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Ekeleme N, Yusuf A, Kastner M, Waite K, Montesanti S, Atherton H, Salvalaggio G, Langford L, Sediqzadah S, Ziegler C, Do Amaral T, Melamed OC, Selby P, Kelly M, Anderson E, O'Neill B. Guidelines and recommendations about virtual mental health services from high-income countries: a rapid review. BMJ Open 2024; 14:e079244. [PMID: 38388504 PMCID: PMC10884256 DOI: 10.1136/bmjopen-2023-079244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES This study reviewed existing recommendations for virtual mental healthcare services through the quadruple aim framework to create a set of recommendations on virtual healthcare delivery to guide the development of Canadian policies on virtual mental health services. DESIGN We conducted a systematic rapid review with qualitative content analysis of data from included manuscripts. The quadruple aim framework, consisting of improving patient experience and provider satisfaction, reducing costs and enhancing population health, was used to analyse and organise findings. METHODS Searches were conducted using seven databases from 1 January 2010 to 22 July 2022. We used qualitative content analysis to generate themes. RESULTS The search yielded 40 articles. Most articles (85%) discussed enhancing patient experiences, 55% addressed provider experiences and population health, and 25% focused on cost reduction. Identified themes included: screen patients for appropriateness of virtual care; obtain emergency contact details; communicate transparently with patients; improve marginalised patients' access to care; support health equity for all patients; determine the cost-effectiveness of virtual care; inform patients of insurance coverage for virtual care services; increase provider training for virtual care and set professional boundaries between providers and patients. CONCLUSIONS This rapid review identified important considerations that can be used to advance virtual care policy to support people living with mental health conditions in a high-income country.
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Affiliation(s)
- Ngozichukwuka Ekeleme
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Karen Waite
- Population Health and Value-based Health Systems, Ontario Health, Toronto, Ontario, Canada
| | | | | | | | - Lucie Langford
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Saadia Sediqzadah
- Department of Psychiatry, Unity Health Toronto, Toronto, Ontario, Canada
| | - Carolyn Ziegler
- Health Sciences Library, Unity Health Toronto, Toronto, Ontario, Canada
| | - Tamara Do Amaral
- Population Health and Value-based Health Systems, Ontario Health, Toronto, Ontario, Canada
| | - Osnat C Melamed
- Addictions Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Addiction Programs, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Martina Kelly
- Department of Family Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | | | - Braden O'Neill
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Senthinathan A, Tu K, Stephenson E, O'Neill B, Lipscombe L, Ji C, Butt DA, Apajee J, Train A, Crampton N. A comparison between different patient groups for diabetes management during phases of the COVID-19 pandemic: a retrospective cohort study in Ontario, Canada. BMC PRIMARY CARE 2024; 25:43. [PMID: 38280984 PMCID: PMC10821561 DOI: 10.1186/s12875-024-02272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND With the onset of the COVID-19 pandemic and the large uptake in virtual care in primary care in Canada, the care of patients with type 2 diabetes has been greatly affected. This includes decreased in-person visits, laboratory testing and in-person assessments such as blood pressure (BP). No studies have investigated if these changes persisted with pandemic progression, and it is unclear if shifts impacted patient groups uniformly. The purpose of this paper was to examine changes in diabetes care pre, early, and later pandemic across different patient groups. METHODS A repeated cross-sectional design with an open cohort was used to investigate diabetes care in adults with type 2 diabetes for a 6-month interval from March 14 to September 13 over three consecutive years: 2019 (pre-pandemic period), 2020 (early pandemic period), and 2021 (later pandemic period). Data for this study were abstracted from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a primary care electronic medical records database in Ontario, Canada. Changes in diabetes care, which included primary care total visits, in-person visits, hemoglobin A1c (HbA1c) testing, and BP measurements were evaluated across the phases of the pandemic. Difference in diabetes care across patient groups, including age, sex, income quintile, prior HbA1c levels, and prior BP levels, were assessed. RESULTS A total of 39,401 adults with type 2 diabetes were included in the study. Compared to the 6-month pre-pandemic period, having any in-person visits decreased significantly early pandemic (OR = 0.079 (0.076-0.082)), with a partial recovery later pandemic (OR = 0.162 (95% CI: 0.157-0.169). Compared to the pre-pandemic period, there was a significant decrease early pandemic for total visits (OR = 0.486 (95% CI: 0.470-0.503)), HbA1c testing (OR = 0.401 (95% CI: 0.389-0.413)), and BP measurement (OR = 0.121 (95% CI: 0.116-0.125)), with partial recovery later pandemic. CONCLUSIONS All measures of diabetes care were substantially decreased early pandemic, with a partial recovery later pandemic across all patient groups. With the increase in virtual care due to the COVID-19 pandemic, diabetes care has been negatively impacted over 1-year after pandemic onset.
