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Primary Health Care: Challenges and Recommendations during a Pandemic

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Coronaviruses (CoV) and COVID-19 Pandemic".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 14397

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Special Issue Editor

Dr. Pierpaolo Ferrante

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Guest Editor

Occupational Medicine Department (DML), National Workers Compensation Authority (INAIL), Research Area, Via Stefano Gradi 55, 00143 Rome, Italy
Interests: epidemiology; public health; statistical methods

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic has dramatically confronted the world with a worrying global fragility: we are not prepared enough to manage pandemics. To improve the global response to the current and future threats, national pandemic plans should be integrated into a comprehensive strategy and driven by a multidisciplinary approach. Furthermore, they should be flexible enough to be updated according to the latest available data, collected through effective, homogeneous, and connected epidemiological surveillance systems. A primary goal they must pursue is to protect the health care workers and to avoid the health system saturation. In such modern and effective pandemic plans, primary health care (PHC) plays the key role in the frontline of the whole response system and carries out multiple tasks including:

To provide early diagnoses (to contain the virus spread) even through video consultations where feasible;
To manage mild cases mitigating pressure on the hospitals;
To be involved in activities of contact tracing, in the epidemiological surveillance system, and in the vaccination campaigns;
To provide up-to-date information to population about the disease and the related prevention measures;
To assure continuity of treatments to patients with chronic conditions;
To learn by daily experience.

What COVID-19 pandemic taught us is that the stronger the PHC is, the more resilient the health system. A successful pandemic plan must rely on a solid PHC.

Research problem considered in this Special Issue:

Sharing the successes and failures PHC has experienced around the world could help health institutions to better prepare for the future. This thematic Special Issue aims to collect the acquired pandemic experience by health professionals in all fields of the PHC. We encourage (without limiting to) submissions of papers about:

The impact of COVID-19 on the national PHC highlighting the stress points (burnout and stress among workers; structural and infrastructural lacks; disruption and delays in out-patient visits: obstetric care, chronic diseases and palliative care; discomforts of nurses working outside of hospitals; etc.) to be strengthened;
The adopted protocols and polices involving the PHC (awareness campaign; PHC as triage; role of PHC in Surveillance; role of PHC in vaccine campaigns; integration of PHC and Public Health; etc.) ;
The innovative experiences (new models in primary care; measures of service quality; telehealth; hospital at home; virtual hospital; etc.) that may drive the PHC evolution.

By sharing your valuable contribution with us, you will help to raise awareness of the central role of PHC in future Health Systems.

Dr. Pierpaolo Ferrante
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

primary health care
pandemics
COVID-19
Healthcare resilience
burnout
out-patient visits
triage
obstetric care
chronic diseases
palliative care
prevention measures
epidemiological Surveillance
awareness campaign
vaccine campaign
integrated Public Health system
video consultations
telehealth
hospital at home
virtual hospital
primary care models
measures of service quality

Published Papers (11 papers)

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17 pages, 873 KiB

Open AccessArticle

A Phenomenological Inquiry of the Shift to Virtual Care Delivery: Insights from Front-Line Primary Care Providers

by Gayle Halas, Alanna Baldwin, Lisa LaBine, Kerri MacKay, Alexander Singer and Alan Katz

Healthcare 2024, 12(8), 861; https://doi.org/10.3390/healthcare12080861 - 20 Apr 2024

