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Cohen G, Duda N, Morrison Lee K, Swankoski K, Giudice G, Palakal M, Mack C, O'Malley AS. How CPC+ supported patient care during the COVID-19 pandemic: Lessons for alternative payment models. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2024; 12:100745. [PMID: 38603835 DOI: 10.1016/j.hjdsi.2024.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/09/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND A growing literature documents how primary care practices adapted to the COVID-19 pandemic. We examine a topic that has received less attention-how participants in an advanced alternative payment model perceive the model influenced their ability to meet patients' care needs during the pandemic. METHODS Analysis of closed- and open-ended questions from a 2021 survey of 2496 practices participating in the Comprehensive Primary Care Plus (CPC+) model (92% response rate) and a 2021 survey of 993 randomly selected primary care physicians from these practices (55% response rate). Both surveys asked whether respondents agreed or disagreed that they or their practice was "better positioned to meet patients' care needs during the coronavirus pandemic" because of participation in CPC+. Both also included an open-ended question about CPC+'s effects. RESULTS Half of practices and one-third of physicians agreed or strongly agreed that participating in CPC+ better positioned them to meet patients' care needs during the pandemic. One in 10 practices and 2 in 10 physicians, disagreed or strongly disagreed, while 4 in 10 practices and slightly more than half of physicians neither agreed nor disagreed (or, for physicians, didn't know). The most commonly identified CPC+ activities that facilitated meeting patient care needs related to practices' work on care management (e.g., risk stratification), access (e.g., telehealth), payment outside of fee-for-service (FFS), and staffing (e.g., supporting care managers). CONCLUSIONS Most CPC+ practices and physicians were positive or neutral about participating in CPC+ in the context of COVID-19, indicating more benefit than risk to payment alternatives to FFS.
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Affiliation(s)
- Genna Cohen
- Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
| | - Nancy Duda
- Mathematica 600 Alexander Park, Suite 100, Princeton, NJ, 08543-2393, USA.
| | | | - Kaylyn Swankoski
- Mathematica 600 Alexander Park, Suite 100, Princeton, NJ, 08543-2393, USA.
| | - Gillian Giudice
- Mathematica 111 East Wacker Dr., Suite 3000, Chicago, IL, 60601, USA.
| | - Maya Palakal
- Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
| | - Caroline Mack
- Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
| | - Ann S O'Malley
- Mathematica 1100 1st St NE 12th Floor Washington, DC, 20002-4221, USA.
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Park S, Nguyen AM. Determinants and effectiveness of annual wellness visits among Medicare beneficiaries in 2020. Fam Pract 2024; 41:203-206. [PMID: 37972381 DOI: 10.1093/fampra/cmad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Annual wellness visits (AWVs) have the potential to improve general health and well-being, but little is known about the role of AWVs during the COVID-19 pandemic. OBJECTIVE We examined the determinants and effectiveness of having an AWV among Medicare beneficiaries in 2020. METHODS We employed a cross-sectional study design using data from the 2020 Medicare Current Beneficiary Survey. Our outcomes included AWV utilization, preventive care utilization, health status, and care satisfaction. To examine the determinants for having an AWV, we performed a linear regression model and explored the associations with other individual-level variables (demographic, socioeconomic, and health characteristics). To examine the effectiveness of having an AWV, we performed a linear regression model on each outcome measure while adjusting for individual-level variables. RESULTS We found that there were several determinants of having an AWV. The four most notable determinants were having a usual source of care, enrolling in Medicare Advantage, being non-Hispanic Black, and being Hispanic. We also found that having an AWV was associated with increases in preventive care use (COVID vaccine, flu shot, pneumonia shot, and blood pressure measurement), but was limited in improving health status and care satisfaction. CONCLUSION Our finding raises critical concerns about inequitable access to health care services for disease prevention and health promotion during the pandemic. Furthermore, the effectiveness of AWVs was mostly in increased preventive care use, suggesting a limited role in meeting the wellness needs of a diverse population of older adults.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Ann M Nguyen
- Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, United States
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Van Poel E, Vanden Bussche P, Pétré B, Ponsar C, Collins C, De Jonghe M, Donneau AF, Gillain N, Guillaume M, Willems S. Quality of care in Belgian general practices during the COVID-19 pandemic: results of the cross-sectional PRICOV-19 study. BMC PRIMARY CARE 2024; 24:282. [PMID: 38443780 PMCID: PMC10916333 DOI: 10.1186/s12875-024-02305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries. METHODS The data collected from 479 Belgian practices during 2020-2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system. RESULTS Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries. CONCLUSIONS Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care.
