Maintaining continuity of care, and managing patients with chronic diseases, has proven difficult during the COVID-19 pandemic. Many providers and health system resources are being directed toward the pandemic, while fear of exposure to the virus has led to many patients with chronic and comorbid conditions avoiding care.
These patients need proactive care management now more than ever. Patients with chronic diseases will be more likely to experience acute care crises as a result of not receiving necessary treatment and care maintenance. Emergency departments, far from ideal points of care in the best of times, are now impacted with coronavirus patients, presenting a real risk to non-coronavirus patients who may be admitted down the line as a result of forgoing care.
To avert care crises and to ensure better continuity of care for our patients who need it most, Primary Medical Group, the primary care organization of which I am both president/COO and a physician, quickly adopted a telehealth platform, which we have been leveraging since early March. Through our expedited telehealth implementation, we went from no telehealth capabilities to near 90 percent adoption by our primary care workforce.
Telehealth technologies such as eConsults and video conferencing platforms have enabled our physicians to provide care remotely while maintaining open offices, empowering PCPs to offer complete, specialist-guided care to at-risk patients as safely as possible.
Telehealth and eConsults address key needs for chronic patients, preventing care crises and reducing the burden on our health system
Within our practice, we’ve found that telehealth empowers us as PCPs to provide complete care to our patients. eConsults and video conferencing software are helping our practice to address two major challenges: lapses in care for chronic patients, leading to acute crises; and the increased burden on our health system from sudden waves of high-acuity cases.
Regarding the first challenge, chronic care and comorbid patients are unable to maintain appointments as usual during the pandemic, yet they are still in need of care. These patients often require a care team, including specialist doctors, to engage with patients who are due for a visit or in need of routine care. Maintaining a regular care regimen and enabling these patients to continue interfacing with their care team is key to improving outcomes.
Establishing a telehealth platform has allowed us to proactively care for our patients, as we track those who fall outside of typical buffers and may be due for an appointment. Through telehealth, we can engage with these patients to ensure they’re keeping up with their care needs. eConsults, in conjunction with video telemedicine platforms that connect us to patients virtually, allow us to leverage specialist guidance that supports us in maintaining total patient care.
Improving access to care in this way helps us to avoid the downstream challenge of overburdened hospitals, and emergency departments in particular. When patients avoid proactive and non-urgent (but necessary) care, we see the burden to both patients and the healthcare system increase in the long run. By being available for routine care, and by proactively following up with patients, we can improve outcomes and reduce the upcoming strain on the healthcare system caused by a wave of patients seeking care that was put off.
In particular eConsults are a key piece of the puzzle within telehealth implementation, as they support our primary care providers in preventing a backlog of specialty referrals from occurring once these providers are again able to take non-urgent appointments.
Both patients and providers have seen telehealth as a positive addition to our practice
With any major shift in how we provide care to our patients, it’s expected that there will be hiccups and speed bumps as both patients and providers adapt to the change. We have found the transition to focusing on telehealth during the COVID-19 pandemic to be surprisingly smooth, with both patients and providers expressing satisfaction with our new telehealth capabilities.
From my patients, I’ve heard resoundingly positive feedback. Patients in need of routine specialty care have been delighted to find that their needs can be met without the need for an in-person appointment. Certainly, many patients will be glad to get back to something approaching normal. But overall, most patients have been blown away by the sheer volume of treatments and care maintenance that can be administered via telemedicine and telehealth in the meantime.
As a provider, I have also enjoyed providing care via telehealth. Our primary care team as a whole has felt empowered by the access to specialist input we now have via eConsults. Now, we can address both primary care needs and many specialty care needs that are absolutely crucial for our chronic and comorbid patients. Further, on a logistical note, telehealth has quite simply enabled our practice to remain in operation at a much higher capacity than would be possible otherwise. Many primary care offices have been forced to furlough employees, making it even more difficult for non-coronavirus patients to receive care, but adopting a telehealth platform has enabled us to retain our team members and continue to serve our patients.
Conclusion
As the coronavirus pandemic set in, many patients began to forgo care, believing that lockdowns and social distancing requirements would be a temporary blip. However, as weeks have turned to months, patients are realizing that this crisis represents a new normal, and that they will still need to seek care in the interim. For our primary care practice, telehealth implementation has enabled us to provide ongoing care that would otherwise be impossible, improving outcomes for our chronic patients and enabling our providers to continue working and serving their patients.
The willingness of both our providers and our patients to adapt to new ways of administering care has been incredible. Having seen telehealth and telemedicine in action, it seems very likely that our practice will continue to leverage telehealth as a means of providing care well after the crisis has passed. eConsults and video appointments have helped us to overcome many difficulties when it comes to care access, and these telehealth technologies figure to help us keep patients from slipping through the cracks.
Dr. Maria Barrell is a physician and president/COO at Primary Medical Group, an AristaMD, an eConsult partner
