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1.
J Am Board Fam Med ; 35(3): 527-536, 2022.
Article in English | MEDLINE | ID: covidwho-1875335

ABSTRACT

PURPOSE: The COVID-19 pandemic resulted in unprecedented adoption and implementation of virtual primary care services, and little is known about whether and how virtual care services will be provided after the pandemic ends. We aim to identify how administrators at health care organizations perceive the future of virtual primary care services. METHODS: In March-April of 2021, we conducted semistructured qualitative phone interviews with administrators at 17 health care organizations that ranged from multi-state nonfederal delivery systems to single-site primary care practices. Organizations differed in size, structure, ownership, and geography. We explore how health care administrators anticipate their organization will offer virtual primary care services after the COVID-19 pandemic subsides. RESULTS: All interviewed administrators expected virtual primary care services to persist after the pandemic. We categorize expected impact of future virtual services as limited (n = 4); targeted to a narrow set of clinical encounters (n = 5); and a major shift in primary care delivery (n = 8). The underlying motivation expressed by administrators for providing virtual care services was to remain financially stable and competitive. This motivation can be seen in the 3 main goals described for their anticipated use of virtual services: (1) optimizing medical services; (2) enhancing the patient experience; and (3) increasing loyalty among patients. CONCLUSIONS: Health care organizations are considering how virtual primary care services can be used to improve patient outcomes, access to care, and convenience of care. To implement and sustain virtual primary care services, health care organizations will need long-term support from regulators and payers.


Subject(s)
COVID-19 , Administrative Personnel , COVID-19/epidemiology , Delivery of Health Care , Humans , Pandemics , Primary Health Care
2.
Ann Fam Med ; 19(4): 356-361, 2021.
Article in English | MEDLINE | ID: covidwho-1325363

ABSTRACT

Interest and incentives are increasing around strategies whereby the health care sector can better identify and address patients' social and economic needs in the context of primary care delivery. This interest is likely to accelerate during the economic recession following the OVID-19 pandemic. Yet effective and sustainable strategies for integrating social care practices (eg, patient-facing social risk screening and activities to address identified needs) have not been clearly established. Lessons learned from more than 2 decades of research on behavioral health integration could be applied to efforts to integrate social care into primary care. In this article, we synthesize learnings from primary care and behavioral health care integration, and translate them into organizing principles with the goal of advancing social care integration practices to improve the health of both patients and communities.


Subject(s)
Behavioral Medicine/methods , Delivery of Health Care, Integrated/organization & administration , Mental Health Services , Primary Health Care/methods , Social Support , Humans , Patient Care Team
3.
J Gen Intern Med ; 36(7): 1951-1957, 2021 07.
Article in English | MEDLINE | ID: covidwho-1061194

ABSTRACT

BACKGROUND: Social isolation is a known predictor of mortality that disproportionately affects vulnerable populations in the USA. Although experts began to recognize it as a public health crisis prior to 2020, the novel coronavirus pandemic has accelerated recognition of social isolation as a serious threat to health and well-being. OBJECTIVE: Examine patient experiences with screening and assistance for social isolation in primary care settings, and whether patient experiences with these activities are associated with the severity of reported social isolation. DESIGN: Cross-sectional survey conducted in 2018. PARTICIPANTS: Adults (N = 251) were recruited from 3 primary care clinics in Boston, Chicago, and San Francisco. MAIN MEASURES: A modified version of the Berkman-Syme Social Network Index (SNI), endorsed by the National Academies of Sciences, Engineering, and Medicine; items to assess for prior experiences with screening and assistance for social isolation. KEY RESULTS: In the sample population, 12.4% reported the highest levels of social isolation (SNI = 0/1), compared to 36.7%, 34.7%, and 16.3% (SNI = 2-4, respectively). Most patients had not been asked about social isolation in a healthcare setting (87.3%), despite reporting no discomfort with social isolation screening (93.9%). Neither discomfort with nor participation in prior screening for social isolation was associated with social isolation levels. Desire for assistance with social isolation (3.2%) was associated with a higher level of social isolation (AOR = 6.0, 95% CI, 1.3-28.8), as well as poor or fair health status (AOR = 9.1; 95% CI, 1.3-64.1). CONCLUSIONS: In this study, few patients reported being screened previously for social isolation in a primary care setting, despite low levels of discomfort with screening. Providers should consider broadening social isolation screening and referral practices in healthcare settings, especially among sicker and more isolated patients who express higher levels of interest in assistance with social isolation.


Subject(s)
COVID-19 , Social Isolation , Adult , Chicago , Cross-Sectional Studies , Humans , Patient Outcome Assessment , Primary Health Care , SARS-CoV-2 , San Francisco
4.
J Gen Intern Med ; 36(5): 1411-1414, 2021 05.
Article in English | MEDLINE | ID: covidwho-1037988

ABSTRACT

Despite social care interventions gaining traction in the US healthcare sector in recent years, the scaling of healthcare practices to address social adversity and coordinate care across sectors has been modest. Against this backdrop, the coronavirus pandemic arrived, which re-emphasized the interdependence of the health and social care sectors and motivated health systems to scale tools for identifying and addressing social needs. A framework on integrating social care into health care delivery developed by the National Academies of Science, Engineering, and Medicine provides a useful organizing tool to understand the social care integration innovations spurred by COVID-19, including novel approaches to social risk screening and social care interventions. As the effects of the pandemic are likely to exacerbate socioeconomic barriers to health, it is an appropriate time to apply lessons learned during the recent months to re-evaluate efforts to strengthen, scale, and sustain the health care sector's social care activities.


Subject(s)
COVID-19 , Humans , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Pandemics , SARS-CoV-2 , Social Support , United States
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