PT  - JOURNAL ARTICLE
AU  - E. Marshall Brooks
AU  - Alison Huffstetler
AU  - Jacqueline Britz
AU  - Benjamin Webel
AU  - Paulette Lail Kashiri
AU  - Alicia Richards
AU  - Roy Sabo
AU  - Kristen O'Loughlin
AU  - Peter Cunningham
AU  - Andrew Barnes
AU  - Tony Kuzel
AU  - Alex H. Krist
TI  - The Distressed State of Primary Care in Virginia Pre-Medicaid Expansion and Pre-Pandemic
AID  - 10.3122/jabfm.2021.06.210046
DP  - 2021 Nov 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 1189--1202
VI  - 34
IP  - 6
4099  - http://www.jabfm.org/content/34/6/1189.short
4100  - http://www.jabfm.org/content/34/6/1189.full
SO  - J Am Board Fam Med2021 Nov 01; 34
AB  - Background: Primary care is crucial to the health of individuals and communities, but it faces numerous structural and systemic challenges. Our study assessed the state of primary care in Virginia to prepare for Medicaid expansion. It also provides insight into the frontline of health care prior to an unprecedented global COVID-19 pandemic.Methods: We surveyed 1622 primary care practices to understand organizational characteristics, scope of care, capacity, and organizational stress.Results: Practices (484) varied in type, ownership, location, and care for medically underserved and diverse patient populations. Most practices accepted uninsured and Medicaid patients. Practices reported a broad scope of care, including offering behavioral health and medication-assisted therapy for opioid addiction. Over half addressed social needs like transportation and unstable housing. One in three practices experienced a significant stress in 2019, prepandemic, and only 18.8% of practices anticipated a stress in 2020.Conclusions: Primary care serves as the foundation of our health care system and is an essential service, but it is severely stressed, under-resourced, and overburdened in the best of times. Primary care needs strategic workforce planning, adequate access to resources, and financial investment to sustain its value and innovation.