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Affiliation(s)
- A Senthinathan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - K Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - E Stephenson
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - B O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, LiKa Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - C Ji
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - D A Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Scarborough Health Network, Toronto, ON, Canada
| | - J Apajee
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - A Train
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - N Crampton
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
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Siu C, Stephenson E, Christie CD, Selby P, Tu K. The impact of the COVID-19 pandemic on the rate of primary care visits for substance use among patients in Ontario, Canada. PLoS One 2023; 18:e0288503. [PMID: 38127861 PMCID: PMC10734921 DOI: 10.1371/journal.pone.0288503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/27/2023] [Indexed: 12/23/2023] Open
Abstract
The COVID-19 pandemic has led to an increase in the prevalence of substance use presentations. This study aims to assess the impact of the COVID-19 pandemic on the rate of primary care visits for substance use including tobacco, alcohol, and other drug use among primary care patients in Ontario, Canada. Diagnostic and service fee code data were collected from a longitudinal cohort of family medicine patients during pre-pandemic (March 14, 2019-March 13, 2020) and pandemic periods (March 14, 2020-March 13, 2021). Generalized linear models were used to compare the rate of substance-use related visits pre-pandemic and during the pandemic. The effects of demographic characteristics including age, sex, and income quintile were also assessed. Relative to the pre-pandemic period, patients were less likely to have a primary care visit during the pandemic for tobacco-use related reasons (OR = 0.288, 95% CI [0.270-0.308]), and for alcohol-use related reasons (OR = 0.851, 95% CI [0.780-0.929]). In contrast, patients were more likely to have a primary care visit for other drug-use related reasons (OR = 1.150, 95% CI [1.080-1.225]). In the face of a known increase in substance use during the COVID-19 pandemic, a decrease in substance use-related primary care visits likely represents an unmet need for this patient population. This study highlights the importance of continued research in the field of substance use, especially in periods of heightened vulnerability such as during the COVID-19 pandemic.
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Affiliation(s)
- Colin Siu
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Ellen Stephenson
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chelsea D. Christie
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Research Institute and Krembil Centre for Neuroinformatics, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karen Tu
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
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Toulany A, Kurdyak P, Stukel TA, Strauss R, Fu L, Guan J, Fiksenbaum L, Cohen E, Guttmann A, Vigod S, Chiu M, Moore Hepburn C, Moran K, Gardner W, Cappelli M, Sundar P, Saunders N. Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:904-915. [PMID: 36855797 PMCID: PMC9982398 DOI: 10.1177/07067437231156254] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. METHODS This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status. RESULTS Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata. CONCLUSION During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.
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Affiliation(s)
- Alene Toulany
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Paul Kurdyak
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Therese A. Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Lisa Fiksenbaum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Simone Vigod
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital and Women's College Research Institute, Toronto, Canada
| | - Maria Chiu
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Mario Cappelli
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Purnima Sundar
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Natasha Saunders
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
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Senthinathan A, Thompson W, Gomes Z, Kiflen M, Bonilla AO, Stephenson E, Butt D, O’Neill B, Udell JA, Tu K. Assessing Primary Care Blood Pressure Documentation for Hypertension Management During the COVID-19 Pandemic by Patient and Provider Groups. CJC Open 2023; 5:916-924. [PMID: 38204848 PMCID: PMC10774078 DOI: 10.1016/j.cjco.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/10/2023] [Indexed: 01/12/2024] Open
Abstract
Background Primary care electronic medical record (EMR) data can be used to identify, manage, and screen hypertension cases. However, this approach relies on completeness and accessibility of documented blood pressure (BP) values. With the large switch to virtual care due to the COVID-19 pandemic, we assessed BP documentation in primary care EMRs during the pandemic, across patient and physician groups. Methods Hypertension-related visits were identified during the pre-pandemic (January 2017 to February 2020) and pandemic (March 2020 to December 2021) periods from a primary care EMR database in Ontario, Canada. Clustered logistic regression models were used to analyze the relationship of physician and patient characteristics with an outcome variable of documented BP. A chart review of 3200 hypertension visits without a BP recorded in structured data fields was conducted to determine if BP was recorded in progress notes. Results Pre-pandemic, 75.7% of hypertension-related visits (113,966 of 150,511) had a BP recorded in structured documentation, but this significantly decreased to 36.4% (26,660 of 73,239) during the pandemic (odds ratio [OR] = 0.18, 95% confidence interval [CI]: 0.18-0.19). For virtual visits, 14.3% (6357 of 44,572) had a documented BP, vs 74.0% (20,056 of 27,089) for in-person visits. Chart review found that 55.9% of hypertension visits had no associated BP in structured documentation, but did have a BP recorded in the progress note. Male providers, compared to female providers, were less likely to record BPs pre-pandemic (OR = 0.45, 95% CI: 0.32-0.63) and during the pandemic, for both virtual visits (OR = 0.48, 95% CI: 0.32-0.71) and in-person visits (OR = 0.46, 95% CI: 0.33-0.64). Conclusions BP documented in primary care EMRs declined during the pandemic, most likely due to high rates of virtual visits impacting hypertension detection and management.
