Primary care practices were not prepared for the pandemic and must reinvent the ways in which they do business, according to a paper authored by several Virginia doctors published Monday in the Annals of Family Medicine.

Dr. Alex Krist, a Virginia Commonwealth University School of Medicine professor in the Department of Family Medicine and Population Health, and his co-authors say that primary care practices play a critical role in keeping patients out of the hospital. (It’s been feared and predicted that hospitals would exceed capacity with an influx of COVID-19 patients.)

“The pandemic was a crisis for primary care,” Krist said in a statement. “Physicians needed to redesign their practices overnight.”

But primary care doctors have not had adequate COVID-19 testing supplies, personal protective equipment and finances to continue operating, the paper noted. Due to financial constraints, many primary care practices closed and/or furloughed staff during the pandemic. “Seventy-five percent of Americans have primary care physicians, and 54% of all doctors’ visits are made to primary care physicians,” Krist said. “If you shut your doors, patients are abandoned. They go to overwhelmed emergency rooms, or they avoid the health care system and get sick.”

The paper also addresses safety concerns such as having patients in shared waiting rooms, and that there’s not a “road map for how primary care should respond to a pandemic,” Krist said. The co-authors of “Redesigning Primary Care to Address the COVID-19 Pandemic in the Midst of the Pandemic,” however, make several recommendations for primary care physicians at each stage of the outbreak.

The other co-authors of the paper are Dr. Jennifer E. DeVoe of Oregon Health & Science University; Dr. Anthony Cheng of Oregon Health & Science University; Dr. Thomas Ehrlich of Fairfax Family Practice; and Dr. Samuel Jones of Inova Health System. Jones and Ehrlich are also faculty at VCU’s Fairfax Medicine Residency program, which trains primary care physicians.

Recommendations for primary care physicians include:

• Early, widespread testing in primary care setting
• Virtual-first approach to triaging patient care to determine who needs to be seen in person
• Providing “home hospital care” through home virtual monitoring and home visits if patients are reluctant to visit the hospital, or the hospital is at capacity
• Transitioning to rehabilitation and support for patients who overcome COVID-19 at primary care facilities

“VCU Health is committed to expanding access to primary care and family medicine programs in a way that integrates with and complements its range of services,” Dr. Peter Buckley, interim CEO of VCU Health System and interim senior vice president of VCU Health Sciences, said in a statement. “This paper is a great start to an important conversation about the role primary care can play in a pandemic.”

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