scholarly journals Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255992
Author(s):  
Ellen Stephenson ◽  
Debra A. Butt ◽  
Jessica Gronsbell ◽  
Catherine Ji ◽  
Braden O’Neill ◽  
...  
Keyword(s):  
Primary Care ◽  
Preventive Care ◽  
Research Network ◽  
Secondary Outcome ◽  
Primary Care Visit ◽  
Virtual Care ◽  
Number Of Patients ◽  
Before And After ◽  
Practice Based Research ◽  
Virtual Visits

Purpose We aimed to determine the degree to which reasons for primary care visits changed during the COVID-19 pandemic. Methods We used data from the University of Toronto Practice Based Research Network (UTOPIAN) to compare the most common reasons for primary care visits before and after the onset of the COVID-19 pandemic, focusing on the number of visits and the number of patients seen for each of the 25 most common diagnostic codes. The proportion of visits involving virtual care was assessed as a secondary outcome. Results UTOPIAN family physicians (N = 379) conducted 702,093 visits, involving 264,942 patients between March 14 and December 31, 2019 (pre-pandemic period), and 667,612 visits, involving 218,335 patients between March 14 and December 31, 2020 (pandemic period). Anxiety was the most common reason for visit, accounting for 9.2% of the total visit volume during the pandemic compared to 6.5% the year before. Diabetes and hypertension remained among the top 5 reasons for visit during the pandemic, but there were 23.7% and 26.2% fewer visits and 19.5% and 28.8% fewer individual patients accessing care for diabetes and hypertension, respectively. Preventive care visits were substantially reduced, with 89.0% fewer periodic health exams and 16.2% fewer well-baby visits. During the pandemic, virtual care became the dominant care format (77.5% virtual visits). Visits for anxiety and depression were the most common reasons for a virtual visit (90.6% virtual visits). Conclusion The decrease in primary care visit volumes during the COVID-19 pandemic varied based on the reason for the visit, with increases in visits for anxiety and decreases for preventive care and visits for chronic diseases. Implications of increased demands for mental health services and gaps in preventive care and chronic disease management may require focused efforts in primary care.

Evaluating Virtual Care Experiences for Patients with Covid-19 Chief Complaints: Best-Practices Recommendations (Preprint)

2020 ◽  
Author(s):  
Saif Khairat ◽  
Malvika Pillai ◽  
Barbara Edson ◽  
Robert Gianforcaro
Keyword(s):  
Patient Experience ◽  
Wait Time ◽  
Secondary Outcome ◽  
Major Drawback ◽  
Cross Sectional ◽  
Average Wait Time ◽  
Adherence To Medication ◽  
Virtual Care ◽  
Chief Complaints ◽  
Virtual Visits

BACKGROUND Importance: Positive patient experiences are associated with illness recovery and adherence to medication. The shift toward virtual visits creates a need to understand the opportunities and challenges in providing a patient experience that is at least as positive as in-person visits. OBJECTIVE To evaluate the virtual care experience for patients with Covid-19 as their chief complaints. METHODS We conducted a cross-sectional study of the first cohort of patients with Covid-19 concerns in a virtual clinic. We collected data on all virtual visits between March 20-29, 2020. Outcomes: The main endpoints of this study were patient diagnosis, prescriptions received, referrals, wait time and duration, and satisfaction. The secondary outcome was the reported choice of alternative care options. RESULTS Of the 358 total virtual visits, 42 patients marked “Covid-19 Concern” as their chief complaint. Of those patients, 23 (54.8%) female patients, the average age of patients was 33.9 years, and 41 (97.7%) patients were seeking care for themselves and one (3.3%) visit was for a dependent. For all virtual visits, the average wait time (SD) was 157.2 (181.7) minutes and the average wait time (SD) for Covid-19 Concern visits was 177.4 (186.5) minutes. Covid-19 Concern phone visits had an average wait time (SD) of 180.1 (187.2), compared to 63.4 (34.4) minutes for Covid-19 Concern video visits. Thirteen (65%) patients rated their provider as “Excellent” with similar proportions among phone (64.3%) and video (66.7%). CONCLUSIONS This study evaluated the virtual experiences of patients with Covid-19 concerns. There were different experiences for patients depending on their choice of communication. Long wait times were a major drawback in the patient experience. We have learned from evaluating the experience of our first cohort of Covid-19 Concern patients.

scholarly journals Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037064 ◽  
Author(s):  
Vess Stamenova ◽  
Payal Agarwal ◽  
Leah Kelley ◽  
Jamie Fujioka ◽  
Megan Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secure Messaging ◽  
Communication Modality ◽  
Care Services ◽  
Virtual Care ◽  
Virtual Visits

ObjectivesTo evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care.DesignA retrospective cohort study.SettingPrimary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services.Participants326 primary care providers and 14 291 registered patients.InterventionsProviders used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication.Main outcome measuresUser-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients’ satisfaction.ResultsAmong the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again.ConclusionsWhile there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.

