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Background: The COVID-19 pandemic has reshaped healthcare delivery worldwide., Objective: To explore potential changes in the reasons for visits and modality of care in primary care settings through the International Consortium of Primary Care Big Data Researchers (INTRePID)., Methods: We conducted a cross-sectional, retrospective study from 2018-2021. We examined visit volume, modality, and reasons for visits to primary care in Argentina, Australia, Canada, China, Peru, Norway, Singapore, Sweden, and the USA. The analysis involved a comparison between the pre-pandemic and pandemic periods., Results: There were more than 215 million visits from over 38 million patients during the study period in INTRePID primary care settings. Most INTRePID countries experienced a decline in monthly visit rates during the first year of the pandemic, with rate ratios (RR) and 95% confidence intervals (CI) ranging from RR:0.57 (95%CI:0.49-0.66) to RR:0.90 (95%CI:0.83-0.98), except for in Canada (RR:0.99, 95%CI:0.94-1.05) and Norway (RR:1.00, 95%CI:0.92-1.10), where rates remained stable and in Australia where rates increased (RR:1.19, 95%CI:1.11-1.28). Argentina, China, and Singapore had limited or no adoption of virtual care, whereas the remaining INTRePID countries varied in the extent of virtual care utilization. In Peru, virtual visits accounted for 7.34% (95%CI:7.33%-7.35%) of all interactions in the initial year of the pandemic, dipping to 5.22% (95%CI:5.21%-5.23%) in the subsequent year. However, in Canada 75.30% (95%CI:75.20%-75.40%) of the visits in the first year were virtual, decreasing to 62.77% (95%CI:62.66%-62.88%) in the second year. Diabetes, hypertension and/or hyperlipidemia and general health exams were in the top 10 reasons for visits in 2019 for all countries. Anxiety, depression and/or other mental health related reasons were among the top 10 reasons for virtual visits in all countries that had virtual care., Conclusions: The pandemic resulted in changes in reasons for visits to primary care, with virtual care mitigating visit volume disruptions in many countries., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: KT receives a Chair in Family and Community Medicine Research in Primary Care at UHN and a Research Scholar award from the Department of Family and Community University of Toronto. She has received grants from the following organizations in the past 3 years: The Canadian Institutes of Health Research, Rathlyn Foundation Primary Care EMR Research and Discovery Fund, College of Family Physicians of Canada/Foundation for Advancing Family Medicine/CMA Foundation Heart and Stroke Foundation of Ontario, Department of Defense United States of America, St. Michael’s Hospital Foundation, Ontario Health Data Platform First Movers Fund, Queen’s University CSPC Research Initiation Grant, Diabetes Canada, Heart and Stroke Foundation and Brain Canada Heart-Brain IMPACT Award, CANSSI ICES Data Access Grant, North York General Hospital Exploration Fund, CFPC Janus Grant. MSCF receives honoraria and stocks from the Peruvian Cayetano Heredia University (Universidad Peruana Cayetano Heredia). SDL research group receives payments from the University of Oxford and the University of Surrey for conducting health services and primary care research. Moreover, they receive payments from pharmaceutical companies AstraZeneca, GSK, Sanofi, Seqirus, and Takeda for vaccine-related research. Additionally, SDL receives payments for membership on advisory boards for AstraZeneca, Sanofi, and Seqirus. RSK teaches at the Swedish advanced training program in quality improvement, Jonkoping Academy, and owns stocks in the Swedish healthcare company Ambea. AL received datasets and software from the University of Melbourne for data analysis in the present manuscript. He received remuneration as part of contracted wages from the University of Melbourne as part of his existing employment. JMN has received funding from the following organizations in the past 3 years: National Health and Medical Council, Medical Research Future Fund, Paul Ramsay Foundation, RACGP Foundation, and Astra Zeneca. This funding has all been provided to institutions, not personally. Related to use of general practice data, she holds shares in Torch Recruit, clinical trial recruitment software which is a spin off company from The University of Melbourne. WDP sits on the AT Still Research Advisory Board, for which he receives $1000 per year when meetings occur, although these meetings are irregular. He also serves voluntarily on the CO Aca. Fam Med. Leg. Com, Colorado Medicaid Provider Rate Review Com, and NAEPPCC Expert WG #4. He holds stocks in Johnson and Johnson, Eli Lilly, Novo Nordisk, Pfizer, Stryker, Amgen, Moderna, and Novartis, managed by independent advisors. Additionally, he receives supplies from Boehringer Ingelheim and AstraZeneca for COPD quality improvement studies and data analysis using secondary data. JMW was Past President at NAPCRG, an international primary care research organization holding an unpaid position. All other authors have declared that no competing interests exist. No funding sources were involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and the decision to submit the article for publication. The researchers are all independent of funders, and KT, AOB, MCL had full access to all the data and authors from each country had full access to the country-specific data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis., (Copyright: © 2024 Tu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: The majority of patients with respiratory illness are seen in primary care settings. Given COVID-19 is predominantly a respiratory illness, the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), assessed the pandemic impact on primary care visits for respiratory illnesses., Design: Definitions for respiratory illness types were agreed on collectively. Monthly visit counts with diagnosis were shared centrally for analysis., Setting: Primary care settings in Argentina, Australia, Canada, China, Norway, Peru, Singapore, Sweden and the United