Viewed by 307

Abstract

The rapid deployment of virtual primary care visits served as a first-line response to COVID-19 and can now be examined for insights, particularly as virtual care is playing an ongoing role in patient care and consultations. Input from primary care providers directly responsible for virtual care delivery is needed to inform policies and strategies for quality care and interactions. The overarching goal of this research study was to examine the use of virtual care as a mechanism for primary healthcare delivery. A phenomenological approach investigated the shift in primary care service delivery as experienced by primary care providers and initiated during the COVID-19 pandemic. Focus groups were conducted with primary care providers (n = 21) recruited through email, advertisements, and professional organizations, exploring how virtual care was delivered, the benefits and challenges, workflow considerations, and recommendations for future use. Integrating virtual care was performed with a great deal of autonomy as well as responsibility, and overwhelmingly depended on the telephone. Technology, communication, and workflow flexibility are three key operational aspects of virtual care and its delivery. Providers highlighted cross-cutting themes related to the dynamics of virtual care including balancing risk for quality care, physician work/life balance, efficiency, and patient benefits. Primary care providers felt that virtual care options allowed increased flexibility to attend to the needs of patients and manage their practice workload, and a few scenarios were shared for when virtual care might be best suited. However, they also recognized the need to balance in-person and virtual visits, which may require guidelines that support navigating various levels of care. Overall, virtual care was considered a good addition to the whole ‘care package’ but continued development and refinement is an expectation for optimizing and sustaining future use. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

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11 pages, 237 KiB

Open AccessArticle

Health Workers’ Responses to COVID-19 Pandemic’s Impact on Service Delivery to Adolescents in HIV Treatment in Cape Town, South Africa: A Qualitative Study

by Yolanda Mayman, Talitha Crowley and Brian van Wyk

Healthcare 2024, 12(6), 609; https://doi.org/10.3390/healthcare12060609 - 07 Mar 2024

Viewed by 1284

Abstract

Adolescents living with HIV (ALHIVs) are considered a priority population in the fight against HIV, requiring dedicated services. The COVID-19 pandemic and subsequent disruptions deprived ALHIVs on antiretroviral therapy (ART) of the care and social support essential for treatment adherence and positive treatment outcomes. This study describes health managers’ and healthcare workers’ responses to the impact of COVID-19 on service delivery to ALHIVs in HIV treatment in the Cape Town Metropole. A descriptive qualitative design was employed, where semi-structured individual interviews (n = 13) were conducted with senior and programme managers as well as healthcare workers between April and October 2023. Inductive thematic analysis was performed using Atlas.ti version 23. Two main themes emerged from these interviews: “HIV service delivery to adolescents during the COVID-19 pandemic” and “Lessons learnt—the way forward”. The de-escalation of health services at primary health facilities and the disruption of HIV services resulted in disengagement from care by ALHIVs, increasing mental health and treatment challenges. This warrants the restoration of psychosocial support services and the re-engagement of ALHIVs. The findings from this study can function as a guide for health systems and healthcare providers to navigate future pandemics to ensure that vulnerable populations such as ALHIVs continue to receive care and treatment. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

11 pages, 245 KiB

Open AccessArticle

A Cross-Sectional Study on Physical Activity and Burnout among Family Physicians in Slovenia during the First Year of the COVID-19 Pandemic: Are the Results Alarming Enough to Convince Decision-Makers to Support Family Medicine?

by Ksenija Tušek Bunc, Janja Uplaznik and Polona Selič-Zupančič

Healthcare 2024, 12(1), 28; https://doi.org/10.3390/healthcare12010028 - 22 Dec 2023

Viewed by 701

Abstract

Physical activity has a positive effect on general health, but its influence on burnout remains unclear. The aim of this study was to determine the association between physical activity and the incidence of burnout in Slovenian family physicians (FPs) and family medicine trainees (FMTs) during the COVID-19 pandemic, which exacerbated the already-existing problem of burnout. We conducted a cross-sectional observational study among Slovenian family physicians and FMTs in which sociodemographic variables, the type and duration of physical activity, and an assessment of burnout were collected using the Maslach Burnout Inventory. Comparisons between groups were made using the independent-samples t-test, Fisher’s exact test, and the Wilcoxon sign-rank test. A value of p < 0.05 determined the limit of statistical significance. Of 1230 FPs and FMTs invited to participate, 282 completed the survey (22.9% response rate); there were 243 (86.2%) FPs and 39 (13.8%) FMTs. The overall rating for burnout during the pandemic was high, at 48.6% of FPs and FMTs; 62.8% of respondents reported a high rating for emotional exhaustion and 40.1% for depersonalization. Compared to FMTs, emotional exhaustion and total burnout scores were higher for FPs (p < 0.001 and p = 0.010, respectively), but work status was not related to personal acomplishment, which 53.5% of all participants rated as low. Physical activity did not appear to be a statistically significant factor in the occurrence of burnout during the pandemic. Therefore, work status or occupational role (FP vs. FMT) should be thoroughly investigated in the future along with some other factors and a better response rate. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