Medications for Alcohol Use Disorders in a Primary Care Practice-Based Research Network Implementation Study

2014 ◽  
Vol 32 (1) ◽  
pp. 58-66
Author(s):  
Andrea M. Wessell ◽  
Lynne S. Nemeth ◽  
Ruth G. Jenkins ◽  
Steven M. Ornstein ◽  
Peter M. Miller
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Primary Care Practice ◽  
Alcohol Use Disorders ◽  
Research Network ◽  
Care Practice ◽  
Implementation Study ◽  
Practice Based Research

Achievable Benchmarks of Care for Primary Care Quality Indicators in a Practice-Based Research Network

2008 ◽  
Vol 23 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Andrea M. Wessell ◽  
Heather A. Liszka ◽  
Paul J. Nietert ◽  
Ruth G. Jenkins ◽  
Lynne S. Nemeth ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Indicators ◽  
Care Quality ◽  
Research Network ◽  
Primary Care Quality ◽  
Practice Based Research

scholarly journals Utilizing Practice-Based Research Networks to Teach and Implement Quality Improvement in Academic Medicine

2020 ◽  
Vol 52 (9) ◽  
pp. 642-646
Author(s):  
Clarissa Hoff ◽  
Luisito Caleon ◽  
Grace Lee ◽  
Mathew Quan
Keyword(s):  
Quality Improvement ◽  
Family Medicine ◽  
Leadership Skills ◽  
Research Network ◽  
Improvement Project ◽  
Residency Programs ◽  
Before And After ◽  
Practice Based Research ◽  
Attending Physicians ◽  
Family Medicine Residents

Background and Objectives: A 2019 study found that between 2014 and 2017, family medicine residents had little improvement in self-assessed preparedness to lead quality improvement projects. This study explored the effectiveness of leveraging a practice-based research network (PBRN) across multiple family medicine residencies not only for implementing quality improvement projects, but also as a teaching tool designed to improve knowledge, attitudes, beliefs, and leadership skills in family medicine faculty and residents. Methods: Residents in family medicine residency programs and one community internal medicine program and family medicine teaching faculty participated in a PBRN-led quality improvement project (QIP) to improve colon cancer screening in their clinic. Of 101 participants, 79 (78%) were residents and 22 (22%) were faculty or attending physicians. Questions surveying participants’ knowledge and confidence related to QIP before and after the QIP were given. Results: Overall, participants reported an improvement in their basic understanding of QI concepts (P=.004). They also reported having sufficient staff and ancillary support to meaningfully participate (P=.033). Participants indicated they had more confidence in their ability to participate in a QI project (P=.002), initiate, design, and lead such a project (P=.001), and teach their peers and staff basic QI concepts (P<.001). Conclusions: PBRNs appear to be a unique way to subjectively improve residents’ confidence in their quality improvement skills. PBRNs should be further explored as a method for educating family medicine residents in quality improvement.

Abstract W P207: STOP STROKE©-A Novel Medical Application to Improve Coordination of Stroke Care: A Brief Report on Door to Thrombolysis Times After Initiating the Application

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Robert Dickson ◽  
Adrian Nedelcut
Keyword(s):  
Emergency Department ◽  
Rapid Assessment ◽  
Stroke Care ◽  
Medical Application ◽  
Secondary Outcome ◽  
Level Ii ◽  
Number Of Patients ◽  
Before And After ◽  
Patient Arrival ◽  
The Mean

Hypothesis: We hypothesized that introduction of a care coordination application to our emergency stroke care would improve time to thrombolysis in acute ischemic stroke (AIS). Introduction: The objective of our study was to evaluate the effect of the STOP STROKE© medical application on patient arrival to thrombolytic times for patients arriving at our emergency department with AIS. STOP STROKE© is a novel medical application developed by physicians to improve the coordination and communication tasks essential to rapid assessment and care of patients suffering from AIS. Methods: We conducted a retrospective review of the Good Shepherd Health System stroke dashboard between February 2012 and February 2014 (13 months prior to STOP STROKE© and 12 months after). The stroke dashboard is a quality improvement database for acute stroke activations in patients arriving to our level II emergency department with annual volumes of 90,000. We analyzed all data from CMS reportable cases receiving TPA for AIS during the study period. The primary outcome was mean Door-to- Needle (DTN) times before and after initiating STOP STROKE©. Secondary outcome was the effect on the DTN <60 min benchmark. Results: During the study period we had 533 stroke activations (200 pre-application and 333 post-application), representing an 80% increase in activations after the app. A total of 85 patients received TPA therapy for AIS (41 pre-application and 44 post-application). Of these, 17 cases were excluded that did not meet CMS criteria for reporting. We observed the mean D2N times post STOP STROKE© decreased 21 min (77 - 56min), a 28% improvement (p=0.001). Further, the patients meeting D2N < 60 min improved from 32% (11/34) to 82% (28/34) after the app. Conclusions: In this cohort of patients with AIS, STOP STROKE© improved mean D2N times and number of patients treated within 60 min of arrival. Further we saw an increase in total stroke activations. We conclude our results demonstrate the app’s effect of increasing awareness of suspected AIS and improved coordination of care, evidenced by the magnitude of its effect on treatment times.

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