Telehealth helps Berkshire doctors with key virus relief effort: Keeping people healthy
One doctor worries about an elderly patient suddenly alone and unable to hold a funeral for her husband. Another fears for his patients with diabetes, hypertension and other chronic conditions that quickly could take a turn.
As the coronavirus crisis drags on, the need to care for patients only increases — yet, physical access to patients slips away as doctors try to reduce exposure at their practices. And social distancing measures promise to be in place for at least several more weeks.
So, doctors are turning to telehealth appointments, which provide a virtual means of checking up on patients through remote means — typically engaging via online video or even a simple phone call.
Telehealth allows a more-accessible path toward keeping patients healthy and reducing their chances of hospitalization, doctors say.
"People with multiple medical conditions can't afford to go that long without seeing their physicians," said Dr. Thomas Consolati of Suburban Internal Medicine in Lee.
Patients with underlying health conditions like diabetes, lung, heart and kidney disease require more regular care, he said.
"We know from the experience we have so far with coronavirus that people with those conditions tend to do worse if they get [the] coronavirus," he said.
But, even without the virus, he said, "those are conditions that, if you don't stay on top of, they deteriorate quickly."
He said it's important for their health, and the health of the community — hospitalizations during an outbreak would place a strain on an already-stressed hospital system.
Telehealth appointments, which are covered by insurance companies just like an office visit, are easy to do, doctors say.
Patients must simply call their doctors' offices like they normally do, and administrative staff will talk them through the process of downloading and using apps like Zoom, Skype and FaceTime.
They need to have access to a smartphone, tablet or a computer with a camera.
During the visit, doctors can talk patients through symptoms — and they have access to medical records on their computer screen during the process. They can order labs and prescribe medicines based on their observations, just as they do during regular checkups.
"It's certainly not as productive as a face-to-face visit, but it's pretty close," Consolati said. "It's pretty close for most issues, especially chronic issues that we've together been managing for a while."
Patients seem to enjoy the telehealth visits during this isolated time, Consolati said, and it's fun for him, too, to get to see his patients in their homes with their loved ones.
"You actually get to see a little bit of the patient that you wouldn't get to see normally," he said.
When in-person appointments are unwise, medical professionals said, telehealth visits show patients that "we're here."
Joanne Warren of Dalton Medical Associates said telehealth also can offer doctors a chance to soothe during this stressful time.
"This is a time when people are upset," she said. "They're overeating, as we all are."
Stress eating does not bode well for people fighting conditions like hypertension, diabetes and obesity.
"You start losing contact with them at this important time," Warren said, and "their outcomes are not going to be good."
Other patients, she said, are stressed and alone, like the case of a woman whose husband just passed away.
"Those are the people that we really have to focus on," she said, noting that it can be "soothing" to hear your physician's voice.
"The stress of everything, too, can lead to bad outcomes," Warren said.
Patients have responded warmly to telehealth in recent weeks, she said.
"We've had some pretty good success," she said. "I think patients are happy because they want to be seen but they don't want to come in."
Using video conferencing, she and her colleagues have been able to monitor patients testing positive for the coronavirus.
"If we can't get them tested, we're watching every day," Warren said.
Jennifer Wilkinson, chief operating officer for Community Health Programs in Great Barrington, said the organization cares for 40,000 patients countywide. It shifted to primarily telehealth appointments as of March 16, she said, and they had done 2,000 telehealth visits as of Thursday afternoon.
For hands-on services that extend beyond the appointment, Wilkinson said, physicians and practitioners are doing car-side immunizations, throat cultures and injections. The organization also has tents, mobile health units and conducts home visits in some cases, she said, citing pregnant women and newborns.
"We are aggressively working to avoid spreading," she said, describing these approaches as "the new way" to work in these fluid times.
Chris Camillo, head of Berkshire Health Systems' primary care offices, said the network, too, shifted primarily to telehealth appointments. At offices throughout the county, staff are reviewing physicians' schedules for opportunities to shift appointments to telehealth, he said.
"They're also being very proactive at the practices as people are calling and saying, `I feel a little uncomfortable coming in,' " Camillo said.
Doing things this way vastly minimizes the flow of people into a doctor's office, he said, so that "there's very little patient-to-patient contact."
"That's the other value of telehealth," he said. "It really thins out our waiting rooms considerably."
Specialty doctors, too, are on the lookout for ways to reduce exposure in their offices by moving appointments online.
David Henner, division chief of nephrology and medical director of dialysis for BHS, said he works with about 150 people on dialysis and about 1,000 more with lower levels of kidney disease.
For these patients, moving all possible appointments to telehealth is important, Henner said.
"Certainly, we're concerned that they could be at higher risk of catching COVID-19," he said. "So, for those really vulnerable patients, it's been great."
Henner said staff also is pushing to move patients to the kind of dialysis treatments that can be done at home.
"Patients on dialysis just tend to be more prone to infections," Henner said.
A physician's role is to try to keep people healthy, Consolati said, and to keep them out of the hospital.
"And that has never been more important than right now," he said.
Amanda Drane can be contacted at email@example.com, @amandadrane on Twitter, and 413-464-2859.