ABSTRACT
Previous Graham Center Policy One-Pagers published in AFP have provided timely perspectives on a range of topics, such as family physicians' contributions to the care of infants, children, and older adults2–4;attributes that patients most value in their family physicians5;effects of income disparities on medical student specialty choice6;and the underutilization of family physicians in addressing the opioid epidemic.7 In 2020, the Graham Center, in collaboration with IBM Watson Health and the American Board of Family Medicine, produced a chartbook of statistics on the current state of primary care in the United States.8 This issue of AFP features a Graham Center Policy One-Pager derived from this chartbook, demonstrating a wide variation in the ratio of primary care physicians to population by state, with the two highest states (Maine and Vermont) having more than twice the ratio of the lowest (Mississippi).9 Subsequent issues of AFP will feature additional analyses of primary care physicians' employment status and scope of practice. A consensus report from the National Academies of Sciences, Engineering, and Medicine recently affirmed the foundational role of primary care in optimizing individual and population health and called on state and national policy makers to make high-quality primary care “a common good that is accessible to everyone.” 10,11 A recent editorial in AFP described the collaboration of several primary care physician societies and boards, including the American Academy of Family Physicians, to create a new health care payment paradigm with the principles of primary care serving as the backbone.12 Although the COVID-19 pandemic has demonstrated the impressive versatility of family medicine to meet changing health system needs, it has also dangerously stretched practice finances and challenged the resilience of many primary care physicians, with 71% reporting all-time high levels of burn-out or mental exhaustion.13 The primary care chartbook is just one of many resources that remind us of the central role family physicians have in helping our communities thrive.
ABSTRACT
Tests for Coronavirus disease 2019 (COVID-19) are intended for a disparate and shifting range of purposes: (1) diagnosing patients who present with symptoms to inform individual treatment decisions; (2) organizational uses such as "cohorting" potentially infected patients and staff to protect others; and (3) contact tracing, surveillance, and other public health purposes. Often lost when testing is encouraged is that testing does not by itself confer health benefits. Rather, testing is useful to the extent it forms a critical link to subsequent medical or public health interventions. Such interventions might be individual level, like better diagnosis, treatment, isolation, or quarantine of contacts. They might aid surveillance to understand levels and trends of disease within a defined population that enables informed decisions to implement or relax social distancing measures. In this article, we describe the range of available COVID-19 tests; their accuracy and timing considerations; and the specific clinical, organizational, and public health considerations that warrant different testing strategies. Three representative clinical scenarios illustrate the importance of appropriate test use and interpretation. The reason a patient seeks testing is often a strong indicator of the pretest probability of infection, and thus how to interpret test results. In addition, the level of population spread of the virus and the timing of testing play critical roles in the positive or negative predictive value of the test. We conclude with practical recommendations regarding the need for testing in various contexts, appropriate tests and testing methods, and the interpretation of test results.