14 pages, 315 KiB

Open AccessArticle

The Level of Knowledge, Attitudes, and Practices in a Caribbean Colombian Population That Recovered from COVID-19 during the Pandemic

by Mirary Mantilla-Morrón, Damaris Suárez-Palacio and Miguel Alberto Urina-Triana

Healthcare 2023, 11(24), 3119; https://doi.org/10.3390/healthcare11243119 - 08 Dec 2023

Viewed by 685

Abstract

This study aimed to assess the knowledge, attitudes, and behaviors related to COVID-19 among Colombians. A cross-sectional descriptive study was carried out during the pandemic between November 2020 and May 2021 using a survey that focused on knowledge, attitudes, and practices regarding COVID-19. The online survey was completed by 1424 participants who had a history of COVID-19 illness, and the study spanned 3 months. Many respondents were male students who demonstrated adequate knowledge of COVID-19 symptoms and prevention measures, although their understanding of its transmission routes was limited. Nevertheless, 65.9% expressed optimism that COVID-19 would ultimately be successfully controlled, and 71.8% had confidence in the Colombian government’s handling of the crisis. Additionally, more than half of the participants admitted to visiting crowded places, and this practice was more common among those who were less informed about COVID-19. However, many respondents reported using face masks in public. This highlights a significant gap between theoretical knowledge and actual practices that need to be addressed. To bridge this gap, establishing an interdisciplinary support network is crucial, as is launching mass education campaigns targeting specific population groups, and compiling reports on successful practices implemented during the pandemic. These efforts are essential for enhancing the overall level of knowledge, and the attitudes and practices related to COVID-19, and also for preparing for future health emergencies. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

19 pages, 293 KiB

Open AccessArticle

Barriers and Enablers Experienced by General Practitioners in Delivering Safe and Equitable Care during COVID-19: A Qualitative Investigation in Two Countries

by Esther Van Poel, Tessa van Loenen, Claire Collins, Kaatje Van Roy, Maria Van den Muijsenbergh and Sara Willems

Healthcare 2023, 11(23), 3009; https://doi.org/10.3390/healthcare11233009 - 21 Nov 2023

Cited by 1 | Viewed by 851

Abstract

Addressing equity in healthcare is fundamental for delivering safe care to vulnerable patients, especially during COVID-19. This paper aims to identify barriers and enabling factors for general practitioners (GPs) in delivering safe and equitable care during the COVID-19 pandemic. Semi-structured interviews took place during May–July 2020 among 18 Flemish and 16 Dutch GPs. Thematic analysis of the interviews demonstrated that while GPs acknowledged a smooth information flow by governments and professional organizations on care guidelines, the fast-changing information challenged them to stay up to date. Media communication facilitated information dissemination but also fueled misinformation and miscommunication, creating unrealistic patient expectations. Certain guidelines and patient reluctance delayed necessary care. A shortage of personal protective equipment made GPs concerned about patient safety during face-to-face contacts. Teleconsultations became a popular alternative, but posed increased patient safety risks. GPs struggled to identify and reach vulnerable patients. Equitable care was hindered by time constraints; thus, having the appropriate materials facilitated such care. An interprofessional collaboration involving paramedical, social, and city services benefited patient safety and equity in healthcare. However, limitations in this collaboration pressured GPs. The unprecedented and resource-constrained environment challenged GPs’ capacity to provide the healthcare quality they aspired to deliver. A well-structured collaborative network involving all stakeholders could benefit safe and equitable care in future pandemics. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

17 pages, 1865 KiB

Open AccessArticle

Personnel Scheduling during the COVID-19 Pandemic: A Probabilistic Graph-Based Approach

by Mansoor Davoodi, Ana Batista, Abhishek Senapati and Justin M. Calabrese

Healthcare 2023, 11(13), 1917; https://doi.org/10.3390/healthcare11131917 - 03 Jul 2023