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Affiliation(s)
- Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Pierre Vanden Bussche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Benoît Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Cécile Ponsar
- Institute of Health and Society, University of Louvain, Louvain, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Centre, Irish College of General Practitioners, Dublin, D02 XR68, Ireland
| | - Michel De Jonghe
- Centre Académique de Médecine Générale, Université Catholique de Louvain, Brussels, Belgium
| | | | - Nicolas Gillain
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Michèle Guillaume
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Glette MK, Bates DW, Dykes PC, Wiig S, Kringeland T. A resilience perspective on healthcare personnels' experiences of managing the COVID-19 pandemic: a qualitative study in Norwegian nursing homes and come care services. BMC Health Serv Res 2023; 23:1177. [PMID: 37898762 PMCID: PMC10613357 DOI: 10.1186/s12913-023-10187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to new and unfamiliar changes in healthcare services globally. Most COVID-19 patients were cared for in primary healthcare services, demanding major adjustments and adaptations in care delivery. Research addressing how rural primary healthcare services coped during the COVID-19 pandemic, and the possible learning potential originating from the pandemic is limited. The aim of this study was to assess how primary healthcare personnel (PHCP) working in rural areas experienced the work situation during the COVID-19 outbreak, and how adaptations to changes induced by the pandemic were handled in nursing homes and home care services. METHOD This study was conducted as an explorative qualitative study. Four municipalities with affiliated nursing homes and homecare services were included in the study. We conducted focus group interviews with primary healthcare personnel working in rural nursing homes and homecare services in western Norway. The included PHCP were 16 nurses, 7 assistant nurses and 2 assistants. Interviews were audio recorded, transcribed and analyzed using thematic analysis. RESULTS The analysis resulted in three main themes and 16 subthemes describing PHCP experience of the work situation during the COVID-19 pandemic, and how they adapted to the changes and challenges induced by the pandemic. The main themes were: "PHCP demonstrated high adaptive capacity while being put to the test", "Adapting to organizational measures, with varying degree of success" and "Safeguarding the patient's safety and quality of care, but at certain costs". CONCLUSION This study demonstrated PHCPs major adaptive capacity in response to the challenges and changes induced by the covid-19 pandemic, while working under varying organizational conditions. Many adaptations where long-term solutions improving healthcare delivery, others where short-term solutions forced by inadequate management, governance, or a lack of leadership. Overall, the findings demonstrated the need for all parts of the system to engage in building resilient healthcare services. More research investigating this learning potential, particularly in primary healthcare services, is needed.
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Affiliation(s)
- Malin Knutsen Glette
- SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway.
| | - David W Bates
- SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patricia C Dykes
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Siri Wiig
- SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Tone Kringeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
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Barzegari J, Raeissi P, Hashemi SM, Aryan Khesal A, Reisi N. Delivering Primary Health Care (PHC) Services for Controlling NCDs During the COVID-19 Pandemic: A Scoping Review. JOURNAL OF PREVENTION (2022) 2023; 44:579-601. [PMID: 37495870 DOI: 10.1007/s10935-023-00733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 07/28/2023]
Abstract
Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs also increase mortality from COVID-19 and primary health care (PHC) services are an important component in the prevention and control of long-term NCDs. The main goal of the present study was to review primary healthcare services for the NCDs patients via primary healthcare network during COVID-19 pandemic. In this scoping review, Search engines including PubMed, Scopus, and Science-direct up to 1st February 2022 were searched to identify studies regarding primary care services for NCDs patients via primary health care during COVID-19 pandemic. A total of 42 studies met the inclusion criteria and were included in our analysis. 24 studies were about the status and changes of primary health services for NCDs patients in PHC settings, while 18 studies focused on adaptive strategies used during COVID-19 in different countries including United States, Canada, United Kingdom, Portugal, Georgia, South Africa, Thailand, Mexico, India, Kenya, Guatemala and Saudi Arabia. These strategies included remote monitoring, follow up, consultation, empowerment and educational services as well as home visiting Disruption of NCDs services in PHC during the COVID-19 pandemic was observed in different countries, which highlights the urgency of attention of researchers and policy-makers to development of appropriate and adaptive policies to improve PHC service coverage and its quality during the pandemics.