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Affiliation(s)
- Arrani Senthinathan
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wade Thompson
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Women’s College Hospital, Toronto, Ontario, Canada
| | - Zoya Gomes
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michel Kiflen
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela Ortigoza Bonilla
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ellen Stephenson
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Debra Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Scarborough Health Network, Toronto, Ontario, Canada
| | - Braden O’Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jacob A. Udell
- Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada
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Fikree S, Hafid S, Lawson J, Agarwal G, Griffith LE, Jaakkimainen L, Mangin D, Howard M. The association between patients' frailty status, multimorbidity, and demographic characteristics and changes in primary care for chronic conditions during the COVID-19 pandemic: a pre-post study. Fam Pract 2023; 40:523-530. [PMID: 37624946 DOI: 10.1093/fampra/cmad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess the impact of SARS-COV-2 (Severe acute respiratory syndrome coronavirus 2) pandemic on primary care management (frequency of monitoring activities, regular prescriptions, and test results) of older adults with common chronic conditions (diabetes, hypertension, and chronic kidney disease) and to examine whether any changes were associated with age, sex, neighbourhood income, multimorbidity, and frailty. METHODS A research database from a sub-set of McMaster University Sentinel and Information Collaboration family practices was used to identify patients ≥65 years of age with a frailty assessment and 1 or more of the conditions. Patient demographics, chronic conditions, and chronic disease management information were retrieved. Changes from 14 months pre to 14 months since the pandemic were described and associations between patient characteristics and changes in monitoring, prescriptions, and test results were analysed using regression models. RESULTS The mean age of the 658 patients was 75 years. While the frequency of monitoring activities and prescriptions related to chronic conditions decreased overall, there were no clear trends across sub-groups of age, sex, frailty level, neighbourhood income, or number of conditions. The mean values of disease monitoring parameters (e.g. blood pressure) did not considerably change. The only significant regression model demonstrated that when controlling for all other variables, patients with 2 chronic conditions and those with 4 or more conditions were twice as likely to have reduced numbers of eGFR (Estimated glomerular filtration rate) measures compared to those with only 1 condition ((OR (odds ratio) = 2.40, 95% CI [1.19, 4.87]); (OR = 2.19, 95% CI [1.12, 4.25]), respectively). CONCLUSION In the first 14 months of the pandemic, the frequency of common elements of chronic condition care did not notably change overall or among higher-risk patients.
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Affiliation(s)
- Shireen Fikree
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Shuaib Hafid
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Jennifer Lawson
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Liisa Jaakkimainen
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Canada
- Department of General Practice and Clinical Skills, University of Otago Christchurch, New Zealand
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Canada
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7
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Senthinathan A, Tadrous M, Hussain S, Craven BC, Jaglal SB, Moineddin R, Shepherd J, Cadel L, Noonan VK, McKay S, Tu K, Guilcher SJT. Examining the impact of COVID-19 on health care utilization among persons with chronic spinal cord injury/dysfunction: a population study. Spinal Cord 2023; 61:562-569. [PMID: 37660208 DOI: 10.1038/s41393-023-00930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
STUDY DESIGN A retrospective longitudinal cohort time-series analysis study. OBJECTIVES To examine healthcare utilization and delivery during the COVID-19 pandemic in individuals with spinal cord injury/dysfunction (SCI/D). SETTING Health administrative database in Ontario, Canada. METHODS In 5754 individuals with SCI/D diagnosed from 2004-2014 and living in the community, healthcare utilization (physician visits, primary care visits, specialist visits, urologist visits, physiatrist visits, emergency department (ED) visits, and hospital admissions) and delivery (total, in-person, virtual) were determined at the (1) pre-pandemic period (March 2015 to February 2020), (2) initial pandemic onset period (March 2020-May 2020), and (3) pandemic period (June 2020 to March 2022). Autoregressive integrated moving average (ARIMA) modelling was conducted to determine the impact of the pandemic on monthly healthcare utilization and delivery. RESULTS The initial pandemic onset period had a significant reduction of 24% in physicians (p = 0.0081), 35% in specialists (p < 0.0001), and 30% in urologist (p < 0.0001) visits, compared to pre-pandemic levels, with a partial recovery as the pandemic progressed. In April 2020, compared to the pre-pandemic period, a significant increase (p < 0.0001) in virtual visits for physicians, specialists, urologists, and primary care was found. The initial pandemic onset period had a 58% decrease in hospital admissions (p = 0.0011), compared to the pre-pandemic period. CONCLUSION Healthcare utilization dropped in the initial pandemic onset period as physicians, specialists, and urologists, as well as hospitalization visits decreased significantly (p < 0.05) versus pre-pandemic levels. Virtual visit increases compensated for in-person visit decreases as the pandemic progressed to allow for total visits to partially recover.
