ORIGINAL RESEARCH
Leah Tuzzio, MPH; Kathy S. Gleason, PhD; James D. Ralston, MD, MPH; Melanie Drace, MPH; Marlaine Figueroa Gray, PhD; Ruth Bedoy, MPH; Jennifer L. Ellis, MSPH; Richard W. Grant, MD, MPH; Elizabeth A. Bayliss, MD, MSPH
Corresponding Author: Elizabeth A. Bayliss, MD, MSPH; Institute for Health Research - Kaiser Permanente Colorado
Email: elizabeth.bayliss@kp.org
DOI: 10.3122/jabfm.2023.230053R2
Keywords: Caregivers, Continuity of Care, COVID-19, Family Health, Multiple Chronic Conditions, Pandemics, Primary Health Care, Qualitative Research, Telemedicine
Dates: Submitted: 02-15-2023; Revised: 08-25-2023; 09-06-2023; Accepted: 09-11-2023
FINAL PUBLICATION: |HTML| |PDF|
BACKGROUND: Optimal care for persons with multiple chronic conditions (MCC) requires primary and specialty care continuity, access to multiple providers, social risk assessment, and self-management support. The COVID-19 pandemic abruptly changed primary care delivery to increase reliance on telehealth and virtual care. We report on the experiences of individuals with MCC and their family caregivers on managing their health and receiving healthcare during the initial pandemic.
METHODS: Semi-structured qualitative interviews with 30 patients (19 English speaking, 11 Spanish speaking) plus 9 accompanying care partners, who had 2+ primary care encounters between March 1, 2020, and November 30, 2020, 2+ chronic conditions, and one or more self-reported social risks. Questions focused on access to and experiences with care, roles for care partners, and self-management during the first 6 months of the pandemic.
RESULTS: Participants experienced substantial changes in care delivery. The most commonly reported changes were a shift to more virtual relative to in-person care and shifting roles for care partners. Changes fostered new perspectives on self-management and an appreciation of personal resilience and self-reliance. Virtual care was an acceptable complement to in-person care, though not a substitute for periodic in-person visits. It was more acceptable for English speakers and with a usual provider
CONCLUSION: New models of care delivery that recognize patient and family resilience and resourcefulness, emphasize provider continuity, and combine virtual and in-person care may support self-management for individuals with MCC and social needs.