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Published April 30, 2020
While the COVID-19 virus has altered or even halted the routines of many people’s lives, health care providers at the University of Wyoming Educational Health Center of Wyoming (EHCW) clinic sites not only have continued to serve patients -- they also have taken the next steps to ensure health care delivery now and beyond the pandemic.
One primary tool that has evolved to ensure patient and provider safety during the extremely volatile spread of the novel coronavirus is telehealth.
Albany Community Health Clinic
Katie Doherty, a registered nurse and nursing supervisor with the Albany Community Health Clinic (ACHC) in Laramie, says an important aspect of being a nurse is the connection with patients. Yet, that “seemed to change overnight” due to the pandemic.
“Fortunately, our clinic was moving down a path to initiate more telehealth and, thus, some of the technology was in place. It was a matter of how to use it and educating our patients on this technology as well,” Doherty says.
The ACHC also initiated a telephone triage for patients calling with potential COVID-19 symptoms. These calls included a significant increase in patients with mental health concerns related to anxiety and increased stress due to isolation and worries over possible infection.
Nancy McGee, a psychiatric mental health nurse practitioner with the ACHC, provides evaluation, diagnosis, medication management and brief psychotherapy interventions for people with mental health and substance abuse problems. She serves as a consultant for primary care providers at the ACHC.
“Prior to the COVID-19 outbreak, the ACHC team had been working to expand telebehavioral health services (a form of telehealth) in an attempt to increase access to behavioral health treatment throughout our rural state,” McGee says. “We were fortunate to have already developed telehealth policies and procedures, and had begun the early implementation phases of telebehavioral health services in the weeks prior to the outbreak.”
Moving behavioral health appointments to telehealth platforms allowed the behavioral health providers to work remotely, thus reducing the number of patients and providers on-site at the clinic each day. Primary care also has shifted health care delivery models to telehealth platforms -- phone and secure Zoom.
“I think the innovation that has come out of this crisis will ultimately move health care forward,” McGee says. “In many ways, telehealth has allowed me to continue interacting with patients in the same way we always have. In a state like Wyoming, with critical health care provider shortages in many communities, my hope is that telehealth is here to stay.”
Casper Family Medicine Residency Program
Cynthia Works has served as a family physician with the Casper Family Medicine Residency Program since 2002. She says the Casper clinic started early by helping the elderly and those considered immunocompromised through phone calls and telehealth so they could stay safe at home and avoid risking potential exposure by coming to the clinic.
“During this challenging time of COVID-19, the clinic and residency teams have been called upon to shift and change at a rapid pace to keep our patients and staff safe and to continue to meet the needs of the patients we serve,” Works says. “Our clinic and residency leadership has stepped up and lived up to the description of ‘servant’ leaders, as they have guided not only the clinic, but also have helped the Casper community by playing key roles in the response to COVID.”
Long-term care facility visits also were done virtually, so health care providers who work in many different settings would not carry COVID-19 into the care settings of the most vulnerable members of the community.
“Every department of the clinic has pulled together to take care of each other and our patients,” Works says. “Our pharmacy delivering meds, curbside lab draws, resident physicians and medical students volunteering -- along with many more efforts -- have been true to our mission of service to help meet the health care needs of the Casper community.”
Becky Griffith, clinic nursing director and herself a longtime nurse, says COVID-19 has dramatically changed the way she takes care of her patients by taking away a lot of hands-on contact.
“I have always given my heart and gentle words to my patients with hugs and sympathetic understanding,” Griffith says. “With the pandemic happening, patients and co-workers have been quite stressed out and very anxious about what this has done to all of us and our normalcy. Nerves have been on edge and patience short at times.”
But the situation has improved, she says.
“Now that we have been doing our new and always changing normal for about five weeks now, everyone seems to have settled in and are focused on taking the best care we can of our patients and each other,” Griffith says. “We have been working feverishly to reassure and educate our patients with the information that we have on symptoms of COVID, quarantining, screening, refilling medications and any other issues that are happening.”
A second-year resident physician, Jared Lambert, also has adapted to the changes resulting from COVID-19. Lambert, originally from Phoenix, Ariz., works closely with his attending physician supervisors.
“It has required me to ensure that I’m up to date with current events to best reassure and provide recommendations to my patients,” Lambert says. “I plan to more closely follow current medical events, both in and out of this pandemic situation, to ensure I am prepared to answer any questions my patients may have.”
There have been some negative consequences from the pandemic that have affected clinic staff and operations.
“In the short term, we have experienced a 30 percent decrease in the number of patient visits over the past month,” Lambert says. “However, I believe this pandemic will actually have a lasting positive benefit to our clinic in having necessitated all of us to adapt in serving our patients through the use of telehealth and phone visits.”
Cheyenne Family Medicine Residency Program
Resident physician Baier Rakowski, with the Cheyenne Family Medicine Residency Program, shares Lambert’s concerns for patient/provider safety during the current crisis.
Rakowski, from Portland, Ore., notes that while telehealth is an interesting tool, “established standards for ensuring a high-quality telehealth visit have been put aside as secondary to many of the challenges posed by the pandemic.”
“As we work toward performing more virtual visits, we will need to learn to balance the risks of exposure with the need to evaluate patients,” Rakowski says.
Karen Jefcoat, a Cheyenne resident and physician assistant with the clinic, was skeptical, at first, using telehealth to interact with patients.
“Having now done several telehealth encounters, I realize that good patient care can be accomplished even in nontraditional ways,” Jefcoat says. “It surprised me to see how much my patients seem to enjoy the video visits.”
Jefcoat now sees the quick initiation of telehealth in the Cheyenne clinic as a way to “provide better care to patients when there are issues such as transportation, weather or viral outbreaks such as COVID-19 and influenza.”
As a nursing supervisor with the clinic, Cheyenne native John Goetz points to the effects of the pandemic as having “deprived both patients and nurses of this sense of interconnectedness.” Still, however challenging the current and future conditions imposed by COVID-19 are, Goetz sees positive outcomes for not only the Cheyenne clinic, but also all clinics included in the EHCW.
“Almost overnight, the entire clinic embraced telehealth,” Goetz says. “The transition had a few challenges in the beginning, but now we have hit our stride. We have discovered, unsurprisingly, the key benefit of telehealth is improving access to care.”
Positive Outcomes for Patients and Students
With many changes taking place in the delivery of health care due to COVID-19 -- through either telehealth or other means -- and the positive outcomes for patients who use these services, providers are continuing to review these technologies with the goal of continued advancement in patient care.
For students who are considering careers in health care, this rapidly changing environment offers both new challenges and opportunity.
“We will use the lessons we have learned as a health care community during this unprecedented time to increase training opportunities around telehealth,” McGee says. “While most traditional field placements were halted by the pandemic, telehealth has allowed many health sciences students an opportunity to continue their education and participate in direct patient care.”
“For all those students considering careers in health care, may service be at the heart of their motivation to enter these careers,” Works says.