States., Participants: Over 38 million patients seen in primary care settings in INTRePID countries before and during the pandemic, from January 1st, 2018, to December 31st, 2021., Main Outcome Measures: Relative change in the monthly mean number of visits before and after the onset of the pandemic for acute infectious respiratory disease visits including influenza, upper and lower respiratory tract infections and chronic respiratory disease visits including asthma, chronic obstructive pulmonary disease, respiratory allergies, and other respiratory diseases., Results: INTRePID countries reported a marked decrease in the average monthly visits for respiratory illness. Changes in visits varied from -10.9% [95% confidence interval (CI): -33.1 to +11.3%] in Norway to -79.9% (95% CI: -86.4% to -73.4%) in China for acute infectious respiratory disease visits and - 2.1% (95% CI: -12.1 to +7.8%) in Peru to -59.9% (95% CI: -68.6% to -51.3%) in China for chronic respiratory illness visits. While seasonal variation in allergic respiratory illness continued during the pandemic, there was essentially no spike in influenza illness during the first 2 years of the pandemic., Conclusion: The COVID-19 pandemic had a major impact on primary care visits for respiratory presentations. Primary care continued to provide services for respiratory illness, although there was a decrease in infectious illness during the COVID pandemic. Understanding the role of primary care may provide valuable information for COVID-19 recovery efforts and planning for future global emergencies., Competing Interests: JW holds the position of Vice President and is employed by the DARTNet Institute, a non-profit organization specializing in primary care research. AB and ML work for the University of Toronto and part of their salary is supported by grants. WP has received grant funding from NIMCH, sits on the advisory board of AT Still Research Foundation, has stock in Moderna, Johnson and Johnson, Eli Lilly, Novo Nordisk, Styker, Amgen, Novartis, and Pfizer; and received supplies from Boehringer Ingelheim and AstraZeneca. RK teaches at the Swedish advanced training program in quality improvement and owns stocks in the Swedish healthcare company Ambea. SL is the director of the Royal College of General Practitioners (RCGP) Research and Surveillance Center (RSC) as part of his academic post at Oxford. He has received payment to his research group for health services and primary care research from the University of Oxford and the University of Surrey and a wide range of grant funding through his university for vaccine-related research from AstraZeneca, GSK, Sanofi, Segirus and Takeda. MC-F receives honoraria and stocks from the Peruvian Cayetano Heredia University (Universidad Peruana Cayetano Heredia). KT receives a Chair in Family and Community Medicine Research in Primary Care at UHN and a Research Scholar award from the Department of Family and Community University of Toronto. KT received grants from the following organizations in the past 3 years: The Canadian Institutes of Health Research, Rathlyn Foundation Primary Care EMR Research and Discovery Fund, College of Family Physicians of Canada/Foundation for Advancing Family Medicine/CMA Foundation Heart and Stroke Foundation of Ontario, Department of Defense United States of America, St. Michael’s Hospital Foundation, Ontario Health Data Platform First Movers Fund, Queen’s University CSPC Research Initiation Grant, Diabetes Canada, Heart and Stroke Foundation and Brain Canada Heart-Brain IMPACT Award, CANSSI ICES Data Access Grant, North York General Hospital Exploration Fund, CFPC Janus Grant. All funding sources were not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and the decision to submit the article for publication. The researchers are all independent of funders, and KT, AB, ML had full access to all the data and authors from each country had full access to the country-specific data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Westfall, Bonilla, Lapadula, Zingoni, Wong, Wensaas, Pace, Silva-Valencia, Scattini, Ng, Manski-Nankervis, Ling, Li, Heald, Laughlin, Kristiansson, Hallinan, Goh, Gaona, Flottorp, de Lusignan, Cuba-Fuentes, Baste and Tu.)

Background: Primary care electronic medical record (EMR) data can be used to identify, manage, and screen hypertension cases. However, this approach relies on completeness and accessibility of documented blood pressure (BP) values. With the large switch to virtual care due to the COVID-19 pandemic, we assessed BP documentation in primary care EMRs during the pandemic, across patient and physician groups., Methods: Hypertension-related visits were identified during the pre-pandemic (January 2017 to February 2020) and pandemic (March 2020 to December 2021) periods from a primary care EMR database in Ontario, Canada. Clustered logistic regression models were used to analyze the relationship of physician and patient characteristics with an outcome variable of documented BP. A chart review of 3200 hypertension visits without a BP recorded in structured data fields was conducted to determine if BP was recorded in progress notes., Results: Pre-pandemic, 75.7% of hypertension-related visits (113,966 of 150,511) had a BP recorded in structured documentation, but this significantly decreased to 36.4% (26,660 of 73,239) during the pandemic (odds ratio [OR] = 0.18, 95% confidence interval [CI]: 0.18-0.19). For virtual visits, 14.3% (6357 of 44,572) had a documented BP, vs 74.0% (20,056 of 27,089) for in-person visits. Chart review found that 55.9% of hypertension visits had no associated BP in structured documentation, but did have a BP recorded in the progress note. Male providers, compared to female providers, were less likely to record BPs pre-pandemic (OR = 0.45, 95% CI: 0.32-0.63) and during the pandemic, for both virtual visits (OR = 0.48, 95% CI: 0.32-0.71) and in-person visits (OR = 0.46, 95% CI: 0.33-0.64)., Conclusions: BP documented in primary care EMRs declined during the pandemic, most likely due to high rates of virtual visits impacting hypertension detection and management., (© 2023 The Authors.)