Primary Care: A Critical Stopgap of Mental Health Services During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic resulted in a worsening mental health crisis, while also dramatically reducing access to in-person primary care services. Primary care, an essential provider of mental health services, rapidly adopted telemedicine to address behavioral health needs. Here we examine the provision of mental health services by primary care during the pandemic, including the essential use of telemedicine. METHODS: Data were collected via a series of national, cross-sectional surveys of primary care clinicians in November 2020 by the Larry A. Green Center. The survey was distributed through a network of partner organizations and subscribers. Descriptive and chi squared analysis were utilized. RESULTS: Among 1,472 respondents, 88% reported increased mental health needs and 37% reported higher rates of substance use among patients. Most (65%) clinicians became more involved in providing mental health support, and 64% reported using telemedicine to provide behavioral health services. Phone-based care was more common for care delivery among patients who were uninsured (60% vs 42%, P < .01), Medicare beneficiaries (45% vs 36%, P < .05), non-English speaking (67% vs 40%, P < .001), and racial and ethnic minorities (58% vs 34%, P < .001). CONCLUSIONS: Primary care is a leading provider of mental health services and has played a critical role during the pandemic. Primary care clinicians have strong relationships with their patients as well as outreach within communities that may otherwise struggle to access mental health services. The use of telemedicine in primary care, and specifically phone-based services, has been an essential tool to providing equitable access to mental health services.

Health Equity: The Only Path Forward for Primary Care.

The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on Implementing High-Quality Primary Care identifies 5 high-level objectives regarding payment, access, workforce development, information technology, and implementation. Nine junior primary care leaders (3 internal medicine, 3 family medicine, 3 pediatrics) invited from broad geographies, practice settings, and academic backgrounds used appreciative inquiry to identify priorities for the future of primary care. Highlighting the voices of these early career clinicians, we propose a response to the report from the perspective of early career primary care physicians. Health equity must be the foundation of the future of primary care. Because Barbara Starfield's original 4 Cs (first contact, coordination, comprehensiveness, and continuity) may not be inclusive of the needs of under-resourced communities, we promote an extension to include 5 additional Cs: convenience, cultural humility, structural competency, community engagement, and collaboration. We support the NASEM report's priorities and its focus on achieving health equity. We recommend investing in local communities and preparatory programs to stimulate diverse individuals to serve in health care. Finally, we support a blended value-based care model with risk adjustment for the social complexity of our patients.Appeared as Annals "Online First" article.