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Britz JB, Huffstetler AN, Brooks EM, Richards A, Sabo RT, Webel BK, McCray N, Krist AH. Increased Organizational Stress in Primary Care: Understanding the Impact of the COVID-19 Pandemic, Medicaid Expansion, and Practice Ownership. J Am Board Fam Med 2024; 36:892-904. [PMID: 38092433 PMCID: PMC10860742 DOI: 10.3122/jabfm.2023.230145r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/26/2023] [Accepted: 07/24/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Primary care is the foundation of health care, resulting in longer lives and improved equity. Primary care was the frontline of the COVID-19 pandemic public response and essential for access to care. Yet primary care faces substantial structural and systemic challenges. As part of a longitudinal analysis to track the capacity and health of primary care, we surveyed every primary care practice in Virginia in 2018 and again in 2022. METHODS Surveys were emailed or mailed up to 6 times and nonresponders received a phone call. Questions assessed organizational characteristics, scope of care, capacity, and organizational stress in the prior year. From respondents, 39 clinicians, nurses, staff, administrators, and practice managers were interviewed. RESULTS 526 out of 2296 primary care practices (23% response rate) completed the survey, with broad representation across geography, ownership, and payer mix. Compared with 2018, in 2022 there were increases in practices owned by health systems (25% vs 43%, P < .0001) and average percent of patients with Medicaid per practice (12% vs 22%, P < .0001). The percent of practices reporting any major stressor increased from 34% to 53% (P < .0001). The main increased stress was losing a clinician, with 13% of practices in 2018 versus 42% in 2022 reporting losing a clinician (P < .0001). CONCLUSIONS Primary care practices are resilient and continue to serve their communities, including a broad scope of services and care for underserved people. However, the COVID-19 pandemic caused significant stress. With an increase in clinicians leaving clinical practice, we anticipate worsening access to primary care.
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Affiliation(s)
- Jacqueline B Britz
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC). )
| | - Alison N Huffstetler
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - E Marshall Brooks
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Alicia Richards
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Roy T Sabo
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Ben K Webel
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Neil McCray
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Alex H Krist
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
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Tong ST, Webel BK, Donahue EE, Richards A, Sabo RT, Brooks EM, Lail Kashiri P, Huffstetler AN, Santana S, Harris LM, Krist AH. Understanding the Value of the Wellness Visit: A Descriptive Study. Am J Prev Med 2021; 61:591-595. [PMID: 33952411 PMCID: PMC8455445 DOI: 10.1016/j.amepre.2021.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/22/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical preventive services can reduce mortality and morbidity, but Americans receive only half of the recommended care. Although wellness visits protect time for clinicians to review needs and discuss care with patients, studies have not shown that having a wellness visit improves health outcomes. This study seeks to understand the types of discussions and volume of care delivered during wellness visits. METHODS Using a sample of 1,008 patients scheduled for a wellness visit from 22 primary care clinicians across 3 states from 2018 to 2019, electronic health records were reviewed, and a subset of visits was audio recorded. The discussion and delivery of clinical preventive services, as recommended by the U.S. Preventive Services Task Force, were measured, and new diagnoses were identified from the clinical preventive services. Analyses were completed in 2020. RESULTS Even though patients were up to date with 80% of the recommended clinical preventive services 3 months after the visit, only 0.5% of patients were up to date with all the recommended clinical preventive services. On average, 6.9 clinical preventive service discussions occurred during each wellness visit on the basis of electronic health records review, and 7.7 clinical preventive services discussions occurred on the basis of audio recordings. An average of 0.4 new diagnoses was identified, including cancer diagnoses, cardiovascular risks, and infections. CONCLUSIONS Wellness visits are an important time for patients and clinicians to discuss prevention strategies and to deliver recommended clinical preventive services, leading to the identification of previously unrecognized diagnoses. This will improve patients' health. Policies and incentives that promote wellness visits are important, and efforts are needed to deliver them to those most in need.
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Affiliation(s)
- Sebastian T Tong
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland.
| | - Ben K Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Erin E Donahue
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Alicia Richards
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Edward Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Paulette Lail Kashiri
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Alison N Huffstetler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Stephanie Santana
- Office of Disease Prevention and Health Promotion, Rockville, Maryland
| | - Linda M Harris
- Office of Disease Prevention and Health Promotion, Rockville, Maryland
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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