Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK
Open accessAbstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a rapid change in workload across healthcare systems. Factors related to this adaptation in UK primary care have not yet been examined. Aim: To assess the responsiveness and prioritisation of primary care consultation type for older adults during the COVID-19 pandemic. Design and setting: A cross-sectional database study examining consultations between 17 February and 10 May 2020 for patients aged ≥65 years, drawn from primary care practices within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network, UK. Method: The authors reported the proportion of consultation type across five categories: clinical administration, electronic/video, face-to-face, telephone, and home visits. Temporal trends in telephone and face-to-face consultations were analysed by polypharmacy, frailty status, and socioeconomic group using incidence rate ratios (IRR). Results: Across 3 851 304 consultations, the population median age was 75 years (interquartile range [IQR] 70–82); and 46% (n = 82 926) of the cohort (N = 180 420) were male. The rate of telephone and electronic/video consultations more than doubled across the study period (106.0% and 102.8%, respectively). Face-to-face consultations fell by 64.6% and home visits by 62.6%. This predominantly occurred across week 11 (week commencing 9 March 2020), coinciding with national policy change. Polypharmacy and frailty were associated with a relative increase in consultations. The greatest relative increase was among people taking ≥10 medications compared with those taking none (face-to-face IRR 9.90, 95% CI = 9.55 to 10.26; telephone IRR 17.64, 95% CI = 16.89 to 18.41). Conclusion: Primary care has undergone an unprecedented in-pandemic reorganisation while retaining focus on patients with increased complexity.
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Most remote consultations before and during the pandemic occurred by telephone.
“most remote consultations before and during the pandemic occurred by telephone (3, 12–15).”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [15]
Staff experienced the pandemic shift to remote consultation as organizationally and professionally challenging but considered it justified for safety reasons.
“that staff experienced the shift as organizationally and professionally challenging but considered it justified for safety reasons”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [15]
Staff later reported feeling tired and under pressure as well as concerned about the loss of in-person care, threats to the therapeutic relationship, potential for missed diagnoses especially in deprived and vulnerable groups, and a rising backlog of unmet need.
“they later reported feeling tired and under pressure as well as concerned about the loss of in-person care, threats to the therapeutic relationship, potential for missed diagnoses especially in deprived and vulnerable groups, and a rising backlog of unmet need”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [15]
Observational studies documented a sharp increase in remote consultations (telephone, e- and video, in that order) during the first wave in the UK.
“Observational studies documented a sharp increase in remote consultations (telephone, e- and video, in that order) during the first wave in the UK (14, 15)”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [15]
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“Observational studies documented a sharp increase in remote consultations (telephone, e- and video, in that order) during the first wave in the UK (14, 15).”
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- Authors
- Joy, M., McGagh, D., Jones, N., Liyanage, H., Sherlock, J., Parimalanathan, V., Akinyemi, O., van Vlymen, J., Howsam, G., Marshall, M., Hobbs, F. R., & de Lusignan, S.
- Affiliations
- University of Oxford (GB)
- Royal College of General Practitioners (GB)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2020-07-13
- Volume
- 70
- Issue
- 697
- Pages
- e540-e547
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC7363277
- OpenAlex
- W3042676969
- Cited by
- 178
- References
- 17
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 26 · 2023: 47 · 2022: 35 · 2021: 44 · 2020: 6
- FWCI
- 11.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of General Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (ACF-2014-13-014, NF-SI-0611-10273)
- Topics
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- COVID-19 pandemic, primary care, older adults, telephone consultation, video consultation, face-to-face consultation, home visits, polypharmacy, frailty, general practice
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Aged, Cross-Sectional Studies, Female, United Kingdom, House Calls, Humans, Male, Pneumonia, Viral, Primary Health Care, Coronavirus Infections, General Practitioners, Pandemics
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