When COVID-19 hit the U.S., stay-at-home orders went into effect across the country. As a result, Kaiser Permanente hospitals in Northern California—like so many other health systems and physician practices—saw a dramatic reduction in the number of patients coming to emergency departments with strokes. In some areas there was a 30% reduction while heart attack admissions fell to nearly half of what would be expected.
Data from the National Syndromic Surveillance system also found that emergency department visits declined 42% during the early COVID-19 pandemic, from a mean of 2.1 million per week (March 31–April 27, 2019) to 1.2 million (March 29–April 25, 2020).
“There are two pandemics: the pandemic of COVID-19 and the pandemic of fear, and what we see in behaviors that are keeping people away,” said Richard S. Isaacs, MD, CEO and executive director of The Permanente Medical Group (TPMG) in Northern California and co-chief executive officer of The Permanente Federation. “We’re seeing that also in routine checkups as well. People have been following the shelter-in-place orders and they’ve limited their activity for some of these essential health needs.”
It is vital, though, that patients who have urgent medical conditions or who are due for immunizations or screenings continue to get their care, especially as hospitals and medical offices take extra precautions to keep everyone safe.
Here is what Kaiser Permanente physicians are doing to help patients get the safe and timely health care they need.
“We are using telemedicine in an unparalleled way,” said Dr. Isaacs who is also president and CEO of Mid-Atlantic Permanente Medical Group (MAPMG). Both TPMG and MAPMG are among eight Permanente medical groups in the U.S. that, with Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, comprise Kaiser Permanente.
Currently, Permanente physicians conduct an average of more than 20,000 video visits per day in Northern California and about 45,000 video visits across the country. Read more about how Permanente uses telehealth during the COVID-19 pandemic.
“We’re able to provide care without the patients coming in, and we’re really proud of that,” said Dr. Isaacs. “What we’re learning is the patients really like the convenience of having their physicians see them on video in their home, so it’s really changing the way we think about health care.”
Learn more from the AMA about how to establish telehealth and deliver patient care while practicing physical distancing.
It is vital that patients with chronic conditions receive necessary care to protect their health and well-being during the pandemic. This is why TPMG continues to enhance access to home care through telemedicine.
“What we’ve found is that patients—and we’re studying this population here at Kaiser Permanente—understand that chronic conditions contribute or make them more vulnerable to COVID-19,” said Dr. Isaacs. “There’s actually been outreach by these patients with chronic conditions to get their diabetes and hypertension under control in a COVID-19 era, much differently than what we saw pre-COVID.”
Learn more about strengthening long-distance care for chronic disease patients.
As stay-at-home orders are lifted and patients think about scheduling in-person appointments with their doctors, they might be worried or afraid of contracting COVID-19. The Permanente Medical Groups are educating patients about how to stay safe outside of their home.
“It’s really about hygiene, hand washing and wearing masks, so we don’t transmit disease,” said Dr. Isaacs. “Then in the medical centers, we are practicing social distancing.
“We stagger appointments and we remove chairs from waiting rooms so patients aren’t too close to each other—basically delay waiting,” he added.
This helps to maximize safety for patients and minimize exposure. To add to this, Kaiser Permanente uses its electronic medical record platform to send messages to patients “once or twice a week with information about how to stay safe and what they will experience when they need to come into the medical center for their care,” said Dr. Isaacs.
Data has shown a decline in routine pediatric vaccine ordering and doses administered during the pandemic, which may indicate that U.S. children and their communities face increased risks for outbreaks of vaccine-preventable diseases.
“We’re making it convenient for patients to limit their exposure and get their routine immunizations, particularly the patients who are at risk, which include people over the age of 65, those with diabetes, hypertension and other chronic conditions, and young children who need their immunizations,” he said.
“In many cases we’re providing that care in a drive-through setting.”
Patients will “come into the medical center at an appointed time,” said Dr. Isaacs. “However, they don’t have to leave the comfort of their own car to get the vaccine, which creates a secure environment.”
Physicians continue to encourage patients to get their scheduled immunizations and are also providing recommendations for the upcoming flu season to create a longer impact for patients.
“Another important focus for our organization is testing,” said Dr. Isaacs. “We are identifying those patients who are coming in for procedures ahead of time to identify whether they are COVID-19 positive or negative.”
This allows them to keep COVID-19 positive patients separate from those who are negative. To do this, Kaiser Permanente keeps patients separated to segregate the disease as much as possible. Patients are encouraged to call and get tested before coming in for their appointment as an added layer of safety.
The AMA has developed a COVID-19 resource center as well as a physician’s guide to COVID-19 to give doctors a comprehensive place to find the latest resources and updates from the Centers for Disease Control and Prevention and the World Health Organization.