience, 75% of clinicians do not believe fee-for-service should account for the majority of primary care payment. Series 27 summary. 25 March, 2021. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/167001
Original Research: Clinical Usefulness Of Sars-Cov-2 Rapid Antigen Tests In Adults During High Prevalence Community Outbreaks
Jose R. Seco, Raul Curado, Ana M. Mateos, Jorge F. Almeida, Ruben Ruiz-Mateos, Ruth Garcia, Gabriel Gomez, Juan D. Checa
Hospital Universitario Virgen de Valme
We evaluated performance of Abbott PanBio® COVID-19 Rapid Antigen Test Device (RATD) to detect SARS-CoV-2 infection in adults during high prevalence COVID-19 outbreaks. We found high accuracy in correct diagnosis (88% CI 85-91%, p<0.05) regardless of gender, presence of symptoms, disease timeline. Test sensitivity appeared to increase with age, specificity seemed to decline. Best diagnostic accuracy was obtained in middle-aged adults (94% CI 89-97%, p<0.05), but remained high through all ages. These results support RATD as a reliable measure to determine isolation of infected individuals during outbreaks. More studies are needed to assess RATD performance in low prevalence post-vaccination scenarios. 22 March, 2021. Non-refereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166596
Innovations in Primary Care: A Reflection on our Drive Through Flu Vaccine Clinic "Vires Rebus Adversis"
Tadhg Crowley
Facing great demand for the flu vaccine toward the end of 2020, and wanting to keep both patients and staff safe, the authors set about organizing Ireland's first drive-through flu vaccine clinic. During a ten-week period, (September 29th to December 5th, 2020) 1754 adult patients and 908 pediatric patients were vaccinated in their cars. On evaluation of this clinical innovation, which suggested high levels of satisfaction amongst staff and patients, we intend to replicate this approach for delivery of the Covid vaccine. 22 March, 2021. Non-refereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166586
Special Report: Integrating General Practice into the Australian COVID-19 response: A description of the GP Respiratory Clinic program in Australia
Leslee Roberts, Jane Desborough, Sally Hall Dykgraaf, Penelope Burns, Michael Kidd, Raglan Maddox, Lucas de Toca, Kamalini Lokuge, Stephanie Davis
Australian National University
Integrating primary care within the health response is key to managing pandemics and other health emergencies. In recognition of this role the Australian Government established a network of General Practitioner (GP) led respiratory clinics (GPRCs) in response to the COVID-19 pandemic, as part of a suite of broader measures aimed at sustaining community access to primary care. GPRCs provide holistic face to face assessment and treatment to those with respiratory symptoms in an environment with strict protocols for infection prevention and control; ensuring that this patient cohort is able to access high quality primary care whilst protecting the General Practice workforce and other patients. The GPRC model was rapidly developed and operationalised with the first 2 GPRCs opening on March 21, 10 days after the policy was announced. Subsequently a total of 150 GPRCs have opened with broad geographic coverage that have serviced over 800,000 individuals living in more than 99% of Australia's postcodes. Through use of a standardised data collection tool GPRCs also provide the largest and most complete source of primary care surveillance data of respiratory illness in Australia. The success of the GPRC model has been possible through strong partnerships with Primary Health Networks and individual general practices who rapidly shifted operations to embrace this new approach. The GPRC network offers ongoing infrastructure and workforce capability to manage other health emergencies, and may be able to be adapted to other settings. 16 March, 2021. Under review, online collection only. Permanent URL: http://hdl.handle.net/2027.42/166482
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