Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: From Key Lessons to a Framework for Implementation (preprint)

Background: With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. Objective: We explored GPs' perspectives on the main benefits and challenges of using digital remote care. Methods: GPs across 20 countries completed an online questionnaire between June - September 2020. GPs' perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. Results: 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and the accompanying legal frameworks. Main challenges included patient's preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. Conclusion: At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how. Lessons learned during the emergency phase can be used to inform the stable adoption of virtual care solutions, and co-design processes and platforms that are technologically robust, secure, and supported by a strategic long-term plan.

Splenic infarction as a complication of covid-19 in a patient without respiratory symptoms: A case report and literature review.

INTRODUCTION: Multiple studies suggest that SARS-CoV-2 infection is associated with a pro-thrombotic state and thrombotic events have been recorded in several organs and systems. We report a patient with no respiratory symptoms, presented with abdominal pain and an extensive splenic infarction after COVID-19. CASE REPORT: A 67 year-old man was admitted to the emergency department with a moderate, dull, left-sided abdominal pain. The patient denied respiratory symptoms but referred contact with family members positive for COVID-19. He tested positive for COVID-19 and had increased D-dimer levels. Imaging studies revealed splenic infarcts and ground-glass opacities in bilateral pulmonary bases. He was treated with full-dose anticoagulation and was discharged home on oral Rivaroxaban. DISCUSSION: Although rare in the literature, cases of acute abdomen in COVID-19 patients associated with vascular infarctions have increased. Coagulopathy may be present even without clinical respiratory manifestations of the disease. Patients meeting disseminated intravascular coagulation criteria or with markedly elevated D-dimer may benefit from anticoagulant therapy. CONCLUSION: Clinicians should suspect of abdominal visceral infarctions in COVID-19 patients presented with acute abdominal pain, despite the absence of respiratory symptoms.