Increased Organizational Stress in Primary Care : Understanding the Impact of the COVID-19 Pandemic, Medicaid Expansion, and Practice Ownership
© Copyright by the American Board of Family Medicine..
BACKGROUND: Primary care is the foundation of health care, resulting in longer lives and improved equity. Primary care was the frontline of the COVID-19 pandemic public response and essential for access to care. Yet primary care faces substantial structural and systemic challenges. As part of a longitudinal analysis to track the capacity and health of primary care, we surveyed every primary care practice in Virginia in 2018 and again in 2022.
METHODS: Surveys were emailed or mailed up to 6 times and nonresponders received a phone call. Questions assessed organizational characteristics, scope of care, capacity, and organizational stress in the prior year. From respondents, 39 clinicians, nurses, staff, administrators, and practice managers were interviewed.
RESULTS: 526 out of 2296 primary care practices (23% response rate) completed the survey, with broad representation across geography, ownership, and payer mix. Compared with 2018, in 2022 there were increases in practices owned by health systems (25% vs 43%, P < .0001) and average percent of patients with Medicaid per practice (12% vs 22%, P < .0001). The percent of practices reporting any major stressor increased from 34% to 53% (P < .0001). The main increased stress was losing a clinician, with 13% of practices in 2018 versus 42% in 2022 reporting losing a clinician (P < .0001).
CONCLUSIONS: Primary care practices are resilient and continue to serve their communities, including a broad scope of services and care for underserved people. However, the COVID-19 pandemic caused significant stress. With an increase in clinicians leaving clinical practice, we anticipate worsening access to primary care.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Journal of the American Board of Family Medicine : JABFM - 36(2024), 6 vom: 05. Jan., Seite 892-904 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Britz, Jacqueline B [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 08.01.2024 Date Revised 14.02.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.3122/jabfm.2023.230145R2 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM365831360 |
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| 520 | |a © Copyright by the American Board of Family Medicine. | ||
| 520 | |a BACKGROUND: Primary care is the foundation of health care, resulting in longer lives and improved equity. Primary care was the frontline of the COVID-19 pandemic public response and essential for access to care. Yet primary care faces substantial structural and systemic challenges. As part of a longitudinal analysis to track the capacity and health of primary care, we surveyed every primary care practice in Virginia in 2018 and again in 2022 | ||
| 520 | |a METHODS: Surveys were emailed or mailed up to 6 times and nonresponders received a phone call. Questions assessed organizational characteristics, scope of care, capacity, and organizational stress in the prior year. From respondents, 39 clinicians, nurses, staff, administrators, and practice managers were interviewed | ||
| 520 | |a RESULTS: 526 out of 2296 primary care practices (23% response rate) completed the survey, with broad representation across geography, ownership, and payer mix. Compared with 2018, in 2022 there were increases in practices owned by health systems (25% vs 43%, P < .0001) and average percent of patients with Medicaid per practice (12% vs 22%, P < .0001). The percent of practices reporting any major stressor increased from 34% to 53% (P < .0001). The main increased stress was losing a clinician, with 13% of practices in 2018 versus 42% in 2022 reporting losing a clinician (P < .0001) | ||
| 520 | |a CONCLUSIONS: Primary care practices are resilient and continue to serve their communities, including a broad scope of services and care for underserved people. However, the COVID-19 pandemic caused significant stress. With an increase in clinicians leaving clinical practice, we anticipate worsening access to primary care | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Family Medicine | |
| 650 | 4 | |a Health Policy | |
| 650 | 4 | |a Health Services Accessibility | |
| 650 | 4 | |a Health Workforce | |
| 650 | 4 | |a Medicaid | |
| 650 | 4 | |a Medically Underserved Area | |
| 650 | 4 | |a Pandemics | |
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| 650 | 4 | |a Primary Health Care | |
| 650 | 4 | |a Surveys and Questionnaires | |
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| 700 | 1 | |a Sabo, Roy T |e verfasserin |4 aut | |
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| 700 | 1 | |a McCray, Neil |e verfasserin |4 aut | |
| 700 | 1 | |a Krist, Alex H |e verfasserin |4 aut | |
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