New COVID-19 Research from Robert Graham Center Aims to Improve
Population Health During and After Pandemic
WASHINGTON, DC — In February 2021, the Journal of the American Board of Family Medicine published a special supplemental edition featuring new COVID-19 research, including five articles from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.
This latest research from the Robert Graham Center aims to improve individual and population health. both during and after the COVID-19 pandemic, by enhancing the delivery of primary care. The following articles are available now:
Policy Brief: COVID-19 Timeline: Centers for Medicare and Medicaid Services Changes and Primary Care Support Were Not Enough to Prevent Practice Losses
Christian Gausvik, MD, and Yalda Jabbarpour, MD
Many scholars correctly predicted that the U.S. health care system was not prepared to effectively handle a pandemic such as COVID-19. Although the focus of the shortcomings of the U.S. health care system has been on lack of personal protective equipment and ICU capacity, the lack of support for primary care has been devastating. Surveys by the Larry A. Green Center and Primary Care Collaborative, as well as the American Academy of Family Physicians National Research Network, have consistently shown that primary care practices continue to struggle financially because of the pandemic, with many laying off staff or closing their practices. Modeling analysts predict this could exacerbate primary care shortages nationwide.
Although the reasons for this financial impact are multifactorial and cannot be blamed on any single entity, researchers at the Robert Graham Center sought to understand how the timeline of policy changes by the Center for Medicare and Medicaid Services may have impacted primary care practices in the U.S., with a focus on reimbursement and telehealth changes.
Commentary: Site of Care for COVID-19 Like Illness
John M Westfall, MD, MPH; Anuradha Jetty, MPH; Stephen Petterson, PhD; and Yalda Jabbarpour, MD
While there are additional COVID-19 symptoms beyond upper and lower respiratory conditions, patients have historically received most of their respiratory care from primary care physicians, with family physicians caring for a majority of patients in rural and underserved areas.
Primary care physicians will likely continue to play an important frontline role in diagnosing COVID-19 infection, providing care and treatment, and offering crucial triage for patients with moderate to severe disease. Policies related to primary care payment, federal relief efforts, PPE access, testing and follow-up capacity, and telehealth technical support are essential so primary care can provide first contact and continuity for their patients and communities throughout the COVID-19 pandemic response and recovery.
Original Research: Capacity of Primary Care to Deliver Telehealth in the United States
Anuradha Jetty, MPH; Yalda Jabbarpour, MD; Matthew Westfall, BA; Douglas B Kamerow, MD, MPH; Stephen Petterson, PhD; John Westfall, MD, MPH
The COVID-19 pandemic has led many U.S. primary care practices to implement telehealth visits to keep patients at home and prevent the spread of infection in the health care setting. Given the change in care delivery, it is essential to understand what primary care services and visits could be done via telehealth. This study demonstrates that 46% (check me on that) of primary care visits could be done via telehealth modalities
However, many patients do not have access to the technology required to sustain video visits with their physician. Other reasons for demographic disparities in telehealth use include mistrust in the use of technology for obtaining care, poor health literacy, or lack of technical skills in seeking health care. This study found that patients aged 65 and older and those with chronic conditions are less likely to engage in telehealth.
These findings from the Robert Graham Center underscore the importance of patient education and training in the use of telehealth services, as well as equitable funding for telephone visits, to ensure that patients with the highest medical and social needs are not disproportionately affected by the pandemic.
Family Medicine and the Health Care System: Uniting Public Health and Primary Care for Healthy Communities in the COVID-19 Era and Beyond
John M. Westfall, MD, MPH; Winston Liaw, MD; Kim Griswold, MD, MPH, RN; Kurt Stange, MD, PhD, Larry A. Green, MD; Robert Phillips, MD, MSPH, Andrew Bazemore, MD, MPH; Carlos Roberto Jaén, MD, PhD, Lauren S. Hughes, MD, MPH, Jennifer DeVoe, MD; Heidi Gullett, MD; James C. Puffer, MD; Robin S. Gotler, MA
The COVID-19 pandemic has exposed some of the greatest weaknesses in the U.S. health care system. Decades of neglect and dwindling support for public health, coupled with declining access to primary care medical services, have left many vulnerable communities without adequate COVID-19 response and recovery capacity.
A powerful proposal for a health care system that engaged primary care leadership within a broad, community public health framework was developed in the 1966 report, “Health is a Community Affair,” and updated in 2012. The report was the result of a 3-year study of healthy communities framed on the notion of “communities of solution,” defined as a group of community members who come together to address an important problem or seize an opportunity to improve health. In addition to community members, primary care clinicians, and public health professionals, communities of solution include an array of public and private partners and community-based organizations depending on the nature of the problem and the community.
The 1966 report’s visionary recommendations were only temporarily embraced and not widely implemented. However, after decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in Health is a Community Affair still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.
Brief Report: Not Telehealth: What Primary Care Visits Need In-Person Care?
Yalda Jabbarpour, MD; Anuradha Jetty, MPH; Matthew Westfall; John Westfall, MD MPH
The COVID-19 pandemic has resulted in a rapid shift to telehealth, and many services that need in-person care have been delayed or avoided. The question now becomes, “What services can be performed via telehealth, and which cannot?”
Using the 2016 National Ambulatory Medical Survey, Robert Graham Center researchers estimated what proportion of visits were amenable to telehealth prior to COVID-19 as a guide. They divided services into those that needed in-person care and those that could be done via telehealth. Any visit that included at least one service where in-person care was needed was counted as an “in-person only” visit.
The researchers found that 66 percent of all primary care visits reported in NAMCS in 2016 required an in-person service. Ninety percent of all wellness visits and immunizations were done in primary care offices, as were a quarter of all pap smears. As practices reopen, patients will need to catch up on services such as these that were postponed. At the same time, the authors write, patients and clinicians now accustomed to telehealth may have reservations about returning to in-person only environment. This work serves to guide practices as they navigate how to deliver care in a post COVID-19 environment.
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The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.
Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP. Learn more about Robert Graham Center.