Viewed by 989

Abstract

Effective personnel scheduling is crucial for organizations to match workload demands. However, staff scheduling is sometimes affected by unexpected events, such as the COVID-19 pandemic, that disrupt regular operations. Limiting the number of on-site staff in the workplace together with regular testing is an effective strategy to minimize the spread of infectious diseases like COVID-19 because they spread mostly through close contact with people. Therefore, choosing the best scheduling and testing plan that satisfies the goals of the organization and prevents the virus’s spread is essential during disease outbreaks. In this paper, we formulate these challenges in the framework of two Mixed Integer Non-linear Programming (MINLP) models. The first model aims to derive optimal staff occupancy and testing strategies to minimize the risk of infection among employees, while the second is aimed only at optimal staff occupancy under a random testing strategy. To solve the problems expressed in the models, we propose a canonical genetic algorithm as well as two commercial solvers. Using both real and synthetic contact networks of employees, our results show that following the recommended occupancy and testing strategy reduces the risk of infection 25–60% under different scenarios. The minimum risk of infection can be achieved when the employees follow a planned testing strategy. Further, vaccination status and interaction rate of employees are important factors in developing scheduling strategies that minimize the risk of infection. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

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19 pages, 2631 KiB

Open AccessArticle

Challenges in Caring for People with Cardiovascular Disease through and beyond the COVID-19 Pandemic: The Advantages of Universal Access to Home Telemonitoring

by Luminita Iliuță, Andreea Gabriella Andronesi, Marius Rac-Albu, Florentina Ligia Furtunescu, Mădălina-Elena Rac-Albu, Alexandru Scafa-Udriște, Horațiu Moldovan and Eugenia Panaitescu

Healthcare 2023, 11(12), 1727; https://doi.org/10.3390/healthcare11121727 - 12 Jun 2023

Viewed by 1129

Abstract

(1) Background: Cardiovascular prevention was left in second place during the COVID-19 pandemic and the use of telemedicine turned out to be very useful. We aimed to evaluate the effectiveness of a telemedicine application for remote monitoring and treatment adjustments in terms of improving cardiovascular prevention. (2) Methods: A prospective study of 3439 patients evaluated between the 1st of March 2019 and the 1st of March 2022, in the pre-pandemic period by face-to-face visits and during the pandemic by teleconsultations or hybrid follow-up. We compared four periods: pre-pandemic—Pre-P (1 March 2019–1 March 2020), lockdown—Lock (1 March–1 September 2020), restrictive-pandemic—Restr-P (1 September 2020–1 March 2021), and relaxed–pandemic—Rel-P (1 March 2021–1 March 2022). (3) Results: The average values of total cholesterol (TC), LDL cholesterol, triglycerides, uric acid, and glucose had an increasing trend during Lock and Restr-P, and they decreased close to the baseline level during the Rel-P, with the exception of glucose which remained elevated in Rel-P. The number of patients with newly discovered DM increased significantly in the Rel-P, and 79.5% of them had mild/moderate forms of COVID-19. During Lock and Res-P, the percentage of obese, smoking, or hypertensive patients increased, but probably through the use of telemedicine, we managed to reduce it, although it remained slightly higher than the pre-pandemic level. Physical activity decreased in the first year of the pandemic, but in Rel-P people became more active than before the pandemic. (4) Conclusions: The use of telemedicine for cardiovascular prevention seems to yield favorable results, especially for secondary prevention in the very high-risk group and during the second year. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

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10 pages, 1269 KiB

Open AccessArticle

The Emergency Performance of the Hungarian Ambulance Service during the COVID-19 Pandemic

by Klára Bíró, Máté Sándor Deák, György Pápai, Attila Nagy, Viktor Dombrádi, Gábor Tamás Szabó, Klára Boruzs, Gábor Bányai and Gábor Csató

Healthcare 2022, 10(11), 2331; https://doi.org/10.3390/healthcare10112331 - 21 Nov 2022