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Affiliation(s)
- Javad Barzegari
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran.
| | - Seyed- Masoud Hashemi
- Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aidin Aryan Khesal
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Nahid Reisi
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Child Growth and Development Research Center and Isfahan Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Elliott J, Tong C, Gregg S, Mallinson S, Giguere A, Brierley M, Giosa J, MacNeil M, Juzwishin D, Sims-Gould J, Rockwood K, Stolee P. Policy and practices in primary care that supported the provision and receipt of care for older persons during the COVID-19 pandemic: a qualitative case study in three Canadian provinces. BMC PRIMARY CARE 2023; 24:199. [PMID: 37770822 PMCID: PMC10536733 DOI: 10.1186/s12875-023-02135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The effects of the COVID-19 pandemic on older adults were felt throughout the health care system, from intensive care units through to long-term care homes. Although much attention has been paid to hospitals and long-term care homes throughout the pandemic, less attention has been paid to the impact on primary care clinics, which had to rapidly change their approach to deliver timely and effective care to older adult patients. This study examines how primary care clinics, in three Canadian provinces, cared for their older adult patients during the pandemic, while also navigating the rapidly changing health policy landscape. METHODS A qualitative case study approach was used to gather information from nine primary care clinics, across three Canadian provinces. Interviews were conducted with primary care providers (n = 17) and older adult patients (n = 47) from October 2020 to September 2021. Analyses of the interviews were completed in the language of data collection (English or French), and then summarized in English using a coding framework. All responses that related to COVID-19 policies at any level were also examined. RESULTS Two main themes emerged from the data: (1) navigating the noise: understanding and responding to public health orders and policies affecting health and health care, and (2) receiving and delivering care to older persons during the pandemic: policy-driven challenges & responses. Providers discussed their experiences wading through the health policy directives, while trying to provide good quality care. Older adults found the public health information overwhelming, but appreciated the approaches adapted by primary care clinics to continue providing care, even if it looked different. CONCLUSIONS COVID-19 policy and guideline complexities obliged primary care providers to take an important role in understanding, implementing and adapting to them, and in explaining them, especially to older adults and their care partners.
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Affiliation(s)
- Jacobi Elliott
- Lawson Health Research Institute, London, ON, Canada.
- St. Joseph's Health Care London, London, ON, Canada.
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Catherine Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Susie Gregg
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sara Mallinson
- Alberta Health Services, Calgary, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Laval, QC, Canada
| | | | - Justine Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- SE Research Centre, SE Health, Markham, ON, Canada
| | - Maggie MacNeil
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Don Juzwishin
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Davis SA, Knoll H, Ireland C, Frayne D. A Quality Improvement Innovation for Reproductive Health Planning in the Time of COVID. Matern Child Health J 2023:10.1007/s10995-023-03705-5. [PMID: 37256518 DOI: 10.1007/s10995-023-03705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To see if an outreach approach with telehealth is feasible and acceptable to patients to talk about their reproductive health; and as a secondary outcome, capture data on time spent on the visit and what kind of information was discussed. METHODS A registry was created from three family physicians' panels of all adult patients with anticipated ability to become pregnant ages 18-45 who had not had a documented reproductive health discussion in the previous 6 months. Using that registry, outreach was performed to schedule a telehealth visit to discuss their reproductive health with their primary care provider. The visit was standardized using the One Key Question approach. For patients who agreed to participate in the research, the patient completed a survey about their experience. The provider also completed a survey on the time spent and the issues addressed. RESULTS Two hundred and six patients were called. Ninety patients (44%) could not be reached. Of the remaining patients, 34 scheduled either a telehealth or in-person visit and 7 also agreed to participate in the survey. New information was uncovered in the visit in 86% of participants. The most common need uncovered during the visit was unrelated medical needs (71%), followed by preconception health education/advice (43%) and contraception needs/counseling (29%). Most participants found the telehealth visit valuable. CONCLUSIONS An outreach methodology can uncover unmet health needs, both reproductive and otherwise. We found that people who had the visit often needed something, but a majority of patients declined the visit saying that they did not think they needed it. It is possible that patients are not aware of the value of reproductive health discussions, and therefore clinicians need to take every opportunity to have these discussions whenever possible, whether through outreach or inreach (during already scheduled visits).