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Affiliation(s)
- Arrani Senthinathan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Mina Tadrous
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Swaleh Hussain
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - B Catharine Craven
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Susan B Jaglal
- ICES, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - John Shepherd
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | | | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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8
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McDougall A, Fortier JH, Zhang C, Ehrat C, Best K, Blois H, Garber G. Family physicians' questions about the COVID-19 pandemic: a content analysis of 2,272 helpline calls. BMC PRIMARY CARE 2023; 24:192. [PMID: 37726697 PMCID: PMC10510291 DOI: 10.1186/s12875-023-02147-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, family physicians faced challenges including travel restrictions for patients, lockdowns, diagnostic testing delays, and changing public health guidelines. Given that 95% of Canadian physicians are members of the Canadian Medical Protective Association (CMPA), the CMPA's telephone helpline - which offers peer-to-peer support - provides valuable insights into family physicians' experiences during the pandemic. METHODS We used a content analysis approach to identify and understand family physicians' questions and concerns related to the COVID-19 pandemic expressed during calls to the Canadian Medical Protective Association (CMPA) telephone helpline. Calls were classified with preliminary codes and subsequently organized into themes. We collected aggregated data on calls, including province, call date, and whether the physician self-identified having hospital-based activities as part of their practice. Findings from the analysis were explored alongside family physician calls per month (call volume). RESULTS Between 01 and 2020 and 31 December 2021, 2,272 family physician calls related to the pandemic were included for content analysis. We identified six major themes across these calls: challenging patient interactions; COVID-related care; the impact of the pandemic on the healthcare system; virtual care; physician obligations and rights; and public health matters. COVID-related call volumes were highest early in the pandemic especially among physicians without major hospital affiliation when family physicians practiced with little guidance on how to balance patient care and scarce resources in the face of a novel pandemic. CONCLUSIONS This research provides unique insight on the effects the COVID-19 pandemic had on family medicine in Canada. These results provide insights on the needs and information gaps of family physicians in a public health crisis and can inform preparedness efforts by public health agencies, professional organizations, educators, and practitioners.
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Affiliation(s)
- Allan McDougall
- Faculty of Education, University of Ottawa, Ottawa, ON, Canada
- The Canadian Medical Protective Association, Ottawa, ON, Canada
| | | | - Cathy Zhang
- The Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Caroline Ehrat
- The Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Kerri Best
- The Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Heather Blois
- The Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Gary Garber
- The Canadian Medical Protective Association, Ottawa, ON, Canada.
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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9
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Irimata KE, Pleis JR, Heslin KC, He Y. Reduced Access to Preventive Care Due to the COVID-19 Pandemic, by Chronic Disease Status and Race and Hispanic Origin, United States, 2020-2021. Public Health Rep 2023; 138:341-348. [PMID: 36524404 PMCID: PMC9760498 DOI: 10.1177/00333549221138855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has disproportionately affected racial and ethnic minority populations in the United States. The National Center for Health Statistics adapted the Research and Development Survey (RANDS), a commercial panel survey, to track selected health outcomes during the pandemic using the series RANDS during COVID-19 (RC-19). We examined access to preventive care among adults by chronic condition status, race, and Hispanic origin. METHODS NORC at the University of Chicago conducted RC-19 among US adults in 3 rounds (June-July 2020 [round 1, N = 6800], August 2020 [round 2, N = 5981], and May-June 2021 [round 3, N = 5458]) via online survey and telephone. We evaluated reduced access to ≥1 type of preventive care due to the pandemic in the past 2 months for each round by using logistic regression analysis stratified by chronic condition status and race and Hispanic origin, adjusting for sociodemographic and health variables. RESULTS Overall, 35.8% of US adults reported missing ≥1 type of preventive care in the previous 2 months in round 1, 26.0% in round 2, and 11.2% in round 3. Reduced access to preventive care was significantly higher among adults with ≥1 chronic condition (vs no chronic conditions) in rounds 1 and 2 (adjusted odds ratios [aOR)] = 1.5 and 1.4, respectively). Compared with non-Hispanic White adults, non-Hispanic Black adults reported significantly lower reduced access to preventive care in round 1 (aOR = 0.7), and non-Hispanic Other adults reported significantly higher reduced access to preventive care in round 2 (aOR = 1.5). CONCLUSIONS Our findings may inform policies and programs for people at risk of reduced access to preventive care.
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Affiliation(s)
- Katherine E. Irimata
- Division of Research and Methodology,
National Center for Health Statistics, Centers for Disease Control and Prevention,
Hyattsville, MD, USA
- Katherine E. Irimata, PhD, National Center
for Health Statistics, Division of Research and Methodology, 3311 Toledo Rd,
Hyattsville, MD 20782, USA.
