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2.
American Family Physician ; 104(2):124-125, 2021.
Article in English | ProQuest Central | ID: covidwho-1353252

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.

4.
J Prim Care Community Health ; 12: 21501327211023871, 2021.
Article in English | MEDLINE | ID: covidwho-1264113

ABSTRACT

OBJECTIVES: To assess primary care contributions to behavioral health in addressing unmet mental healthcare needs due to the COVID-19 pandemic. METHODS: Secondary data analysis of 2016 to 2018 Medical Expenditure Panel Survey of non-institutionalized US adults. We performed bivariate analysis to estimate the number and percentage of office-based visits and prescription medications for depression and anxiety disorders, any mental illness (AMI), and severe mental illness (AMI) by physician specialty (primary care, psychiatry, and subspecialty) and medical complexity. We ran summary statistics to compare the differences in sociodemographic factors between patients with AMI by seeing a primary care physician versus those seeing a psychiatrist. Binary logistic regression models were estimated to examine the likelihood of having a primary care visit versus psychiatrist visit for a given mental illness. RESULTS: There were 394 023 office-based visits in the analysis sample. AMI patients seeing primary care physician were thrice as likely to report 1 or more chronic conditions compared to those seeing psychiatrist. Among patients with a diagnosis of depression or anxiety and AMI the proportion of primary care visits ([38% vs 32%, P < .001], [39% vs 34%, P < .001] respectively), and prescriptions ([50% vs 40%, P < .001], [47% vs 44%, P < .05] respectively) were higher compared to those for psychiatric care. Patients diagnosed with SMI had a more significant percentage of prescriptions and visits to a psychiatrist than primary care physicians. CONCLUSION: Primary care physicians provided most of the care for depression, anxiety, and AMI. Almost a third of the care for SMI and a quarter of the SMI prescriptions occurred in primary care settings. Our study underscores the importance of supporting access to primary care given primary care physicians' critical role in combating the COVID-19 related rise in mental health burden.


Subject(s)
COVID-19 , Psychiatry , Adult , Cross-Sectional Studies , Health Care Surveys , Health Expenditures , Humans , Office Visits , Pandemics , Primary Health Care , SARS-CoV-2 , United States
5.
J Am Board Fam Med ; 34(3): 489-497, 2021.
Article in English | MEDLINE | ID: covidwho-1259317

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) disrupted and undermined primary care delivery. The goal of this study was to examine the financial impacts the pandemic has had on primary care clinicians and practices. METHODS: The American Academy of Family Physicians National Research Network and the Robert Graham Center distributed weekly surveys from March 27, 2020, through June 15, 2020, to a network of more than 1960 physicians. Responses to the question, "Could you please tell us about any financial impact the COVID-19 pandemic has had on your practice, if any?" were analyzed using a grounded theory approach of qualitative analysis. The number of unique respondents who answered the financial impact question totaled 461 over the 12 weeks. RESULTS: Severe declines in patient visits, causing drastic revenue reductions, greatly impacted the ability to serve patients. Primary care clinicians and practices experienced significant changes in several areas about financial implications: patient visits, financial strain, staffing and telehealth. DISCUSSION: Preliminary findings revealed that even with Coronavirus Aid, Relief, and Economic Security Act, also known as CARES Act, funding, business viability remains questionable for some primary care practices. CONCLUSIONS: Low patient visits directly resulted in decreased revenues, which in turn, impacted staffing decisions and fueled telehealth implementation. It is difficult to predict whether patient visits will increase after June. Alternate payment models could provide some financial stability and address business viability.


Subject(s)
COVID-19/economics , Pandemics/economics , Primary Health Care/economics , Humans , Telemedicine , United States
6.
J Am Board Fam Med ; 34(2): 424-429, 2021.
Article in English | MEDLINE | ID: covidwho-1175522

ABSTRACT

The COVID-19 pandemic has added further urgency to the need for primary care payment reform. Fee-for-service payments limit the flexibility of practices to respond to crises and leave practices without sufficient revenues when visit volumes decrease. Historic fee-for-service payments have been inadequate, and prior implementations of prospective payments have encountered challenges; there is a need to bring forward the best available evidence on how to design prospective payments for payers and policymakers. Evidence suggests setting primary care investment at 10% to 12% of the total cost of care, approximately translating to an average $85 per member per month, with significant variation based on age and adjustment for medical and social measures of risk. Enhanced investment in primary care should be aligned across payers and support practice transformation to advanced models of care.


Subject(s)
Health Care Reform/economics , Primary Health Care/economics , Prospective Payment System , COVID-19 , Fee-for-Service Plans , Humans
7.
Ann Fam Med ; 19(4): 351-355, 2021.
Article in English | MEDLINE | ID: covidwho-1133663

ABSTRACT

PURPOSE: Coronavirus disease 2019 (COVID-19) pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination. With the advent of several COVID-19 vaccines, the dissemination and delivery of COVID-19 immunization across the nation is of concern. Previous immunization delivery patterns may reveal important components of a comprehensive and sustainable effort to immunize everyone in the nation. METHODS: The delivery of vaccinations were enumerated by provider type using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey. The delivery of these services was examined at the service, physician, and visit level. RESULTS: In 2017 Medicare Part B Fee-For-Service, primary care physicians provided the largest share of services for vaccinations (46%), followed closely by mass immunizers (45%), then nurse practitioners/physician assistants (NP/PAs) (5%). The Medical Expenditure Panel Survey showed that primary care physicians provided most clinical visits for vaccination (54% of all visits). CONCLUSIONS: Primary care physicians have played a crucial role in delivery of vaccinations to the US population, including the elderly, between 2012-2017. These findings indicate primary care practices may be a crucial element of vaccine counseling and delivery in the upcoming COVID-19 recovery and immunization efforts in the United States.


