Virtual primary care in high-income countries during the COVID-19 pandemic: Policy responses and lessons for the future

Abstract

Background

Telemedicine, once defined merely as the treatment of certain conditions remotely, has now often been supplanted in use by broader terms such as ‘virtual care’, in recognition of its increasing capability to deliver a diverse range of healthcare services from afar. With the unexpected onset of COVID-19, virtual care (e.g. telephone, video, online) has become essential to facilitating the continuation of primary care globally. Over several short weeks, existing healthcare policies have adapted quickly and empowered clinicians to use digital means to fulfil a wide range of clinical responsibilities, which until then have required face-to-face consultations.

Objectives

This paper aims to explore the virtual care policies and guidance material published during the initial months of the pandemic and examine their potential limitations and impact on transforming the delivery of primary care in high-income countries.

Methods

A rapid review of publicly available national policies guiding the use of virtual care in General Practice was conducted. Documents were included if issued in the first six months of the pandemic (March to August of 2020) and focussed primarily on high-income countries. Documents must have been issued by a national health authority, accreditation body, or professional organisation, and directly refer to the delivery of primary care.

Results

We extracted six areas of relevance: primary care transformation during COVID-19, the continued delivery of preventative care, the delivery of acute care, remote triaging, funding & reimbursement, and security standards.

Conclusion

Virtual care use in primary care saw a transformative change during the pandemic. However, despite the advances in the various governmental guidance offered, much work remains in addressing the shortcomings exposed during COVID-19 and strengthening viable policies to better incorporate novel technologies into the modern primary care clinical environment.

Keywords:

• Primary care
• health policy
• COVID-19
• telemedicine
• health informatics
• clinical informatics

Author contributions

Conception and design of the work: ALN, ECL, GF, ALN, ECL, PPG and GF wrote the manuscript. AD provided critical revision of drafts for important intellectual content. All authors provided input into drafts of the manuscript and agree on the contents of the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

ALN, EL and AD are supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre. Infrastructure support was provided by the NIHR Imperial Biomedical Research Centre (BRC).