TY - JOUR
T1 - Redesigning primary care to address the COVID1-9 pandemic in the midst of the pandemic
AU - Krist, Alex H.
AU - Devoe, Jennifer E.
AU - Cheng, Anthony
AU - Ehrlich, Thomas
AU - Jones, Samuel M.
N1 - Publisher Copyright:
© 2020, Annals of Family Medicine, Inc. All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - During a pandemic, primary care is the first line of defense. It is able to reinforce public health messages, help patients manage at home, and identify those in need of hospital care. In response to the COVID-19 pandemic, primary care scrambled to rapidly transform itself and protect clinicians, staff, and patients while remaining connected to patients. Using the established public health framework for addressing a pandemic, we describe the actions primary care needs to take in a pandemic. Recommended actions are based on observed experiences of the authors’ primary care practices and networks. Early in the COVID-19 pandemic, tasks focused on promoting physical distancing and encouraging patients with suspected illness or exposure to self-quarantine. Testing was not available and contract tracing was not possible. As the pandemic spread, in-person care was converted to virtual care using telehealth. Practices remained connected to patients using registries to reach out to those at risk for infection, with uncontrolled chronic conditions, or were socially vulnerable. Practices managed most patients with suspected COVID-19 at home. As the pandemic decelerates, practices are now preparing to address the direct and indirect consequences—complications from COVID-19 infections, missed treatment for acute problems, inadequate prevention, uncontrolled chronic disease, mental illness, and greater social needs. Throughout, practices bore tremendous financial burden, laying off staff or even closing at a time when most needed. Primary care must learn from this experience and be ready for the next pandemic. Policymakers and payers cannot fail primary care during their next time of need.
AB - During a pandemic, primary care is the first line of defense. It is able to reinforce public health messages, help patients manage at home, and identify those in need of hospital care. In response to the COVID-19 pandemic, primary care scrambled to rapidly transform itself and protect clinicians, staff, and patients while remaining connected to patients. Using the established public health framework for addressing a pandemic, we describe the actions primary care needs to take in a pandemic. Recommended actions are based on observed experiences of the authors’ primary care practices and networks. Early in the COVID-19 pandemic, tasks focused on promoting physical distancing and encouraging patients with suspected illness or exposure to self-quarantine. Testing was not available and contract tracing was not possible. As the pandemic spread, in-person care was converted to virtual care using telehealth. Practices remained connected to patients using registries to reach out to those at risk for infection, with uncontrolled chronic conditions, or were socially vulnerable. Practices managed most patients with suspected COVID-19 at home. As the pandemic decelerates, practices are now preparing to address the direct and indirect consequences—complications from COVID-19 infections, missed treatment for acute problems, inadequate prevention, uncontrolled chronic disease, mental illness, and greater social needs. Throughout, practices bore tremendous financial burden, laying off staff or even closing at a time when most needed. Primary care must learn from this experience and be ready for the next pandemic. Policymakers and payers cannot fail primary care during their next time of need.
KW - COVID-19
KW - Pandemic
KW - Practice transformation
KW - Primary care
KW - Public health
UR - http://www.scopus.com/inward/record.url?scp=85087974557&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087974557&partnerID=8YFLogxK
U2 - 10.1370/afm.2557
DO - 10.1370/afm.2557
M3 - Article
C2 - 32661037
AN - SCOPUS:85087974557
SN - 1544-1709
VL - 18
SP - 349
EP - 354
JO - Annals of family medicine
JF - Annals of family medicine
IS - 4
ER -