Patients’ overall health continues to suffer due to the pandemic, with the majority of primary care physicians reporting that their patients' mental health has declined during the past eight months.
Over a third (37%) of primary care physicians say their patients with chronic conditions are in “noticeably worse health resulting from the pandemic.” This is due, in part, to visits that are not happening: 56% of surveyed clinicians have seen an increase in negative health burdens due to delayed or inaccessible care, according to a survey of clinicians conducted in mid-October, seven months into the pandemic.
The results of the survey were released by the Larry A. Green Center, a research organization, in collaboration with the Primary Care Collaborative (PCC) and 3rd Conversation.
"Patients are becoming sicker during the pandemic. I'm seeing more uncontrolled diabetics and new diabetics. They prefer telehealth yet no access to glucose monitoring or blood pressure cuff. I am concerned about patients' isolation and mental health. People are delaying care," a clinician based in Pennsylvania said, according to the survey.
Over 85% of respondents report that the mental health of their patients has decreased during the pandemic, with 31% seeing a rise in patients suffering with addiction.
These findings come as COVID-19 cases spike in most states and the healthcare system sees signs of again being pushed to its limits. The survey also assessed the state of primary care practices, which continue to deal with the consequences of the first COVID-19 surge. These include the inability to fill open staff positions (35%), persistent challenges with COVID-19 testing (61%), and inadequate supplies or not having proper PPE (37%).
“It was great to hear positive news this month regarding new vaccines on the horizon. Primary care is the most likely front line to distribute the vaccine, and yet we continue to ignore its sustainability,” said Rebecca Etz, Ph.D., co-director of The Larry A. Green Center. “Primary care is essential to our national health, and it requires essential funding to safeguard care teams while they safeguard us.”
“If we are going to be successful in managing this next wave of the pandemic and responding to patients’ needs, we will need a more robust primary care system,” said Ann Greiner, president and CEO of the PCC. “Public and private payers can create more stability in primary care by committing to appropriately set prospective payments and maintenance of telehealth at parity with in-person visits until the vaccine is widely disseminated.”
COVID cases are rising, but the strain on practices may be holding steady for now. Sixty percent of respondents say they have seen a rise in COVID-19 illness in their communities. Yet respondents continue to rate the level of “unusual strain” on their practices due to COVID-19 at around the same levels over the past four survey rounds dating back to late August. Consistently around half of the respondents rate their level of strain as a 4 or 5 out of 5. And the percent of respondents rating their strain as low (1 or 2) has ranged between 11% and 19%.
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Practices are rising to the challenge by adapting the way they deliver care, but it may not be fast enough. Over two-thirds of practices are using telehealth for visits with patients who have stable chronic conditions, and over 60% use telehealth for mental health visits.
Twenty-seven percent say they are more involved in helping patients with poor access to food, housing, and employment, and over a fifth have increased connections to community organizations. Still, only 16% of respondents report that their practice has added capacity to help patients with mental or behavioral health, despite the increasing burden.
Financial barriers faced by primary care practices may have lessened—for now. Only 6% of respondents say they are unable to pay some of their bills. And where reimbursement for virtual visits used to pose significant challenges to primary care, just 7% of surveyed clinicians now say that they would like to use video-based care more often but can’t because of low reimbursement. (Fifteen percent say the same for phone-based care).
Today, bigger obstacles to practices include trouble hiring new staff (35%).
COVID-19 and influenza still loom over primary care. Testing for COVID-19 remains a challenge for primary care practices, with 44% reporting that results take more than two days to receive and 26% reporting they cannot get patients tested as often as they think they should. Roughly a quarter (23%) say low amounts of PPE or reused PPE may them feel unsafe at work.
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Clinicians also are reporting high interest in the flu vaccine this year but significant skepticism among patients about a COVID-19 vaccine.
"Patients are leery of any rushed COVID vaccine. Patients would rather have a well-vetted vaccine next year than a rush vaccine this year," a clinician in Pennsylvania said.
"Most say they will not take a vaccine unless Dr. Fauci says it’s safe," a Tennessee-based physician said.
“These survey results are sounding a very loud alarm bell that I hope everyone hears,” said Christine Bechtel, patient advocate and co-founder of 3rd Conversation. “After the first pandemic wave, around one in 10 primary care practices was predicting closure, and 40% had laid off staff. Are we going to let that happen again? President-elect Joe Biden’s COVID-19 task force has an opportunity to do what no leaders have yet done: target resources to primary care so that the backbone of the U.S. health system survives when we need it the most.”
The survey of clinicians received 582 responses from 47 states and Guam. Among the respondents, 66% identify their practice as family medicine, 15% as internal medicine, 6% as pediatrics, 5% as geriatrics, 2% as mental health, and 6% as other. Settings include 20% rural, 9% community health centers, and 7% in schools/offices. About a third of respondents have 1-3 clinicians in the practice, and 40% have more than 10 clinicians.
Among the respondents, 42% are owned by a health system, 29% are self-owned, 17% are independent and large-group, and 4% are government-owned.