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.

Associations of Health, Lifestyle and Psycho-Social Factors With Sleep Quality During the Early Phase of the COVID-19 Pandemic: A Focus on UK Older Adults Deemed Clinically Extremely Vulnerable (preprint)

Background: Sleep quality is crucial for health and wellbeing in all ages and sleep abnormalities may contribute to multimorbidity in older adults. The impact of pandemic-related disruptions to sleep quality in older adults, particularly those deemed “clinically extremely vulnerable” to COVID-19-related complications (COVID-19CEV) remains unknown.Methods: In this cross-sectional study, conducted during the first UK lockdown (April- June 2020), we surveyed 5558 adults aged 50 years and over (of whom 523 met criteria for COVID-19CEV) with assessments of sleep quality, health/medical, lifestyle, psychosocial and sociodemographic factors. We identified associations between these factors and sleep quality and explored interactions of COVID-19CEV status with factors significantly associated with sleep quality to identify potential moderating variables.Findings: 37% of participants reported poor sleep quality which was associated with younger age, female sex and multimorbidity. Significant associations with poor sleep included, among health/medical factors: COVID-19CEV status, higher BMI, arthritis, pulmonary disease, and mental health disorders; .and the following lifestyle and psychosocial factors: living alone, higher alcohol consumption, an unhealthy diet and higher depressive and anxiety symptoms. r Moderators of the COVID-19CEV status - sleep quality relationship included marital status, loneliness, anxiety and diet. Within this subgroup, less anxious and less lonely males, as well as females with healthier diets, reported better sleep quality. Interpretation: Sleep quality in older adults was compromised during the sudden unprecedented nation-wide lockdown due to distinct health/medical, lifestyle and psychosocial factors. Male and female older adults with COVID-19CEV status may benefit from targeted mental health and dietary interventions, respectively. Results inform tailored interventions and policy for older adults deemed COVID-19CEV. Funding Information: This study was sponsored by Imperial College London and partly funded by the ICHT BRC.Declaration of Interests: Dr. Middleton reports clinical trial grants from Janssen R&D, Novartis and Takeda outside the submitted work. All authors declare no competing interests related to this study.Ethics Approval Statement: Data collected as in this study are anonymized and kept strictlyconfidential in accordance with the UK General Data Protection Regulations (2016). The CCRR study was ethically approved by the Imperial College London Joint Research Compliance Office (20IC5942) and by the Health Research Authority (16/EM/0213).