Chronic Care in the Era of Covid-19
BY NEIL A. SOLOMON, MD
When I ended my blog post last month (The Camden Trial: Where do We Go From Here) saying that I would explore MedZed’s approach to integrating medical care and social services, I had no idea our model would be completely changed by the time I sat down to write. Covid-19 has upended our telemedicine-enabled home care model which relied on nurses in the home connected to a remote primary care provider to treat and address both medical and social needs for high-cost, high-need patients. Our immediate shift to an all-remote model as the virus started to spread has highlighted several important truths.
Preventing excess hospitalization and ER utilization is more important than ever – and will remain so for the foreseeable future. At MedZed, our goal has always been to reduce disease burden and increase self-management so complex patients can receive the care they need, longitudinally, in the home. Given the burden Covid-19 has placed on our hospitals and the risk of exposure they represent, management in the home is of paramount importance. But management in the home is different than just not seeking care – our patients’ chronic conditions will worsen in the absence of treatment, leading to more illness and poorer prognosis when they do present. We have adapted our treatment of chronic conditions to reflect the realities – proactively providing extra medications such as steroids and antibiotics to patients with lung disorders in case they flare and converting patients to three- month mail-order supplies of medications. Such interventions will minimize the risk that chronic conditions will worsen during the pandemic.
Early detection and remote support for suspected and confirmed Covid-19 patients is critical for vulnerable populations. We’ve created an entire Covid-19-focused program to reduce the chances that our chronically ill patients will fail. We actively screen all our patients for Covid-19 symptoms both before and during all visits. We teach patients with Covid-19 symptoms how to self-isolate and we follow up on them daily. Some patients use home pulse oximeters to track oxygen saturation for early signs of decompensation. We have also increased the number of advance care conversations and updated POLST forms to reflect the new realities. In addition, we created an on-line resource guide for all of our patients that delivers information about the epidemic, provides a symptom checker, reviews home care and quarantine procedures, offers tools and strategies for emotional support, suggests how to keep children active and engaged, and shows community-based resources for those in need.
Managing behavioral health symptoms is a critical part of the strategy. We have always believed that integrated care is most effective, and we see this clearly during these frightening times. For our vulnerable population, the fear associated with the virus can be palpable. Depression and anxiety are flaring in many patients and need to be addressed to enable our patients to keep focused on their health. We address these issues with both medication and non-pharmacologic strategies such as mindfulness. We are also seeing more decompensated schizophrenia and other severe mental illness. The MedZed team acts as an active advocate for these patients, helping them gain access to increasingly scarce mental health services. A fully integrated delivery model strips away access and navigation barriers, especially in these challenging times.
Today Covid-19 related crises and life-and-death challenges abound inside hospitals. Simultaneously the ambulatory setting is being tested in very significant ways. If we embrace these challenges with creativity, compassion, and much effort, we can keep many patients healthy, and simultaneously reduce burden on the overcrowded hospitals. My organization is proud to be part of the solution.
Neil A. Solomon, M.D., Co-Fouder and CMO
Neil is Co-Founder and Chief Strategist at MedZed, where he is responsible for developing our service programs, overseeing our CareForce, and establishing our clinical processes. He is a graduate of the Yale University School of Medicine and Board Certified in Internal Medicine.