COVID-19 Could Make Lasting Changes in Primary Care

Laird Harrison

July 29, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The expansion of telemedicine during the COVID-19 pandemic has shown how technology can extend the reach of primary care providers, according to a team of researchers.

The researchers from the Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine in Stanford, California, call for higher reimbursement and less regulation of telemedicine, more sharing of patients' data, and the expansion of artificial intelligence to meet shortfalls in primary care.

"The COVID-19 pandemic taught us valuable lessons," write Steven Lin, MD, a clinical associate professor of medicine – primary care and population health at Stanford Hospital and Clinics in Palo Alto, and colleagues.

"Let us not squander this opportunity to make primary care better," Lin and colleagues write. Their essay was published online on July 23 in Mayo Clinic Proceedings.

The pandemic has shown that the primary care system is already overburdened and can't handle a crisis, they write. They argue that the system relies too heavily on brick-and-mortar clinics and not enough on prevention.

Innovations developed in response to the crisis, such as increased reliance on telemedicine, pre-visit planning, and centralized population health programs, should become permanent, the researchers suggest.

Whereas only 28% of US physicians used telemedicine prior to the pandemic, it is now "the preferred, if not dominant, method of delivering care," they write. At Stanford, the volume of telehealth and video visits jumped from 400 to 3000 per day over a period of 2 weeks.

Practices such as schedule sweeping, pre-visit screening, and triaging visit priorities have also taken hold during the crisis and should endure, the researchers say.

They recommend requiring patients to "contextualize" their symptoms through smartphone apps as a way to discourage unnecessary conversations with providers.

The call for increased use of technology to ease burdens on providers resonates with the leadership of the American Academy of Family Physicians (AAFP), Steven E. Waldren, MD, vice president and chief medical informatics officer, AAFP, told Medscape Medical News.

"I agree that we need to retool primary care," he said. "The AAFP has advocated for investment in primary care to enable this transformation."

As an example, he cited a pilot project that uses a voice recognition program enhanced by artificial intelligence to save time entering data in electronic health records.

"Unfortunately, administrative complexity is cannibalizing resources in primary care, and the current payment models lead to primary care physicians being on the proverbial 'hamster wheel,' " he said.

Although telehealth and artificial intelligence can increase the capacity of a primary care practice, they should not be used in isolation to create a "virtual-alone" experience, he cautioned.

Casey Tak, PhD, MPH, an assistant professor in the Division of Pharmaceutical Outcomes and Policy at the University of North Carolina at Chapel Hill, agreed that the pandemic offers an opportunity to expand the use of technology as part of a restructuring of primary care.

In particular, telehealth can expand the reach of primary care physicians into rural areas and to other underserved populations. But he cautioned that not everyone has access to broadband, and some people are not able to use computers or smartphones.

"It's not going to be the silver bullet to improving access to care," he told Medscape Medical News.

Patients may feel more comfortable disclosing private information when they meet their doctors in person, he said. And these visits may afford a better opportunity to discuss all of the patient's health concerns.

The authors, Tak, and Waldren have disclosed no relevant financial relationships.

Mayo Clin Proc. Published online July 23, 2020. Abstract

Laird Harrison writes about science, health and culture. His work has appeared in magazines, newspapers , and online publications. He is at work on a novel about alternate realities in physics. Harrison has taught writing at San Francisco State University, UC Berkeley Extension and the Writers Grotto. Visit him at lairdharrison.comor follow him on Twitter: @LairdH.

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