Marshall Emily Gard, Breton Mylaine, Cossette Benoit, Isenor Jennifer, Mathews Maria, Ayn Caitlyn, Smithman Mélanie Ann, Stock David, Frymire Eliot, Edwards Lynn, Green Michael
Primary Care Research Unit, Dalhousie Family Medicine, Halifax, NS, Canada.
Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada.
JMIR Res Protoc. 2021 Oct 13;10(10):e29984. doi: 10.2196/29984.
The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care.
The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions.
The PUPPY study builds on an existing research program exploring patients' access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data.
This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020.
To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient's attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29984.
新冠疫情严重扰乱了加拿大的初级医疗服务，许多随诊诊所和家庭医生诊所最初关闭，或被认为无法就诊；药房虽仍营业，但对患者互动有限制；虚拟医疗迅速普及；实验室检查、诊断及专科护理的转诊减少。
“小狗研究”（COVID-19大流行期间附属和非附属患者在协调和获得初级医疗服务方面的问题加剧）旨在了解新冠疫情对初级医疗服务四大目标的影响，尤其关注对未绑定常规医疗服务提供者的患者和患有慢性疾病患者的影响。
“小狗研究”基于一项现有的探索患者获得初级医疗服务及与初级医疗服务机构绑定情况的研究项目，并进行调整以适应新冠疫情新情况。我们打算开展一项纵向混合方法研究，以了解初级医疗服务获得和协调方面的关键差距，并比较加拿大3个省份（魁北克、安大略和新斯科舍）疫情前和疫情后的相关数据。将使用多种数据来源，如政策审查；对初级医疗服务政策制定者、提供者（即家庭医生、执业护士和药剂师）和患者（N = 120）进行定性访谈；以及药物处方和医疗计费数据。
本研究获得了加拿大卫生研究院新冠疫情快速资助机会基金的资助。2020年11月，安大略省（女王大学健康科学与附属教学医院研究伦理委员会，文件6028052；韦仕敦大学健康科学研究伦理委员会，项目116591；多伦多大学健康科学研究伦理委员会，方案40335）、2020年12月魁北克省（东部地区大学卫生与社会服务综合中心，项目2020 - 3446）以及2020年8月新斯科舍省（新斯科舍省卫生研究伦理委员会，文件1024979）批准了开展本研究的伦理许可。
据我们所知，这是同类研究中首个探讨新冠疫情对初级医疗服务系统影响的研究，尤其关注患者与初级医疗服务的绑定及获得情况问题。通过多利益相关方、跨辖区的方法，“小狗研究”的结果将为加强新冠疫情期间及之后的初级医疗服务提供信息，并对未来政策和实践产生影响。
国际注册报告识别号（IRRID）：DERR1-10.2196/29984 。