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Affiliation(s)
- Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, CB #2521, One University Heights, Asheville, NC, 28804, USA.
| | - Heidi Knoll
- Department of Family Medicine, Mountain Area Health Education Center, Asheville, NC, USA
| | - Cindy Ireland
- Department of Family Medicine, Mountain Area Health Education Center, Asheville, NC, USA
| | - Dan Frayne
- Department of Family Medicine, Mountain Area Health Education Center, Asheville, NC, USA
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Granja M, Alves L, Correia S. Access to General Practitioners during the COVID-19 pandemic in Portugal-A survey study of patient experiences in an urban setting. PLoS One 2023; 18:e0285899. [PMID: 37220164 DOI: 10.1371/journal.pone.0285899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND In 2020, Portugal had high levels of unmet health care needs. Primary Care was reported as the main source of unmet needs. OBJECTIVES To describe face-to-face and remote access to GPs in Portugal during the COVID-19 pandemic. To discover patient experiences and attitudes to access to care. To identify determinants of access to care. METHODS A survey of a random sample of 4,286 adults registered in a group of Family Practices was conducted in 2021. Paper questionnaires were sent by post to patients who had no e-mail address registered with the practice. Patients with an e-mail address were sent a link to an online questionnaire. Outcomes were reported waiting times for face-to-face and remote contacts with GPs, dichotomized to ascertain compliance with standards. Associations between participant characteristics and outcome variables were tested using logistic regression. RESULTS Waiting times for face-to-face consultations with GPs during the pandemic often exceeded the maximum waiting times (MWT) set by the National Health Service. Remote contacts were mostly conducted within acceptable standards. Waiting times for speaking with the GP over the phone were rated as 'poor' by 40% and 27% reported requests for these calls as unmet. The odds of getting care over MWT increased for participants who reported poorer digital skills. Participants were less likely to get non-urgent consultations over MWT if they found it easy to use the online patient portal to book appointments (odds ratio 0.24; 99% confidence intervals 0.09-0.61), request prescriptions (0.18; 0.04-0.74) or insert personal data (0.18; 0.04-0.95). CONCLUSION Patient reported access to GPs during the pandemic was uneven in Portugal. Obtaining non-urgent consultations and remote contacts over MWT affected mainly those patients with poor digital skills. Telephone access to GPs received the worse ratings. Access through traditional pathways must remain available, to prevent the widening of inequities.
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Affiliation(s)
- Mónica Granja
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
| | - Luís Alves
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
| | - Sofia Correia
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
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Granja M, Correia S, Alves L. Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors. BMC PRIMARY CARE 2023; 24:46. [PMID: 36782109 PMCID: PMC9924884 DOI: 10.1186/s12875-023-01994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.
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Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
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Crisis management: the perspectives of physicians working in family physician teams in Lithuania. Prim Health Care Res Dev 2023; 24:e6. [PMID: 36617854 PMCID: PMC9884525 DOI: 10.1017/s1463423622000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM To assess the opinions of physicians working in family physician teams regarding COVID-19 (threat perception, overall work satisfaction, patient satisfaction with services provided, patient access to services, and the need for new tools for service provision). METHODS An anonymous survey of physicians (N = 191) working in family physician teams. Questionnaires were distributed among family physicians with the permission of the managers of their institutions and were collected by the lead researcher within 1-8 weeks. The quantitative study was conducted from 21 June 2021 to 17 September 2021. In total, 398 questionnaires were distributed, yielding a response rate of 48%, or 9% of the total population. Thirty-nine primary health care institutions (PHCIs) were randomly selected for the study: 11 public and 28 private. FINDINGS Older respondents and those with more years of work experience strongly agreed that the COVID-19 pandemic threatened their lives and safety, as well as that of their colleagues. Work satisfaction decreased during the pandemic among older respondents, those with more years of work experience, and those who had been employed at their current institution for longer. Respondents with more work experience believed that patient satisfaction with the services provided by their family medical institution decreased. Older respondents with more work experience asserted that patient access to services decreased during the pandemic. Physicians working further away from urban centers indicated a greater need for new tools in the effort to provide consultations compared to city-based physicians. CONCLUSIONS The current health care crisis prompted by the COVID-19 pandemic is defined by the perception of threats to life and safety among physicians, an overall drop in their work satisfaction, decreased patient satisfaction with services provided, reduced patient access to services, and a greater need for new tools for providing consultations.
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Heltveit-Olsen SR, Lunde L, Brænd AM, Spehar I, Høye S, Skoglund I, Sundvall PD, Fossum GH, Straand J, Risør MB. Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study. Scand J Prim Health Care 2022; 41:2-12. [PMID: 36350846 PMCID: PMC10088916 DOI: 10.1080/02813432.2022.2142796] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change. DESIGN Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September-December 2020, the second round from January-April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2-4 months apart. To analyze the data, we used thematic analysis. RESULTS The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. CONCLUSIONS Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.Key PointsFacing the COVID-19 pandemic, the primary health care service in Norway had to reorganize to ensure safe patient treatment and maintain infection control.Several GPs experienced challenges in collaboration with the municipalities.There is a need for clarification of responsibilities between GPs and the municipality.