| | - John R. Pleis
- Division of Research and Methodology,
National Center for Health Statistics, Centers for Disease Control and Prevention,
Hyattsville, MD, USA
| | - Kevin C. Heslin
- Division of Viral Hepatitis, National
Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control
and Prevention, Atlanta, GA, USA
| | - Yulei He
- Division of Research and Methodology,
National Center for Health Statistics, Centers for Disease Control and Prevention,
Hyattsville, MD, USA
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10
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Melamed OC, Kalia S, Moineddin R, Greiver M, Kloiber S, Mulsant BH, Selby P, O'Neill BG. Factors Associated With Initiation of Antidepressant Medication in Adults With Type 1 and Type 2 Diabetes: A Primary Care Retrospective Cohort Study in Ontario, Canada. Can J Diabetes 2023; 47:11-18. [PMID: 35933314 DOI: 10.1016/j.jcjd.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/08/2022] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Depression in patients with diabetes mellitus is common and associated with poorer outcomes. This study aims to identify demographic, socioeconomic and medical factors associated with the initiation of antidepressant medication after a diagnosis of diabetes in adult patients without a previous prescription for antidepressants. We also examined frequency of primary care visits in the year after antidepressant initiation compared with the year before treatment began. METHODS This was a retrospective cohort study using routinely collected electronic medical record data spanning January 2011 to December 2019 from the University of Toronto Practice-based Research Network (UTOPIAN) Data Safe Haven. Our primary outcome was a first prescription for an antidepressant in patients with diabetes. We used a mixed-effects logistic regression model to identify sociodemographic and medical factors associated with this event. RESULTS Among 22,750 patients with diabetes mellitus, 3,055 patients (13.4%) began taking an antidepressant medication. Increased odds of antidepressant initiation were observed in younger patients (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39 to 2.26), females (OR, 1.60; 95% CI, 1.46 to 1.7), those receiving insulin treatment (OR, 1.59; 95% CI, 1.43 to 1.78) and cases of polypharmacy (OR, 3.67; 95% CI, 3.29 to 4.11). There was an increase in the mean number of primary care visits from 4.6 to 5.9 per year after antidepressant initiation. CONCLUSIONS In patients with diabetes, age, sex and medical characteristics were associated with the initiation of antidepressants. These patients accessed primary care more frequently. Screening and prevention of depression, particularly in these subgroups, could reduce its personal and systemic burdens.
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Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Sumeet Kalia
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Braden G O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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11
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Butt DA, Stephenson E, Kalia S, Moineddin R, Tu K. Patient visits and prescriptions for attention-deficit/hyperactivity disorder from 2017-2021: Impacts of COVID-19 pandemic in primary care. PLoS One 2023; 18:e0281307. [PMID: 36913355 PMCID: PMC10010552 DOI: 10.1371/journal.pone.0281307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/20/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine whether more patients presented with Attention-deficit/hyperactivity disorder (ADHD)-related visits and/or sought care from family physicians more frequently during the COVID-19 pandemic. METHODS Electronic medical records from the University of Toronto Practice-Based Research Network were used to characterize changes in family physician visits and prescriptions for ADHD medications. Annual patient prevalence and visit rates pre-pandemic (2017-2019) were used to calculate the expected rates in 2020 and 2021. The expected and observed rates were compared to identify any pandemic-related changes. RESULTS The number of patients presenting for ADHD-related visits during the pandemic was consistent with pre-pandemic trends. However, observed ADHD-related visits in 2021 were 1.32 times higher than expected (95% CI: 1.05-1.75), suggesting that patients visited family physicians more frequently than before the pandemic. CONCLUSION Demand for primary care services related to ADHD has continued to increase during the pandemic, with increased health service use among those accessing care.
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Affiliation(s)
- Debra A. Butt
- Department of Family and Community Medicine, Scarborough General Hospital, Scarborough Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Ellen Stephenson
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sumeet Kalia
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Research and Innovation, Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
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12
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Turner K, Brownstein NC, Whiting J, Arevalo M, Islam JY, Vadaparampil ST, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 Pandemic on Women's Health Care Access: A Cross-Sectional Study. J Womens Health (Larchmt) 2022; 31:1690-1702. [PMID: 36318766 PMCID: PMC9805885 DOI: 10.1089/jwh.2022.0128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There has been limited study of how the COVID-19 pandemic has affected women's health care access. Our study aims to examine the prevalence and correlates of COVID-19-related disruptions to (1) primary care; (2) gynecologic care; and (3) preventive health care among women. Materials and Methods: We recruited 4,000 participants from a probability-based online panel. We conducted four multinomial logistic regression models, one for each of the study outcomes: (1) primary care access; (2) gynecologic care access; (3) patient-initiated disruptions to preventive visits; and (4) provider-initiated disruptions to preventive visits. Results: The sample included 1,285 women. One in four women (28.5%) reported that the pandemic affected their primary care access. Sexual minority women (SMW) (odds ratios [OR]: 1.67; 95% confidence intervals [CI]: 1.19-2.33) had higher odds of reporting pandemic-related effects on primary care access compared to women identifying as heterosexual. Cancer survivors (OR: 2.07; 95% CI: 1.25-3.42) had higher odds of reporting pandemic-related effects on primary care access compared to women without a cancer history. About 16% of women reported that the pandemic affected their gynecologic care access. Women with a cancer history (OR: 2.34; 95% CI: 1.35-4.08) had higher odds of reporting pandemic-related effects on gynecologic care compared to women without a cancer history. SMW were more likely to report patient- and provider-initiated delays in preventive health care. Other factors that affected health care access included income, insurance status, and having a usual source of care. Conclusions: The COVID-19 pandemic disrupted women's health care access and disproportionately affected access among SMW and women with a cancer history, suggesting that targeted interventions may be needed to ensure adequate health care access during the COVID-19 pandemic.
