When Is It Safe to Go Back in the Field?
BY NEIL A. SOLOMON, MD
It was an easy decision to pull our nurses and other staff out of the field almost four months ago. It is much more difficult to figure out when, where and how to reintroduce our teams into the community.
As a mobile medical group that cares exclusively for very high-risk individuals, we know that our patients could fare poorly if they contract Covid-19. The last thing we want to do is contribute to the spread the virus. We worry that a nurse could contract coronavirus in one house and then deposit it in other patients’ homes. In essence, our field staff could unwittingly become vectors of the virus among high-risk individuals. We could become part of the problem instead of the solution.
We weigh that against the need to help our homebound and homeless vulnerable patients. We have been conducting a combination of video and phone visits since the onset of the pandemic. We have shipped pulse oximeters, blood pressure cuffs and other home equipment to help us manage remotely. When it works, it’s great to be able to do our visits smoothly and safely.
But what about when it doesn’t work? Some of our patients lack internet access, or a phone. Others have a phone and cell service, but the video is a challenge for them. Phone-only visits limit data collection and are much weaker in creating the therapeutic relationships we seek. We send monitoring devices, but they might not arrive due to shortages at the durable medical equipment companies. Even when the devices arrive, the patients sometimes have difficulty operating them. Nothing is straightforward during a pandemic!
It seemed prudent to conduct our visits all-remote in the beginning, but now that approach is showing its holes. We felt we could adequately manage most chronic conditions completely remotely for a couple of months. If blood pressures inched up or ankles swelled a little they probably could be fixed soon enough when things got back to normal, or so we thought.
Now that we all realize we will be living in a pandemic for many months and possibly longer, we are figuring out the new normal. The key question is how to balance risks from possible coronavirus infection against declining health of patients living with chronic conditions. Certainly, no easy answer.
Our approach is evolving. We are tracking current prevalence of virus (i.e. new infections in last two weeks) in every county where we operate. We screen for virus symptoms and exposures when we make our confirmation calls. We conduct different visit types—including outdoor visits—based on patient need and local virus prevalence. We have equipped and trained our field staff (nurses and community health workers) to use PPE, to minimize high risk interactions, and to recognize symptoms of Covid-19 in themselves and their patients. We are still rolling out part of the field strategy and will certainly evolve as we learn more.
Many clinicians have begun to recognize the secondary health toll of the pandemic on chronic conditions. Presently many patients’ chronic illnesses are not getting adequate attention and are likely to get significantly worse as the pandemic drags on. Amid these challenges, MedZed is navigating a careful return to our patients’ homes to both improve their health and to help them avoid coronavirus exposure. Our work is a narrow balance of risks and benefits, and will likely evolve with the pandemic itself.
Relevant Articles:
Health crisis looming inside a health crisis: People are avoiding going to the doctor:
https://www.latimes.com/california/story/2020-07-29/coronavirus-people-avoid-visits-to-doctor
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.