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Affiliation(s)
- Silje Rebekka Heltveit-Olsen
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lene Lunde
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anja Maria Brænd
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ivan Spehar
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Psychology, Oslo New University College, Oslo, Norway
| | - Sigurd Høye
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingmarie Skoglund
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Pär-Daniel Sundvall
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Guro Haugen Fossum
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jørund Straand
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mette Bech Risør
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The General Practice Research Unit, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Varandani S, Nagib ND. Evaluating the Impact of the COVID-19 Pandemic on Monthly Trends in Primary Care. Cureus 2022; 14:e28353. [PMID: 36168368 PMCID: PMC9507076 DOI: 10.7759/cureus.28353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction As the COVID-19 pandemic progressed, multiple barriers arose for patients and providers in the primary care setting. Despite the attempt to utilize telemedicine to overcome barriers, visits remained lower than pre-pandemic levels. This raises concern for preventative medicine and chronic disease management. Methods This study aimed to evaluate the impact of the pandemic in primary care by utilizing two years of data from a family medicine clinic. Data obtained from the electronic medical record for March 2019 through February 2020 and March 2020 through February 2021 were used to evaluate monthly trends from the year before the pandemic and the first year of the pandemic in the following six categories: hypertension control, diabetes control, lipid profile screening, breast cancer screening, colorectal cancer screening, and cervical cancer screening. Results The paired t-tests found a significant difference in the averages between the two years for all categories except hypertension control. The results for chi-square demonstrated a significant difference in four months for cervical cancer screening, five months for hypertension control and colorectal cancer screening, nine months for diabetes control and lipid profile screening, and 10 months for breast cancer screening. Conclusion These results show a profound impact of the pandemic on both preventative medicine and chronic disease management. This study had a large sample size but is not generalizable to the entire population. These results can help guide quality improvement measures going forward. However, further research is necessary to better understand the full extent of COVID-19’s impact on primary care.
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Knottnerus B, Heijmans M, Rademakers J. The role of primary care in informing and supporting people with limited health literacy in the Netherlands during the COVID-19 pandemic: a qualitative interview study. BMC PRIMARY CARE 2022; 23:115. [PMID: 35546226 PMCID: PMC9091153 DOI: 10.1186/s12875-022-01723-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, people have been confronted with a large amount of information about the virus and the governmental measures against its spreading. However, more than a quarter of individuals have limited health literacy (HL), meaning that they have difficulty finding, understanding, and applying health information. The purpose of this interview study was to investigate how individuals with limited HL acquire information about COVID-19 and governmental measures, what difficulties they experience in understanding and applying it, and what may be needed to overcome these difficulties. We also addressed other problems that they might face as a result of the pandemic. Using our findings, we aimed to make recommendations on the possible role of primary care in informing and supporting patients with limited HL during the pandemic. METHODS Between June and October 2020, 28 individuals with limited HL were interviewed by phone (age range 20-84). The interviews were semi-structured and focused on the first months of the pandemic in the Netherlands (March/April/May 2020). RESULTS The participants generally found COVID-19-related information abundant and complicated, and sometimes contradictory. Information provision by their own health care professionals was highly appreciated, especially in the context of chronic illnesses. General health care problems resulting from COVID-19 measures were postponement of regular care and difficulty with digital contacts. CONCLUSIONS Individuals with limited HL may benefit from provision of COVID-19-related information and support by their own health care providers. This applies in particular to patients with chronic illnesses. Primary care professionals are in the ideal position to take this role.
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Affiliation(s)
- Bart Knottnerus
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Jany Rademakers
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
- CAPHRI (Care and Public Health Research Institute), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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Bhatia R, Aliberti G, Gilliam E, DesRochers L, Brockmeyer D, Davis RB, Schonberg MA. A survey of Massachusetts primary care physicians' experience with telemedicine in older adults. J Am Geriatr Soc 2022; 70:683-687. [PMID: 34967947 PMCID: PMC10022479 DOI: 10.1111/jgs.17645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/21/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Roma Bhatia
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Gianna Aliberti
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Elizabeth Gilliam
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Laura DesRochers
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Diane Brockmeyer
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Roger B Davis
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Mara A Schonberg
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
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