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Affiliation(s)
- Kea Turner
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T. Vadaparampil
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Cathy D. Meade
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Clement K. Gwede
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Shannon M. Christy
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
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13
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Stephenson E, Yusuf A, Gronsbell J, Tu K, Melamed O, Mitiku T, Selby P, O'Neill B. Disruptions in Primary Care among People with Schizophrenia in Ontario, Canada, During the COVID-19 Pandemic. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022:7067437221140384. [PMID: 36453004 PMCID: PMC9720063 DOI: 10.1177/07067437221140384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To investigate how primary care access, intensity and quality of care changed among patients living with schizophrenia before and after the onset of the COVID-19 pandemic in Ontario, Canada. METHODS This cohort study was performed using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN), a network of > 500 family physicians in Ontario, Canada. Data were collected during primary care visits from 2643 patients living with schizophrenia. Rates of primary care health service use (in-person and virtual visits with family physicians) and key preventive health indices indicated in antipsychotic monitoring (blood pressure readings, hemoglobin A1c, cholesterol and complete blood cell count [CBC] tests) were measured and compared in the 12 months before and after onset of the COVID-19 pandemic. RESULTS Access to in-person care dropped with the onset of the COVID-19 pandemic. During the first year of the pandemic only 39.5% of patients with schizophrenia had at least one in-person visit compared to 81.0% the year prior. There was a corresponding increase in virtual visits such that 78.0% of patients had a primary care appointment virtually during the pandemic period. Patients prescribed injectable antipsychotics were more likely to continue having more frequent in-person appointments during the pandemic than patients prescribed only oral or no antipsychotic medications. The proportion of patients who did not have recommended tests increased from 41.0% to 72.4% for blood pressure readings, from 48.9% to 60.2% for hemoglobin A1c, from 57.0% to 67.8% for LDL cholesterol and 45.0% to 56.0% for CBC tests during the pandemic. CONCLUSIONS There were substantial decreases in preventive care after the onset of the pandemic, although primary care access was largely maintained through virtual care. Addressing these deficiencies will be essential to promoting health equity and reducing the risk of poor health outcomes.
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Affiliation(s)
- Ellen Stephenson
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| | - Abban Yusuf
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jessica Gronsbell
- Department of Statistical Sciences, 7938University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, 8613North York General Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, 26625Toronto Western Hospital, Toronto, Ontario, Canada
| | - Osnat Melamed
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health and Addiction (CAMH), Toronto, Ontario, Canada
| | - Tezeta Mitiku
- Department of Psychiatry, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Selby
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health and Addiction (CAMH), Toronto, Ontario, Canada
| | - Braden O'Neill
- Department of Family and Community Medicine, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 508783Unity Health Toronto, Toronto, Ontario, Canada
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14
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Adler L, Vinker S, Heymann AD, Van Poel E, Willems S, Zacay G. The effect of the COVID-19 pandemic on primary care physicians in Israel, with comparison to an international cohort: a cross-sectional study. Isr J Health Policy Res 2022; 11:34. [PMID: 36127744 PMCID: PMC9486777 DOI: 10.1186/s13584-022-00543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic had a major impact on primary care and primary care physicians (PCPs) in Israel and around the world. There is paucity of information regarding treatment of patients with COVID-19 in the community, since most research was performed in hospitals. The aim of this study was to describe the Israeli PCPs' experience. METHODS This study is a part of an international cross-sectional study, the PRICOV-19. A translated version of the questionnaire was distributed among Israeli PCPs from December 2020 to July 2021. In this study, we describe the Israeli results and compare them to the international results. RESULTS 5,961 respondents from 29 countries answered the questionnaire, 94 from Israel, with an Israeli response rate of 16%. Israeli PCPs reported an increase in use of telemedicine from 11 to 49% during the COVID epidemic. PCPs also reported a decline in their wellbeing; absence of secured time slots for keeping updated; perception that the Ministry of Health guidelines were a threat to the staff wellbeing and organization of practice and delays in the examination of non-COVID urgent cases. CONCLUSIONS The findings of this study raise concerns regarding the PCPs experience and may form the basis for an improved process of care. Guidelines for proper usage of telemedicine, substitutes for the physical examination and procedures for minimizing delayed patient examination for urgent conditions should be developed. Government directives and clinical guidelines should be communicated in a timely manner, with secured timeslots for physicians' self-learning or updating. Ensuring physicians' well-being in general should be an organization priority.
