Access impacts to primary care rehabilitation practice during the COVID-19 pandemic

Abstract

Introduction: The COVID-19 pandemic introduced significant changes in delivery of primary care health services. Rehabilitation professionals working in primary care experienced major changes to their practice. This upheaval impacted both how patients accessed care, and who could access care. Some of these changes, including virtual care, may continue. An evaluation of the access impacts associated with these practice changes is important, so that we understand how these changes impacted equitable access, and to help inform which practice changes should be continued into the future. Purpose: To explore changes in access to primary care rehabilitation practice during the COVID-19 pandemic from the perspective of healthcare providers, applying a lens of equitable access. Methods: In this qualitative descriptive study, thirteen rehabilitation professionals working in primary care in Manitoba and Ontario participated in semi-structured interviews, timed 9-10 months into the pandemic. The interview questions explored the practice changes and access impacts. Qualitative analysis steps included data immersion, coding to identify the access impacts associated with each practice change, then application of Levesque et al.’s Patient-Centred Access to Healthcare framework as a lens of equitable access to inform the findings. Findings: Primary care rehabilitation professionals described practice changes that both enhanced and reduced access, some of which had equity-specific impacts. Virtual care, outreach activities, and wellness checks all enhanced equitable access for some patients, making care more accessible for patient populations who may have been underserved. However, for some patient populations, the shift to virtual care created new access inequities via new access barriers, resulting in some patients completely unable to reach care. Conclusion: The findings from this thesis indicate there were practice changes that enhanced equitable access, yet also suggest that some of these changes, specifically virtual care, led to new access inequities. Access, from an equity perspective, was found to be negatively impacted when the organizational change(s) did not align with patients’ abilities and resources. As primary care organizations and clinicians consider which changes should be kept into the future, the findings from this study, and others, should be considered to ensure all patients gain or continue to have equitable access care.