Cited by 2 | Viewed by 1628

Abstract

The COVID-19 pandemic had a considerable impact on the whole health sector, particularly on emergency services. Our aim was to examine the performance of the Hungarian National Ambulance Service during the first four waves of the pandemic. We defined the 2019 performance of the service as the baseline and compared it with the activity during the pandemic years of 2020 and 2021. The data contained deliveries related to acute myocardial infarction, hemorrhagic stroke, ischemic stroke, overall non-COVID-related ambulance deliveries, COVID screenings performed by the ambulance service, and COVID-related ambulance deliveries. The data were aggregated for each week of the investigated time period and stratified by gender and age. Compared with the pre-pandemic era, we found a significant increase in all three medical conditions and overall deliveries (p < 0.001 in all cases). As a result of the increased burden, it is important for emergency services to prepare for the next global epidemic and to improve organizational performance and rescue activities. The Hungarian example highlights that in a pandemic, it can be beneficial to organize the emergency care of a country or a larger region under a single provider with a single decision maker supported by business intelligence. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

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17 pages, 9294 KiB

Open AccessArticle

Design and Development of Smart Weight Measurement, Lateral Turning and Transfer Bedding for Unconscious Patients in Pandemics

by Imran Shafi, Muhammad Siddique Farooq, Isabel De La Torre Díez, Jose Breñosa, Julio César Martínez Espinosa and Imran Ashraf

Healthcare 2022, 10(11), 2174; https://doi.org/10.3390/healthcare10112174 - 30 Oct 2022

Cited by 1 | Viewed by 2539

Abstract

Patient care and convenience remain the concern of medical professionals and caregivers alike. An unconscious patient confined to a bed may develop fluid accumulation and pressure sores due to inactivity and deficiency of oxygen flow. Moreover, weight monitoring is crucial for an effective treatment plan, which is difficult to measure for bedridden patients. This paper presents the design and development of a smart and cost-effective independent system for lateral rotation, movement, weight measurement, and transporting immobile patients. Optimal dimensions and practical design specifications are determined by a survey across various hospitals. Subsequently, the proposed hoist-based weighing and turning mechanism is CAD-modeled and simulated. Later, the structural analysis is carried out to select suitable metallurgy for various sub-assemblies to ensure design reliability. After fabrication, optimization, integration, and testing procedures, the base frame is designed to mount a hydraulic motor for the actuator, a DC power source for self-sustenance, and lockable wheels for portability. The installation of a weighing scale and a hydraulic actuator is ensured to lift the patient for weight measuring up to 600 pounds or lateral turning of 80 degrees both ways. The developed system offers simple operating characteristics, allows for keeping patient weight records, and assists nurses in changing patients’ lateral positions both ways, comfortably massage patients’ backs, and transport them from one bed to another. Additionally, being lightweight offers reduced contact with the patient to increase the healthcare staff’s safety in pandemics; it is also height adjustable and portable, allowing for use with multiple-sized beds and easy transportation across the medical facility. The feedback from paramedics is encouraging regarding reducing labor-intensive nursing tasks, alleviating the discomfort of long-term bed-ridden patients, and allowing medical practitioners to suggest better treatment plans. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

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12 pages, 244 KiB

Open AccessArticle

Changes in Daily Life, Physical Activity, GAD, Depression, and Personal Hygiene of Adolescents in South Korea Due to the COVID-19

by Eun-Yeob Kim, Chilhwan Oh, Hwa-Jung Sung and Jaeyoung Kim

Healthcare 2022, 10(10), 1881; https://doi.org/10.3390/healthcare10101881 - 27 Sep 2022

Cited by 2 | Viewed by 1568

Abstract

This study used raw data obtained from the Adolescents’ Health Behavior Survey by government-affiliated agency open data. A total of 109,796 students were sampled. A comparative analysis was performed based on the year 2020 and when the COVID-19 pandemic occurred, in which we analyzed changes in adolescents’ depression and panic anxiety perception and dietary habits, physical factors, physical activity, and handwashing habits. There was no weight control in the second year compared to the first year of the COVID-19 pandemic, and obesity also increased. The continuation of the non-contact situation caused by COVID-19 led to a worsening of subjective health awareness, and the experience of generalized anxiety disorder, depression, sadness and hopelessness, and suicidal thoughts and attempts increased. The frequency of washing hands with soap before meals and after using the toilet at school or at home was reduced. As a result of this analysis, we believe that there needs to be a system of support in place to address the academic gaps and deficiencies in learning caused by COVID-19, and that psychological and emotional support needs to be strengthened at this time, as well as the issues to be supported after the end of the non-contact situation. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

