Dataset Information

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

ABSTRACT:

Introduction

Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery.

Objective

To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE).

Methods

We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states.

Results

There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022.

Conclusion

Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.

SUBMITTER: Cook N

PROVIDER: S-EPMC10843627 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

Cook Nicole N McGrath Brenda M BM Navale Suparna M SM Koroukian Siran M SM Templeton Anna R AR Crocker Laura C LC Zyzanski Stephen J SJ Bensken Wyatt P WP Stange Kurt C KC

Journal of the American Board of Family Medicine : JABFM 20240105 6

<h4>Introduction</h4>Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery.<h4>Objective</h4>To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE).<h4>Methods</h4>We compared annual and monthly patients from 2019 to 2022 for new ...[more]

PMID: 37857445

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Project description:ImportanceExtraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being.ObjectiveTo determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point.Design, setting, and participantsThis survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US.ExposuresSafety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate.Main outcomes and measuresThe percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree); neutral or higher scores were counted as "percent concerning" for exhaustion.ResultsElectronic surveys were returned by 37 187 (of 49 936) HCWs in 2019, 38 460 (of 45 268) in 2020, and 31 475 (of 41 224) in 2021 to 2022 for overall response rates of 74.5%, 85.0%, and 76.4%, respectively. The overall sample comprised 107 122 completed surveys. Nursing was the most frequently reported role (n = 43 918 [40.9%]). A total of 17 786 respondents (16.9%) reported less than 1 year at their facility, 59 226 (56.2%) reported 1 to 10 years, and 28 337 (26.9%) reported 11 years or more. From September 2019 to September 2021 through January 2022, overall %EE increased from 31.8% (95% CI, 30.0%-33.7%) to 40.4% (95% CI, 38.1%-42.8%), with a proportional increase in %EE of 26.9% (95% CI, 22.2%-31.8%). Physicians had a decrease in %EE from 31.8% (95% CI, 29.3%-34.5%) in 2019 to 28.3% (95% CI, 25.9%-31.0%) in 2020 but an increase during the second year of the pandemic to 37.8% (95% CI, 34.7%-41.3%). Nurses had an increase in %EE during the pandemic's first year, from 40.6% (95% CI, 38.4%-42.9%) in 2019 to 46.5% (95% CI, 44.0%-49.1%) in 2020 and increasing again during the second year of the pandemic to 49.2% (95% CI, 46.5%-51.9%). All other roles showed a similar pattern to nurses but at lower levels. Intraclass correlation coefficients revealed clustering of exhaustion within work settings across the 3 years, with coefficients of 0.15 to 0.17 for emotional exhaustion and 0.22 to 0.24 for emotional exhaustion climate, higher than the .10 coefficient typical of organizational climate (a medium effect for shared variance), suggestive of a social contagion effect of HCW exhaustion.Conclusions and relevanceThis large-scale survey study of HCWs spanning 3 years offers substantial evidence that emotional exhaustion trajectories varied by role but have increased overall and among most HCW roles since the onset of the pandemic. These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions.

Project description:BackgroundJapanese people sleep less compared to other countries around the world. Using a large nationally representative survey in 2019 and 2022, we investigated whether sleep duration and nonrestorative sleep (NRS) among Japanese people have improved or worsened due to the COVID-19 pandemic.MethodsData were drawn from the Comprehensive Survey of Living Conditions, a nationwide cross-sectional sample based on self-administered questionnaires. We analyzed 426,510 people in 2019 and 375,578 people in 2022 aged ≥20 living in the community. The generalized estimating equations of the multivariable Poisson regression models were used to estimate adjusted prevalence of NRS by survey year. Potential confounders included gender, age, marital status, family size, housing tenure, equivalent household expenditures, education, employment status, illness under treatment, lifestyle behaviors (i.e., smoking, drinking, dietary, and fitness habits), mental health, and sleep duration.ResultsAmong the study participants, 35.7% slept less than 6 hours and 20.9% had NRS. Regarding sleep duration, the prevalence of sleep duration of less than 6 hours was significantly lower in 2022 than in 2019 for both men and women. By gender and age, the prevalence of short sleep duration (<6 hours) significantly decreased for both men and women under the age of 49, but increased significantly for men aged ≥50 and women aged ≥75. Regarding NRS, the prevalence of NRS was significantly lower in 2022 than in 2019 regardless of gender and age: Prevalence among men was 21.4% in 2019 and 18.8% in 2022, and prevalence among women was 23.7% in 2019 and 21.2% in 2022. After adjustment for potential confounders, the difference between the 2022 NRS prevalence and the 2019 NRS prevalence was minus 1.64 percent point (pp) (95% confidence interval minus 1.82 pp to minus 1.46 pp, P < 0.001), showing a significant decrease in the 2022 NRS prevalence. A significant improvement of NRS was independent of the prevalence of short sleep duration, age, gender, and employment status.ConclusionsThe prevalence of NRS among the general population in Japan was significantly reduced during the COVID-19 pandemic compared to before the COVID-19 pandemic. We need to monitor whether this decline continues or returns to pre-pandemic levels.

Dataset Information

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

Introduction

Objective

Methods

Results

Conclusion

Publications

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

Similar Datasets

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