| Patient-Centeredness: The provision of care that is respectful of individual patient preferences, needs, and values |
Exacerbation of socioeconomic and health disparities Marked increase in patient behavioral health needs Lack of patient access to in-person visits, routine chronic care, and recommended preventive services (increasing risk of delayed diagnoses) Increasing numbers of patients faced with COVID-19 related issues and both acute and chronic COVID-19 symptoms
| Trusting relationships supporting vaccination efforts in underserved communities Connecting patients with social services to offset lost wages and insurance Expanded telehealth services for preventive services and management of chronic diseases as well as to meet psychosocial and behavioral health needs Development of algorithms to prioritize care for high-risk patients Telephone and text message reminders for COVID-19 symptom assessment and monitoring
|
| Clinician and Practice: The work of primary care clinicians and teams in practice settings committed to delivering high-quality primary care |
Lost revenues and higher operating costs forced practices to close, limiting access and putting pressure on areas with existing workforce shortages Small, solo, and rural practices faced more resource constraints than those connected with a health system Crucial supplies (eg, masks, gowns, sanitizer) were in short supply. Primary care practitioners and staff experienced heightened levels of burnout, with one-third of clinicians reporting high burnout and plans to leave primary care
| Implementing telehealth allowed clinicians to continue to generate some revenue and eased access for many patients. Smaller practices had to be particularly innovative to meet community needs with limited resources Practices reused supplies, found alternatives, and limited office visits Mental health programs for health care workers provided support groups or individual sessions supported by federal grants. Team-based care helped to reduce burnout by engaging more staff in the practice’s common goal
|
| Systems and Infrastructure: The broad health systems, organizations, policies, and structural components that support patients, clinicians, and practices |
Telehealth rapidly increased, facilitating access for some while also exacerbating disparities Some practices, particularly in rural communities, lacked the training and resources to implement telehealth The steep decline in routine wellness and acute care visits within fee-for-service payment models made financial stability challenging for practices Increased telehealth visits did not offset revenue loss from decreased in-person visits
| Primary care practices adapted to the needs of their patients and practice sustainability by quickly setting up systems and learning to deliver care via telehealth – a process that otherwise may have taken years Most practices now have the capacity for telehealth and are using it as an additional modality for providing primary care Alternative payment models allowed some practices to navigate financial uncertainty with volume fluctuations Temporary changes to payment for telehealth, helped practices to continue providing care while being reimbursed for services at little or no cost to patients Professional organizations assisted practices with gaining access to federal Provider Relief Funds
|
| Community and Public Health: The organizational resources available within the community in which clinicians and practices are located including linkages with state and local public health agencies |
There was variable engagement of primary care by public health agencies Rapidly evolving policies in response to COVID-19 were often disseminated without the input of primary care, challenging implementation Primary care was largely under-utilized and had an unclear role in vaccine administration in many states Some health system practices were involved in distribution, but small practices faced challenges with getting vaccines for staff and patients
| Primary care practices recognized the need to work with public health and community partners in a more aligned manner to address population health Some FQHCs with deep community roots were able to align with state public health agencies Primary care played an important role in educating patients, engaging in shared decision making and being a source of trust and reliable information and referral for assistance Primary care practices helped fill the gap with closure of mass vaccination sites and helped address disparities in vaccination
|