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Affiliation(s)
- Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel. .,Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Headquarters, Medical Division, Leumit Healthcare Services, Tel Aviv, Israel
| | - Anthony D Heymann
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Galia Zacay
- Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Meuhedet Healthcare Maintenance Organization, Tel Aviv, Israel
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15
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Tu K, Sarkadi Kristiansson R, Gronsbell J, de Lusignan S, Flottorp S, Goh LH, Hallinan CM, Hoang U, Kang SY, Kim YS, Li Z, Ling ZJ, Manski-Nankervis JA, Ng APP, Pace WD, Wensaas KA, Wong WC, Stephenson E. Changes in primary care visits arising from the COVID-19 pandemic: an international comparative study by the International Consortium of Primary Care Big Data Researchers (INTRePID). BMJ Open 2022; 12:e059130. [PMID: 35534063 PMCID: PMC9086267 DOI: 10.1136/bmjopen-2021-059130] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Through the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA. METHODS Visit definitions were agreed on centrally, implemented locally across the various settings in INTRePID countries, and weekly visit counts were shared centrally for analysis. We evaluated the weekly rate of primary care physician visits during 2019 and 2020. Rate ratios (RRs) of total weekly visit volume and the proportion of weekly visits that were virtual in the pandemic period in 2020 compared with the same prepandemic period in 2019 were calculated. RESULTS In 2019 and 2020, there were 80 889 386 primary care physician visits across INTRePID. During the pandemic, average weekly visit volume dropped in China, Singapore, South Korea, and the USA but was stable overall in Australia (RR 0.98 (95% CI 0.92 to 1.05, p=0.59)), Canada (RR 0.96 (95% CI 0.89 to 1.03, p=0.24)), Norway (RR 1.01 (95% CI 0.88 to 1.17, p=0.85)), Sweden (RR 0.91 (95% CI 0.79 to 1.06, p=0.22)) and the UK (RR 0.86 (95% CI 0.72 to 1.03, p=0.11)). In countries that had negligible virtual care prepandemic, the proportion of visits that were virtual were highest in Canada (77.0%) and Australia (41.8%). In Norway (RR 8.23 (95% CI 5.30 to 12.78, p<0.001), the UK (RR 2.36 (95% CI 2.24 to 2.50, p<0.001)) and Sweden (RR 1.33 (95% CI 1.17 to 1.50, p<0.001)) where virtual visits existed prepandemic, it increased significantly during the pandemic. CONCLUSIONS The drop in primary care in-person visits during the pandemic was a global phenomenon across INTRePID countries. In several countries, primary care shifted to virtual visits mitigating the drop in in-person visits.
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Affiliation(s)
- Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Departments of Research and Innovation and Family Medicine-North York General Hospital, Toronto Western Family Health Team-University Health Network, Toronto, Ontario, Canada
| | | | - Jessica Gronsbell
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Signe Flottorp
- Norwegian Institute of Public Health, Oslo, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seo Young Kang
- International Healthcare Center, Asan Medical Center, Seoul, South Korea
| | - Young Sik Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Zhou Li
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zheng Jye Ling
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - William Cw Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ellen Stephenson
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Stephenson E, O'Neill B, Kalia S, Ji C, Crampton N, Butt DA, Tu K. Effects of COVID-19 pandemic on anxiety and depression in primary care: A retrospective cohort study. J Affect Disord 2022; 303:216-222. [PMID: 35139415 PMCID: PMC8818125 DOI: 10.1016/j.jad.2022.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/29/2021] [Accepted: 02/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Population-based surveys indicate that many people experienced increased psychological distress during the COVID-19 pandemic. We aimed to determine if there was a corresponding increase in patients receiving services for anxiety and depression from their family physicians. METHODS Electronic medical records from the University of Toronto Practice Based-Research Network (UTOPIAN; N = 322,920 patients) were used to calculate incidence rates for anxiety/depression related visits and antidepressant prescriptions before the COVID-19 pandemic (January 2018-February 2020) and during the COVID-19 pandemic (March-December 2020). Data from the pre-pandemic period were used to predict expected rates during the pandemic period which was compared to the observed rate. RESULTS The number of patients presenting with anxiety/depression symptoms in primary care varied across age groups, sex, and time since pandemic onset. Among the youngest patients (ages 10-18 years), there were fewer patients than pre-pandemic visiting for new episodes of anxiety/depression and being prescribed antidepressants in April 2020, but by the end of 2020 this trend had reversed such that incidence rates for anxiety/depression related visits were higher than pre-pandemic levels. Among older adults, incidence rates of anxiety/depression related visits increased in April 2020 with the onset of the pandemic, and remained higher than expected throughout 2020. LIMITATIONS A convenience sample of 362 family physicians in Ontario was used. CONCLUSION Demand for mental health services from family physicians varied by patient age and sex and changed with the onset of the COVID-19 pandemic. By the end of 2020, more patients were seeking treatment for anxiety/depression related concerns.
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Affiliation(s)
- Ellen Stephenson
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.
| | - Braden O'Neill
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Sumeet Kalia
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada
| | - Catherine Ji
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Noah Crampton
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Debra A Butt
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Department of Family and Community Medicine, Scarborough Health Network, Toronto, ON, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
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17
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Abstract
Coronavirus disease 2019 (COVID-19)-related stressors and restrictions, in the absence of social and institutional support, have led many individuals to either increase their substance consumption or relapse. Consequently, treatment programs for substance use disorders (SUDs) made a transition from in-person to remote care delivery. This review discusses the following evidence regarding changes prompted by the COVID pandemic to the clinical care of individuals with SUDs: (1) reduction in availability of care, (2) increase in demand for care, (3) transition to telemedicine use, (4) telemedicine for treatment of opioid use disorders, and (5) considerations for use of telemedicine in treating SUDs.
