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How have primary care doctors adapted to the pandemic?

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Shifts in care delivery methods have been the main theme of primary care changes during the COVID-19 pandemic. With most of the US ordered to stay at home for several months this spring, patients and their primary care providers are adapting to new ways of conducting the typical office visit. The use of telehealth, in particular, has increased significantly in recent months.

Several studies have been conducted to determine how primary care providers are adapting during the pandemic. A professor of management, healthcare systems, and health policy at Northeastern University, Timothy Hoff, has been following doctors in New York to study how they’ve adapted to their new reality. New York has been one of the hardest-hit states, especially at the start of the pandemic.

The doctors that Hoff has been studying serve different types of communities and represent a range of experiences. Some of the providers have been practicing medicine for decades while others are relatively new to the field. The doctors work in urban as well as rural settings.

Hoff noted, “What has struck me already is just the level of resilience that all of these physicians have shown. These healthcare professionals have had to think in brand new ways, or adopt new systems and behaviors, in order to care for their patients.”

“Part of what we’re seeing here is doctors who know their patients very well, who have long-standing relationships with their patients, really stepping up to figure out how to care for them,” he says. “And so, what that means for the future of primary care is a really interesting question.”

Examples from Hoff’s study include a rural setting in upstate New York where physicians and nursing staff installed a Wi-Fi hotspot in their parking lot so their patients could use their phones and other electronic devices for virtual appointments. Many of the doctors have had to set up telehealth systems to deliver care to their patients.

Adaptation and innovation have been key to quality healthcare delivery for these providers. One physician conducted exams in the back of his patients’ pickup trucks, fully protected in personal protective equipment. Another provider in the study was able to correctly diagnose a fractured hip in an elderly patient during a virtual visit.

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A separate study conducted by researchers at New York University (NYU) found that many of that city’s primary care practices have been hit hard by the effects of the COVID-19 pandemic and they worry about their survival. Out of almost 500 primary care practices participating in the survey, 85% indicated the pandemic was having a severe impact on them. More than half of the patient visits conducted by those primary care practices that have been able to remain open were conducted by video or telephone.

Dr. Donna Shelley, professor of public health policy and management at the NYU School of Global Public Health, who is leading the research, said, “We all understand that the crisis is at the hospital level, but what’s remarkable is that in the midst of this overwhelming crisis of hospitalizations, people were forgetting there are other front line healthcare workers, and they’re called primary care doctors and nurses.”

Telehealth is becoming the norm for primary care visits. The AMA reports that physicians are now seeing 50 to 175 times the number of patients via telehealth than they did before the pandemic. 46% of patients are now using telehealth to replace the in-person visits that have been canceled because of COVID-19. In addition, 57% of providers view telehealth more favorably than before COVID-19 and 64% report that they are more comfortable using it.

With the Centers for Medicare & Medicaid Services (CMS) temporarily allowing more than 80 new services to be conducted via telehealth, consumers’ preferences for telehealth could become more deeply embedded into the care delivery system while the nation continues to social distance during this health emergency.