PCR058: Primary Care Clinical Experience During a Pandemic: A Model For Medical Crisis Planning

Rodney Erickson, MD; Erin Westfall, DO; Augustine Chavez; Susan Laabs; Thomas Thacher, MD

Abstract

Context: In the aftermath of large disasters such as hurricanes and earthquakes which result in mass casualties and infrastructure disruption, within days primary care becomes an essential element in the recovery of health care services. Both acute and chronic care needs are crucial, followed quickly by the need for mental health services. In the US the COVID pandemic left greater than 30 million infected, over 500,000 dead, and millions suffering. It disrupted health care at all levels. Even as it was surging and those in primary care were assisting with a spectrum of acute care needs, the residual effects, both direct and indirect, appeared. Objective: This study was to identify the roles of primary care clinicians in managing patients during the COVID pandemic and common problems patients were presenting with directly and indirectly due to COVID. Study Design: An intranet survey was sent to members of the system’s primary care learning collaborative. Questions were multiple answer with options for open-ended answers. Setting: Large health system, during and immediately following the largest surge at the study sites. Population: Learning collaborative membership consisting of physicians, nurse practitioners, and physician assistants. Instrument: Brief intranet survey. Outcome measures: Identify common and unique problems being managed by primary care clinicians (PCC’s) across the health system. Results: 94/191 responded (49%). Post-COVID with ongoing problems (83%) were seen by the most PCC’s, followed by post-COVID asymptomatic (79%), acute COVID outpatient (69%), and remote monitoring (56%). Pandemic related non-COVID problems were reported by increases in anxiety (96%), depression (93%), loneliness (87%), delayed/deferred chronic care (79%) and cancer screening (76%). Common COVID related problems reported by PCC’s included loss of smell (69%), fatigue (60%), dyspnea (39%), and Post COVID Syndrome (30%). Conclusions: In the midst of the pandemic, during the largest regional surges, post-illness care was the COVID related problem identified by most clinicians as a primary care concern. Psychological distress and delayed care due to social and healthcare infrastructure disruption were major non-COVID problems. Although on a larger scale, the pattern of primary care needs during the pandemic followed previous patterns in other disasters. Understanding these basic principles will allow health care leaders to better address future health crises.
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Jack Westfall
jwestfall@aafp.org 11/20/2021

This is a great topic and research study. Nice work. Thanks

Rod Erickson
erickson.rodney@mayo.edu 11/22/2021

Thanks, we had the second author do all the work. she comes from a family of workaholics

Rod Erickson
11/22/2021

Oops, was supposed to say third author, forgot which paper. Actually Erin and Susan are both Godsends for our group. They are the Mankato Mafia. They get the job done

Diane Harper
harperdi@med.umich.edu 11/21/2021

You have a large already made network for research. This is one great example of how you are documenting primary care. Expand and tackle many more topics in the future!

Rod Erickson
11/22/2021

It's an awesome group, 84% are community docs. Real blessing

Ann Macaulay
ann.macaulay@mcgill.ca 11/22/2021

Key research - any chance of increasing response rates next time?

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/23/2021

This is such an interesting perspective and take on this pandemic. I also appreciate you have a mafia...er...great team :)

Andy Pasternak
avpiv711@sbcglobal.net 11/28/2021

Great job capturing this data during the pandemic. Had to be difficult!

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