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18
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Tempelaar W, Kozloff N, Crawford A, Voineskos A, Addington D, Alexander T, Baluyut C, Bromley S, Brooks S, de Freitas L, Jindani S, Kirvan A, Morizio A, Polillo A, Roby R, Sosnowski A, Villanueva V, Durbin J, Barwick M. The quick pivot: Capturing real world modifications for the re-implementation of an early psychosis program transitioning to virtual delivery. FRONTIERS IN HEALTH SERVICES 2022; 2:995392. [PMID: 36925835 PMCID: PMC10012808 DOI: 10.3389/frhs.2022.995392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/28/2022] [Indexed: 02/05/2023]
Abstract
Background Team-based Early Psychosis Intervention (EPI) services is standard of care for youth with psychosis. The COVID-19 pandemic required most EPI services to mount an unplanned, rapid pivot to virtual delivery, with limited guidance on how to deliver virtual clinical services or whether quality of re-implementation and treatment outcomes would be impacted. We used a structured approach to identify essential modifications for the delivery of core components and explored facilitators and barriers for re-implementation and fidelity of a virtually delivered EPI intervention. Materials and methods NAVIGATE is a structured approach to team-based EPI. It provides detailed modules to guide delivery of core components including medication management, psychoeducation and psychotherapies, supported employment/education, and family education. Having initially implemented NAVIGATE at the Centre for Addiction and Mental Health (CAMH) in 2017, the EPI service transitioned to virtual delivery amid the COVID pandemic. Using a practice profile developed to support implementation, we detailed how core components of NAVIGATE were rapidly modified for virtual delivery as reported in structured group meetings with clinicians. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions (FRAME) was used to describe modifications. Fidelity to the EPI standards of care was assessed by the First Episode Psychosis Fidelity Scale (FEPS-FS). Re-implementation barriers and facilitators and subsequent mitigation strategies were explored using structured clinician interviews guided by the Consolidated Framework for Implementation Research (CFIR). Results Identified modifications related to the intervention process, context, and training. We identified contextual factors affecting the re-implementation of virtually delivered NAVIGATE and then documented mitigating strategies that addressed these barriers. Findings can inform the implementation of virtual EPI services elsewhere, including guidance on processes, training and technology, and approaches to providing care virtually. Discussion This study identified modifications, impacts and mitigations to barriers emerging from rapid, unplanned virtual delivery of EPI services. These findings can support delivery of high-quality virtual services to youth with psychosis when virtual care is indicated.
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Affiliation(s)
- Wanda Tempelaar
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Don Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Crystal Baluyut
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sarah Bromley
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sandy Brooks
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lauren de Freitas
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Seharish Jindani
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anne Kirvan
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrea Morizio
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexia Polillo
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rachel Roby
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexandra Sosnowski
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Janet Durbin
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Melanie Barwick
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
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19
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Pfoh E, Martinez KA, Hohman J, Misra-Hebert A, Rothberg M. COVID-19 Is Associated With an Increase in Visits for Anxiety but Not Depression. Cureus 2021; 13:e17789. [PMID: 34660000 PMCID: PMC8496338 DOI: 10.7759/cureus.17789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/05/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has increased concerns about mental health. We conducted a time-series analysis to determine whether the percentage of primary care visits for anxiety and depression changed after COVID-19. Methodology We assessed the adjusted weekly change in the percentage of primary care visits for anxiety and depression between August 2019 and October 2020 at a large integrated health system. To account for changes in overall visit behavior during the pandemic, we created three periods: pre-period (August 1, 2019 to March 8, 2020), initial period (March 9, 2020 to June 31, 2020), and return period (July 1, 2020 to October 31, 2020). We used hierarchical linear regression models (clustered by month) to identify the association between the time period and the adjusted mean weekly percentage of visits for depression or anxiety. We conducted the analysis in 2020 and 2021. Results There were 1,691,071 encounters among 605,105 unique adults. The median age was 55 years (interquartile range = 39-68), 57% were female, 78% were white, and 59% had private insurance. Most visits were office-based (versus virtual), of which 99% were in the pre-COVID-19 period and 75% in the return period. There was a significant increase in the percentage of visits associated with anxiety after July compared to before COVID-19 (10.4% versus 9.2%; p = 0.006), and there was no difference in the percentage of visits for depression (p > 0.05). Conclusions Outreach to individuals with depression who have not sought care may be necessary.
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Affiliation(s)
- Elizabeth Pfoh
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, USA
| | | | - Jessica Hohman
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, USA
| | | | - Michael Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, USA
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20
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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; 16:e0255992. [PMID: 34383844 PMCID: PMC8360367 DOI: 10.1371/journal.pone.0255992] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/27/2021] [Indexed: 01/14/2023] Open
Abstract
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.
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