Primary Care in Public Health responses: Essential and Effective. The role and effectivness of Ontario primary care in COVID

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:2570:" COVID{at}Home was a multifaceted remote clinical care and monitoring pathway seated within primary care for patients with COVID-19 scaled up for the province of Ontario (pop15 million) during the more lethal COVID delta variant infections, prior to population vaccination. It was designed to involve primary care providers in triage, ongoing clinical care of COVID-19 positive patients and integrated longitudinal PHR templates OBJECTIVE To describe the effectiveness of including primary care in responses to new population health threats DESIGN Multimethod, cross-sectional evaluation following the RE-AIM framework (Reach, Effectiveness Adoption, Implementation, Maintenance) METHODS We assessed pathway use, effects on population access and equity and patient outcomes including mortality and provincial data. We used electronic medical record clinical data at the population and practice level, provider and patient monitoring surveys, web analytics, healthcare and provincial utilization data, and government holdings data to evaluate RE-AIM outcomes including mortality and health equity RESULTS The pathway had 19,474 unique users and 28,816 oxygen saturation monitors were deployed to primary care clinics for loan-and-return for patients being acutely monitored. Coropleth mapping showed coverage of all equity levels across the province by income and geography. 50% of patients had >1 chronic condition and 10% had >5. PHR templates showed primary care provision of comprehensive care for COVID-19 symptoms, other chronic diseases, and psychosocial needs. Mortality was lower (p=0.0023) compared with a parallel provincial population-based group CONCLUSIONS The Pathway provided major Primary Care support to the provincial public health response to an emergent health crisis. It had rapid and widespread uptake, was made readily adaptable for clinicians and patients which resulted in high levels of satisfaction for both, and reduced patient mortality. Primary care rapidly pivoted to develop, implement, and contextualize a clinical care pathway during the COVID-19 crisis to fill a growing gap in patient care. The results demonstrated the beneficial role and effectiveness of primary care at the population level when patients are provided with timely, accessible, and comprehensive care within an existing longitudinal patient-provider relationship. Future public health responses should explicitly collaborate with primary care to address the health of the population ";}

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