Primary care in the COVID-19 pandemic:
Improving access to high quality primary care, accelerating transitions to alternative forms of care delivery, and addressing health disparities
Edited by:
Sanjay Basu, MD, PhD, HMS Center for Primary Care Director of Research
Jessica Alpert, Center for Primary Care
Russell S. Phillips, MD, HMS Center for Primary Care Director, William Applebaum Professor of Medicine; Professor of Global Health and Social Medicine
Primary care delivery has been dramatically altered by COVID-19, worldwide. Primary care in-person visits were nearly eliminated in most countries during shelter-in-place periods, with variable movement to telemedicine, and variable abilities of patients to engage in virtual care. Loss of revenue has threatened the survival of primary care practices, with small independent practices being at greatest risk. Reasonable concerns about exposure to COVID-19 threatened primary care goals of delivering preventive population management including caring for routine chronic conditions such as heart failure, diabetes, and hypertension, and preventive activities such as cancer screening and vaccination. Care was most affected among populations disproportionately at risk for COVID and disproportionately unable to access resources for primary care. Primary care delivery and quality suffered from social inequalities that were highlighted and heightened by COVID-19, including racism, poverty, and barriers to healthcare access, which manifested in heightened risk among minority communities, among those in essential work roles who could not afford to or were not permitted to shelter-in-place, and among communities historically marginalized and receiving lower-quality care.
Yet it remains unclear how primary care can constructively and sustainably recover from COVID-19-related disruptions, address underlying social inequalities creating barriers to positive outcomes for patients, and transform itself to make use of opportunities and needs highlighted by COVID-19. Primary care has been variably editorialized as being permanently altered as COVID-19 remains active in most of the world, and as the pandemic has highlighted opportunities and threats to the practice of primary care, in terms of demand and supply of virtual visits, transitions from fee-for-service to capitation payment models (in the United States in particular), and long-term effectiveness at delivering preventive health to broad populations.
This edited volume seeks to document, analyze, and make recommendations to primary care practitioners, practice managers, and policy experts, to achieve three goals: (i) describe how access to high quality primary care is being preserved or improved during the COVID-19 pandemic, in light of the challenges to primary care delivery brought forth by the pandemic; (ii) determine what aspects of practice challenges and responses during the COVID-19 pandemic are opportunities for accelerating transitions of traditional care into alternative care realms such as virtual care and value-based payments for population health; and (iii) identify the care strategies that can best address health disparities highlighted or heightened by the COVID-19 pandemic.
Each chapter is oriented towards the work of authors who have carefully analyzed primary care trends during the COVID-19 pandemic among diverse international populations, and each chapter provides an in-depth essay that summarizes the evidence to date concerning the above three points as relevant to the problem and population of interest, provides a critical viewpoint on that evidence, and makes focused recommendations for primary care professionals, organizations, and governing bodies.
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