Primary Care's Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs

Purpose: COVID-19 pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination. With the advent of several COVID-19 vaccines, the dissemination and delivery of COVID-19 immunization across the nation is of concern. Previous immunization delivery patterns may reveal important components of a comprehensive and sustainable effort to immunize everyone in the nation. Methods: The delivery of vaccinations were enumerated by provider type using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey. The delivery of these services was examined at the service, physician, and visit level. Results: In 2017 Medicare Part B Fee-For-Service, Primary Care Physicians provided the largest share of services for vaccinations (46%), followed closely by Mass Immunizers (45%), then NP/PAs (5%). The Medical Expenditure Panel Survey showed that Primary Care Physicians provided most clinical visits for vaccination (54% of all visits). Conclusions: Primary Care Physicians have played a crucial role in delivery of vaccinations to the U.S. population, including the elderly, between 2012-2017. These findings indicate primary care practices may be a crucial element of vaccine counseling and delivery in the upcoming COVID-19 recovery and immunization efforts in the United States.http://deepblue.lib.umich.edu/bitstream/2027.42/166088/1/874-20V3_PP.pdfDescription of 874-20V3_PP.pdf : Main ArticleSEL

Shifting Patterns of Physician Home Visits

Objectives: Home visits have been shown to improve quality of care and lower medical costs for complex elderly patients. We investigated trends in physician home visits and domiciliary care visits as well as physician characteristics associated with providing these services. Design: Longitudinal analysis of Medicare Part B claims data for a national sample of direct patient care physicians in 2006 and 2011. Descriptive statistics were used to characterize the physician sample and to determine numbers of home visits and domiciliary visits in total and by physician specialty. Setting: Patient homes, nursing homes, and domiciliary care facilities. Participants: Direct patient care physicians (n = 22 186). Measurements: Physician demographics, specialty, practice characteristics (practice type, geographic location), number of home visits, and domiciliary visits in 2006 and 2011. Results: We found a small increase (n = 63 501) in total number of home visits made to Medicare beneficiaries between 2006 and 2011 performed by a decreasing percentage of physicians (5.1%, n = 18 165 in 2006; 4.5%, n = 15 296 in 2011). There was substantial growth in domiciliary care visit numbers (n = 218 514) and a small increase in percentage of physicians delivering these services (2.0% in 2006, 2.3% in 2011). Physicians who performed home visits were more likely to be older, in rural locations, specialists in primary care, and more likely to provide nursing home and domiciliary care compared with physicians who did not make any home visits ( P < .05). Conclusion: Home visits and domiciliary visits to Medicare beneficiaries are increasing. General internal medicine physicians provided the highest number of home and domiciliary care visits in 2006, and family physicians did so in 2011. Such delivery models show promise in lowering medical costs while providing high-quality patient care

Assessing Primary Care Contributions to Behavioral Health: A Cross-sectional Study Using Medical Expenditure Panel Survey

Objectives To assess primary care contributions to behavioral health in addressing unmet mental healthcare needs due to the COVID-19 pandemic. Methods Secondary data analysis of 2016 to 2018 Medical Expenditure Panel Survey of non-institutionalized US adults. We performed bivariate analysis to estimate the number and percentage of office-based visits and prescription medications for depression and anxiety disorders, any mental illness (AMI), and severe mental illness (AMI) by physician specialty (primary care, psychiatry, and subspecialty) and medical complexity. We ran summary statistics to compare the differences in sociodemographic factors between patients with AMI by seeing a primary care physician versus those seeing a psychiatrist. Binary logistic regression models were estimated to examine the likelihood of having a primary care visit versus psychiatrist visit for a given mental illness. Results There were 394 023 office-based visits in the analysis sample. AMI patients seeing primary care physician were thrice as likely to report 1 or more chronic conditions compared to those seeing psychiatrist. Among patients with a diagnosis of depression or anxiety and AMI the proportion of primary care visits ([38% vs 32%, P  < .001], [39% vs 34%, P  < .001] respectively), and prescriptions ([50% vs 40%, P  < .001], [47% vs 44%, P  < .05] respectively) were higher compared to those for psychiatric care. Patients diagnosed with SMI had a more significant percentage of prescriptions and visits to a psychiatrist than primary care physicians. Conclusion Primary care physicians provided most of the care for depression, anxiety, and AMI. Almost a third of the care for SMI and a quarter of the SMI prescriptions occurred in primary care settings. Our study underscores the importance of supporting access to primary care given primary care physicians’ critical role in combating the COVID-19 related rise in mental health burden

Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care.

ObjectiveHousing insecurity has been linked to high-risk behaviors and chronic disease, although less is known about the pathways leading to poor health. We sought to determine whether housing insecurity is associated with access to preventive and primary care.MethodsWe conducted weighted univariate, bivariate, and multivariate analyses by using 2011 to 2015 Behavioral Risk factor Surveillance Survey data (N = 228,131 adults). The independent variable was housing insecurity derived from the question on worry about paying rent or mortgage. The outcome measures were health services utilization (no usual source of care, no routine checkup in the past 1 year, and delayed medical care due to cost), self-rated health (number of days reported physical, mental health not good, and poor overall health), and number of chronic diseases (0, 1, 2 or more). The covariates included age, sex, race/ethnicity, income, level of education, marital status, and number of children in the family. We also adjusted for state fixed effects and survey year. We performed χ2 tests and binary logistic regressions on categorical variables and ran t tests and estimated linear regression models on continuous variables. Multinomial logistic regressions were estimated for the number of chronic diseases.ResultsOf the 228,131 adults in the study sample, 28,704 adults reported housing insecurity. We found that those with housing insecurity were more likely to forgo routine check-ups and lack usual sources of care. Low-income individuals, minorities, the unmarried, and middle-aged adults were more likely to report housing insecurity.ConclusionHousing insecurity is associated with worse access to preventive and primary care. Interventions to enhance access for these patients should be developed and studied