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9 pages, 265 KiB

Open AccessBrief Report

The Influence of Socioeconomic and Educational Factors on the Level of Anxiety and Fear of COVID-19

by Valle Coronado-Vázquez, María del Valle Ramírez-Durán, Jaime Barrio-Cortes, Elena Benito-Alonso, Marina Holgado-Juan, María Silvia Dorado-Rabaneda and Juan Gómez-Salgado

Healthcare 2024, 12(1), 99; https://doi.org/10.3390/healthcare12010099 - 01 Jan 2024

Cited by 1 | Viewed by 968

Abstract

During the COVID-19 pandemic, there were reports of heightened levels of anxiety and fear of contagion in the general population. Such psychological responses may be influenced by the socio-environmental context in which individuals reside. This study aimed to examine the relationship between socioeconomic and educational factors and the level of anxiety and fear related to COVID-19. A multicenter, cross-sectional design was used, including patients aged 18 years or older who attended primary care physician consultations at various primary health centers in Toledo, Spain, between October 2020 and January 2021. By means of a non-probabilistic sampling, a total of 150 participants were selected for the study, with 146 of them providing responses to the AMICO questionnaire The level of fear and anxiety associated with COVID-19 was assessed using the validated Anxiety and Fear of COVID-19 Assessment Scale (AMICO). A significant linear relationship was revealed between social class, employment status, and anxiety levels. Specifically, as social class decreased (p = 0.001) and employment situation worsened (unemployment) (p = 0.037), the proportion of participants reporting a high level of anxiety increased. During the second phase of the pandemic, more than half of the patients attending family medicine consultations exhibited a high level of fear and anxiety towards COVID-19, which was significantly associated with lower social class and unemployment. Full article

(This article belongs to the Special Issue Primary Health Care: Challenges and Recommendations during a Pandemic)

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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Experiencing the Shift to Virtual Health Care Delivery: Insights from Front Line Primary Care Providers
Authors: Halas Gayle; Alanna Baldwin; Lisa Labine; Kerri MacKay; Alexander Singer; Alan Katz
Affiliation: University of Manitoba, Rady Faculty of Health Sciences, P228 – 770 Bannatyne Ave. Winnipeg, Manitoba, Canada R3E0W3.
Abstract: The rapid deployment of virtual primary care visits served as a first line response to COVID-19 and can now be examined for insights, particularly as virtual care is having an ongoing role in patient care and consultations. Input from primary care providers directly responsible for virtual care delivery is needed to inform policies and strategies for quality care and interactions. The overarching goal of this research study was to examine the use of virtual care as a mechanism for primary health care delivery. A phenomenological approach investigated the shift in primary care service delivery as experienced by primary care providers and initiated during the COVID-19 pandemic. Focus groups were conducted with primary care providers (n=21) recruited through email, advertisements and professional organizations, exploring how virtual care was delivered, the benefits and challenges, workflow considerations, and recommendations for future use. Integrating virtual care was done with a great deal of autonomy as well as responsibility and overwhelmingly depended on the telephone. Technology, communication, and workflow flexibility are three key operational aspects of virtual care and its delivery. Providers highlighted cross cutting themes related to the dynamics of virtual care including balancing risk for quality care, physician work/life balance, efficiency, and patient benefits. Primary care providers felt that virtual care options allowed increased flexibility to attend to the needs of patients and manage their practice workload, and a few scenarios were shared for when virtual care might be best suited. However, they also recognized the need to balance in-person and virtual visits, which may require guidelines that support navigating various levels of care. Overall, virtual care was considered a good addition to the whole ‘care package’ but continued development and refinement is an expectation for optimizing and sustaining future use.

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