The question many physicians and their teams are asking is, “What happens if a patient with COVID-19 walks into our office?” For a family practice in Houston, it is no longer a question of “if,” but “now what?”
Houston’s Village Medical unexpectedly had to care for two patients with COVID-19 in February. They have since had their third case. This has prompted the team to change how they care for patients, especially those at high risk.
The AMA and the Centers for Disease Control and Prevention (CDC) are closely monitoring the COVID-19 global pandemic. Learn more at the AMA COVID-19 resource center and consult the AMA’s physician guide to COVID-19.
“We are handling the situation as all other providers that we know are, with as much professionalism as we can, given the incredible uncertainty around the information as well as the fluidity of the situation,” said Clive Fields, MD, chief medical officer and co-founder of VillageMD, a 100-physician family practice.
With the heightened risk of COVID-19, Dr. Fields shared seven ways Village Medical has adjusted their approach to patient care.
“We are, through our organization, able to risk-stratify our patients that are most at risk for morbidity and mortality if they did contract the infection,” said Dr. Fields. “We’re actively and proactively reaching out to those high-risk patients to make sure they have their prescriptions.”
If a patient is running low or out of one of their regular prescription medications, the Village Medical team will arrange for home delivery from their own pharmacy to minimize exposure and risk. This also helps relieve some anxiety for those patients.
“We are aggressively recommending what most large organizations are doing now, which is effectively perform social distancing when at all possible,” he said, adding that “most are incredibly relieved to actually hear from us.”
During this outbreak, Dr. Fields emphasizes the importance of keeping high-risk patients out of the emergency department or hospital if they do not have a true emergency.
“We’re afraid that if we neglect those patients that we always care for with congestive heart failure, COPD and diabetes, that they may end up in the emergency room for something that would have been predictably avoidable,” he said.
At Village Medical, all appointments have been moved to 100% telehealth, which will help eliminate possible exposures to COVID-19 in the health care setting. This helps physicians eliminate nonessential health care visits to protect both patients and health care professionals.
“We’re going to start to see a number of phone calls from people who have tested positive at the health department or a hospital,” said Dr. Fields. “[Telehealth] is going to turn out to be the kinds of capabilities that are going to be critical, not just in this outbreak, but truly in the management of chronic disease prevention and wellness.”
In an effort to keep our health care workers and patients safe amid the COVID-19 pandemic, the AMA has designed a quick guide to telemedicine in practice to help physicians and practices in expediting implementation.
When the health department shared that another Village Medical patient tested positive for COVID-19, it led to unanswered questions. The patient was concerned and was not able to get the information he wanted from the health department.
“Family doctors are going to find themselves in positions where they may be best serving their patients,” said Dr. Fields. “They're using their relationship to deliver sometimes difficult information to patients about the critical need for them to follow recommendations around social distancing to slow the spread of disease, isolation if they have tested positive and quarantine for a minimum of 14 days if they have been exposed.”
Stress and anxiety are often caused by a lack of information. However, in this situation, there may be information overload that adds to patient fears.
“There's so much that I think people are struggling to find a source of truth,” said Dr. Fields. “We're asking those people to identify either a national source of truth or their local trusted health care provider like Village Medical as a place to go for answers to their questions.
“What we've found is that with clarity, there's a significant reduction in anxiety,” he added.
While it might seem minimal, updating medical office websites can be beneficial because patients often turn to their family physician for guidance. For example, Village Medical continues to update their website on a regular basis with information about COVID-19 as it becomes available.
“What two weeks ago started out with ‘What is COVID-19?’ has rapidly moved to what social distancing means and has us moving to our telehealth capabilities,” said Dr. Fields. “Ultimately, we’ll end in ‘what to do if I am COVID-19 positive?’”
In the next few weeks, handling stress levels from the health care team will “become a much bigger issue, especially as we start to report more and more positives,” said Dr. Fields. “We have a different obligation at this point than other professionals, very similar to firemen and policemen that lend towards a battle.
“That's what we signed up for, but we are going above and beyond to protect our employees, our health care professionals with all CDC recommendations and the move to virtual will eliminate much of the patient contact,” he added.
Dr. Fields recommends finding one or two health care professionals at each site who would be appropriate for testing or the evaluation of a patient who is at high-risk for COVID-19. This will help during times where there is a lack of supplies—whether it is N95 masks or full protective equipment that impacts the ability to have multiple health care professionals.
The AMA’s COVID-19 FAQ will help physicians address patient concerns and offers advice on key issues such as how to optimize personal protection equipment supply.