Pandemic preparedness lessons for family physicians and other primary care providers

Role supports need to be ready and communicated in advance of the next pandemic

Although details related to the epidemiology, clinical presentation, and management of infectious disease may not be known in advance, information on how to adapt primary care settings and services can be anticipated.^2,3 This information includes guidance and expectations relating to the roles and responsibilities of FPs and other PCPs^2-4; infection prevention and control procedures, as well as the accessibility of suitable supplies⁵; clinical safety, privacy, and triaging for virtual care⁶; prioritization of preventative care visits and creation of additional capacity to address the backlog in missed preventative care (eg, evening clinics)⁷; management of patients without access to specialist consultations or routine laboratory testing^8,9; and delivery of care in congregate residential settings.¹⁰

In addition, FPs and other PCPs may need supplemental training in leadership,¹¹ providing virtual care,⁶ and addressing vaccine hesitancy and misinformation,¹² as well as structured and role-specific education tailored to pandemic response and just-in-time training in physical and psychological safety, especially when deployed to new settings.¹³ Similarly, changes to regulations, including standards of practice (eg, for virtual care and for prescribing) and funding (eg, fee codes, reimbursement for infection prevention and control implementation, income stabilization grants) need to be planned and communicated in advance so practices can better anticipate changes in access and delivery of care to prevent disruptions such as clinic closures, staffing reductions, or service interruptions that threaten continuity of care during and after a pandemic.^2-4

FPs and other PCPs face high levels of risk and uncertainty in early stages of pandemics

Sick patients will often seek initial care from their FP or PCP, placing primary care practices at high risk during community-based outbreaks.⁵ Additionally, providers routinely work across multiple settings and with medically vulnerable patients and must minimize the risk of transmission to other patients, community members, staff, and trainees, as well as to themselves and their families.^10,13,14 FPs and other PCPs must balance continuity of patient care while minimizing infection risk. Thus, plans to implement and enact resources and supports (eg, personal protective equipment and mobile testing centres) are needed when public health advisories are issued or community outbreaks are first detected so the risk of exposure can be mitigated.^3,5 In addition, government-operated assessment and testing centres and influenzalike illness clinics are needed to divert high-risk patients away from primary care practices.⁵ When providers are redeployed to high-risk settings (eg, congregate residential care facilities, shelters, emergency departments, and critical care units), community-level leadership must facilitate and coordinate this deployment to minimize potential risks.¹⁰

Preserve primary care capacity so routine primary care can continue

Primary care remains the backbone of a high-performing health care system, particularly during a pandemic or other health emergency.² Given their broad scope of practice, FPs are expected to take on new and additional responsibilities during a pandemic and asked to provide surge capacity in diverse settings.^2,13 However, unlike many other redeployed health care workers, FPs still retain responsibility for their own patients. During the COVID-19 pandemic, FPs highlighted the need to ensure coverage for their patients—a challenge made more complex when other providers on their team (such as primary care nurses) were redeployed, further reducing a practice’s capacity to provide routine primary care.^10,13 Pandemic plans need to preserve (and conserve) primary care capacity by incorporating strategies to engage other non–primary care workers to fulfill pandemic roles where possible, including expanding the scope of practice of other health professionals (eg, pharmacists), streamlining licensure of recently retired and previously unlicensed internationally trained health workers, and permitting non–health professionals (eg, veterinarians, community health workers, and volunteers) to perform specific tasks such as administering vaccines, staffing information help lines, and contact tracing.¹³ Additionally, pandemic plans need to facilitate lower-risk activities (ie, virtual care, staffing information lines, etc) for FPs and other PCPs with chronic illness or those who have caregiving responsibilities for vulnerable family members.^5,14 Moreover, providers in rural communities face challenges in limiting the risk of cross-infection given the limited number of providers in the community. Supports, including local leadership and locum coverage, are needed to assist rural providers in coordinating staffing across multiple and high-risk settings.^8,10,15

Pandemic response continues after infection risks and acute care pressures subside

During the pandemic recovery period,² FPs and other PCPs had to address the increased demand for services stemming from the backlog of preventive and routine care; the effects of postponed specialist visits, surgery, diagnostic testing, and other elective care; increased mental health concerns; the need to provide care for patients who contracted the disease, including administering new therapies; and the management of post-infection conditions, such as long COVID.^7-9

Moreover, the impact of vaccine hesitancy and misinformation, which may extend to other health conditions, should be addressed in primary care, where providers have established longitudinal relationships and trust with patients.¹² Pandemic plans must include the need for surge capacity in primary care to enable a faster return to prepandemic workloads.¹³

Addressing underlying system issues helps with adaptiveness

Primary care reforms such as interprofessional, team-based models of care; larger group practices (vs solo practice); prospective forms of practice payment models (ie, models other than fee-for-service); and improved adoption of electronic medical records better enable primary care practices to cope with heavy workloads, provider burnout, changes in patient volumes and overhead costs, and short-term provider leaves for illness or quarantine.¹⁵ Research found that integration of primary care practices with regional organizations through academic or hospital affiliation improves communication and coordination with individual practices.^4,13,15 The development of an effective communication system between primary care and other health sectors should facilitate timely and consistent updates, support adherence to protocols, reduce confusion, enable the spread of innovations, and foster connection among providers. Expansion of these reforms, as well as the introduction of additional supports, such as organized locum tenens and expanded disability programs, provide the foundation for robust pandemic response.^8,10

Conclusion

FPs and other PCPs, public health and health system leaders, and health ministries must act now to implement evidence-informed plans that minimize the impact of future health emergencies on primary care. The lessons learned from the COVID-19 pandemic can inform policies and actionable guidelines to effectively respond to future crises. Strengthening pandemic preparedness for primary care through evidence-based supports and policy frameworks will better equip providers to protect and promote the health of the population, enhance health system functioning, and support the well-being of the primary care workforce.