Primary Care Access During the COVID-19 Pandemic: a Simulated Patient Study.
Primary Care Access During the COVID-19 Pandemic: a Simulated Patient Study.
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DOI：
10.1007/s11606-021-06804-7
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发表时间：
2021-12
影响因子：
5.7
通讯作者：
Ganguli I
中科院分区：
文献类型：
--
作者：
Kyle MA;Tipirneni R;Thakore N;Dave S;Ganguli I
在2019冠状病毒病大流行期间，初级保健实践经历了重大压力，因此新就医的患者可能面临及时就诊的潜在障碍。量化初级保健新患者预约的可用性和等待时间，并描述初级保健做法如何指导疑似COVID-19患者。在2020年9月14日至2020年9月28日期间，训练有素的呼叫者对800个随机抽样的初级保健诊所进行了模拟患者呼叫。我们在2020年9月10日至14日期间从四个地理上分散的州的大型商业保险网络中提取了完整的初级保健医生列表（n= 11521）。在排除非医生提供者和删除重复的电话号码后，我们确定了2705个独特的初级保健医生实践，从中我们在每个地区随机抽样200个实践。初级保健预约情况、平均等待时间（以天为单位）以及对怀疑感染COVID-19的患者的实践指导。在列出的诊所中，有56%的诊所在目录中列出了准确的联系信息，其中84%的诊所提供了新的患者面对面或虚拟预约。中位等待时间为10天（IQR 3-26天）。在疑似COVID-19的情况下，最常见的指导是临床医生咨询，在41%的已完成电话中提供了这一指导。来电者被引导到现场测试（14%）、非现场测试（24%）、COVID-19热线（8%）或紧急护理/急诊科（12%），而2%的做法没有提供指导。尽管资源有限，大多数可及的初级保健做法提供了及时的新患者预约以及COVID-19的直接护理。大流行缓解战略应考虑到并支持初级保健做法在社区大流行应对中的核心作用。在线版本包含补充材料，可在10.1007/s11606-021-06804-7获得。
Primary care practices have experienced major strains during the COVID-19 pandemic, such that patients newly seeking care may face potential barriers to timely visits. To quantify availability and wait times for new patient appointments in primary care and to describe how primary care practices are guiding patients with suspected COVID-19. Trained callers conducted simulated patient calls to 800 randomly sampled primary care practices between September 14, 2020, and September 28, 2020. We extracted complete primary care physician listings from large commercial insurance networks in four geographically dispersed states between September 10 and 14, 2020 (n=11,521). After excluding non-physician providers and removing duplicate phone numbers, we identified 2705 unique primary care physician practices from which we randomly sampled 200 practices in each region. Primary care appointment availability, median wait time in days, and practice guidance to patients suspecting COVID-19 infection. Among 56% of listed practices that had accurate contact information listed in the directory, 84% offered a new patient in-person or virtual appointment. Median wait time was 10 days (IQR 3–26 days). The most common guidance in case of suspected COVID-19 was clinician consultation, which was offered in 41% of completed calls. Callers were otherwise directed to on-site testing (14%), off-site testing (24%), a COVID-19 hotline (8%), or an urgent care/emergency department (12%), while 2% of practices had no guidance to offer. Despite resource constraints, most reachable primary care practices offered timely new patient appointments as well as direct COVID-19 care. Pandemic mitigation strategies should account for and support the central role of primary care practices in the community-based pandemic response. The online version contains supplementary material available at 10.1007/s11606-021-06804-7.
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