Subject(s)
COVID-19/prevention & control , Immunization Programs , Primary Health Care/statistics & numerical data , Vaccination/statistics & numerical data , Humans , Medicare Part B/statistics & numerical data , Nurse Practitioners/statistics & numerical data , Office Visits/statistics & numerical data , Physician Assistants/statistics & numerical data , Physicians, Primary Care/statistics & numerical data , SARS-CoV-2 , Surge Capacity , Surveys and Questionnaires , United States
8.
J Am Board Fam Med ; 34(Suppl): S203-S209, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1100014

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds. After decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in "Health is a Community Affair" still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.


Subject(s)
COVID-19/therapy , Delivery of Health Care, Integrated/organization & administration , Primary Health Care/standards , Public Health/standards , COVID-19/epidemiology , Cooperative Behavior , Delivery of Health Care, Integrated/trends , Humans , Pandemics , Primary Health Care/economics , Primary Health Care/trends , Public Health/economics , Public Health/trends , SARS-CoV-2 , United States/epidemiology
9.
J Am Board Fam Med ; 34(Suppl): S26-S28, 2021 02.
Article in English | MEDLINE | ID: covidwho-1099988

ABSTRACT

COVID-19 is primarily a respiratory illness. Historically, upper and lower respiratory illness has been cared for at home or in the ambulatory primary care setting. It is likely that patients experiencing COVID-19-like symptoms may first contact their primary care provider. The Medical Expenditure Panel Survey (MEPS) is a representative sample of patients from the United States that regularly assesses their use of medical care services. We analyzed 2017 MEPS data to determine the number and proportion of patients who were seen in primary care or family medicine ambulatory settings or hospitalized for upper or lower respiratory illness or pneumonia. In a given year, 19.5 million patients are seen by primary care for an upper respiratory illness, 10.7 million patients for bronchitis, and 9 million for pneumonia. In contrast, 890,000 patients are hospitalized with pneumonia. Given that a primary etiology for respiratory illness in early 2020 was SARS CoV-2 (COVID-19), primary care practices likely were the site of first contact for most patients with COVID-19 illness. Unfortunately, there has been inadequate support for in-person and telehealth visits. Primary care clinicians reported serious shortages of personal protective equipment (PPE) and testing capacity. Inadequate reimbursement for telehealth visits coupled with decreased in-person visits put primary care practices at risk of layoffs and closure. Policies related to primary care payment, federal relief efforts, PPE access, testing and follow-up capacity, and telehealth technical support are essential so primary care can provide first contact and continuity for their patients and communities throughout the COVID-19 pandemic response and recovery.


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19/therapy , Facilities and Services Utilization/statistics & numerical data , Family Practice/statistics & numerical data , Health Resources/statistics & numerical data , Primary Health Care/statistics & numerical data , Ambulatory Care/organization & administration , Family Practice/organization & administration , Health Care Surveys , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/organization & administration , Personal Protective Equipment/supply & distribution , Primary Health Care/organization & administration , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , United States
10.
J Am Board Fam Med ; 34(Suppl): S48-S54, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1099987

ABSTRACT

BACKGROUND: Because of the Coronavirus disease 2019 (COVID 19) pandemic, many primary care practices have transitioned to telehealth visits to keep patients at home and decrease the transmission of the disease. Yet, little is known about the nationwide capacity for delivering primary care services via telehealth. METHODS: Using the 2016 National Ambulatory Medical Survey we estimated the number and proportion of reported visits and services that could be provided via telehealth. We also performed cross-tabulations to calculate the number and proportion of physicians providing telephone visits and e-mail/internet encounters. RESULTS: Of the total visits (nearly 400 million) to primary care physicians, 42% were amenable to telehealth and 73% of the total services rendered could be delivered through telehealth modalities. Of the primary care physicians, 44% provided telephone consults and 19% provided e-consults. DISCUSSION: This study underscores how and where primary care services could be delivered. It provides the first estimates of the capacity of primary care to provide telehealth services for COVID-19 related illness, and for several other acute and chronic medical conditions. It also highlights the fact that, as of 2016, most outpatient telehealth visits were done via telephone. CONCLUSIONS: This study provides an estimate of the primary care capacity to deliver telehealth and can guide practices and payers as care delivery models change in a post-COVID 19 environment.


Subject(s)
Capacity Building , Primary Health Care/statistics & numerical data , Telemedicine/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/epidemiology , Child , Child, Preschool , Databases, Factual , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Primary Health Care/trends , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/trends , United States/epidemiology , Young Adult
11.
Chronic Obstr Pulm Dis ; 8(1)2021 Jan.
Article in English | MEDLINE | ID: covidwho-946392

ABSTRACT

BACKGROUND: Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring. METHODS: We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization. Patients were allocated to Proactive iCare (n=352) or Usual Care ( =159) and were examined for changes in quality of life using the St George's Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and health care utilization. FINDINGS: Proactive iCare improved total SGRQ by 7-9 units (p < 0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced annual COPD-related urgent office visits by 76 visits per 100 participants (p<0.0001), identified unreported exacerbations, and decreased smoking (p=0.01). Proactive iCare also improved symptoms, the body mass index-airway obstruction-dyspnea-exercise tolerance (BODE) index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p=0.08). INTERPRETATION: Linking integrated care with remote monitoring improves the lives of people with advanced COPD, findings that may have been made more relevant by the coronavirus 2019 (COVID-19) pandemic.

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