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Wednesday Nov 18, 2020

A Model for Connecting Primary Care in COVID-19 Era

In mid-May, during the first COVID-19 surge in Colorado, we watched via videoconference as a rural family physician used his phone’s camera to give 200 primary care clinicians a virtual tour of his small, independent practice. As the only site of care for miles, he had no choice but to respond quickly to the pandemic and continue providing care. While many clinics were struggling to create processes to continue seeing patients, this family physician had developed and implemented a workflow that allowed him to continue providing care as safely as possible.

[teamwork or family concept]

He showed us the plastic partitions used to separate “sick” and “not-sick” office space, a tent set up in the parking lot where patients with symptoms suspicious for COVID-19 could be evaluated, and the protocols he put in place for personal protective equipment use before there were clear national guidelines available.

This sort of problem-solving was exactly the type of information that was vital to the survival of primary care clinics across our state, but it might have been overlooked or forgotten by health systems and federal responses during that first wave (because of the focus on hospitalized COVID-19 patients) without a platform to share information.

COVID-19 continues to expose the many flaws of the U.S. health care system. It is as if the system lacks communication between brain and body, and perhaps there is no central nervous system at all. The rapid spread of the pandemic reveals the absence of a centralized and well-coordinated effort to lead the many individual health systems, hospitals, primary care clinics, specialty offices and other sites of health care delivery. The national, state and local health system guidelines and best practices for patient visits, telehealth, PPE usage, and nonessential health services vary wildly in interpretation and implementation. A wealth of front-line experience is being developed by primary care clinicians across the country because the majority of patients with COVID-19 receive testing and care outside of hospitals.(www.ncbi.nlm.nih.gov)

For clinicians saturated with COVID-19 information and bursting at the seams with knowledge or best practices that would be useful for others, a platform was needed to share that expertise. For clinicians struggling to find a reliable source of relevant information, a process was needed to access that knowledge. For clinicians feeling isolated and alone, cut off from their normal educational and practice support systems, a space was needed to share experiences and foster community.

Project ECHO (Extension for Community Health Outcomes)(echocolorado.org) is achieving these goals in Colorado by leveraging telehealth not only as a tool for patient care, but as a means of rapidly disseminating information to primary care clinicians and offering them a platform to share information.

We, the authors of this post, have had the privilege of working on an interprofessional task force to develop and implement a collaborative tele-educational ECHO series with the goal of keeping primary care clinicians informed during the pandemic. The COVID Just-In-Time ECHO for Primary Care series features three weekly sessions, each with a unique focus. Each session begins with an epidemiologic update from our state health department and a medication management update from academic clinical pharmacists. Then an expert presenter provides about 20 minutes of the best available information on the session’s topic.

Our presentation topics are chosen based on the participants’ expression of what they need to know. In our first four weeks, we covered best practices for telehealth, surviving the economic impact of COVID-19, PPE usage and evidence, triage of patients with COVID-19, advance care planning, clinician and patient well-being, a deep dive into pharmacotherapy and more. Each session ends with a Q&A with the presenters during which participants also share their experiences on the front line and in their communities. With more than 650 primary care clinicians and staff registered and averaging 150 to 200 participants in each session, we are able to palpate the pulse of rural and urban communities in Colorado.

AAFP Resources

The AAFP has a variety of resources, including tools related to telemedicine, personal protective equipment and clinical information on its COVID-19 webpage.

The AAFP also has a new, free Telehealth Toolkit(1 MB PDF) designed to help family physicians build and sustain telemedicine programs.

The COVID JiT ECHO for Primary Care series is managed by an interprofessional task force of physicians and pharmacists and enhanced by strong collaborative partnerships with academic health centers and state public health agencies. Hosting three, hour-long presentations each week with additional resources after each session requires significant time. One key to our success is recruitment of medical learners whose clinical rotations were disrupted. Medical students and family medicine residents from the University of Colorado assist with each session, research specific topics and even lead some presentations. At a time when their educational and clinical lives are turned upside down, students and residents continue to learn and exercise their expertise by serving in a different way.

The main purpose of our COVID JiT ECHO for Primary Care series is to provide primary care clinicians a centralized source of best practice knowledge and practice support through the ECHO model. Our series continues to address both clinical and non-clinical priorities, including telemedicine, reimbursement and business practice support, as well as shared experiences, stories and the ability to connect and reduce isolation. By leveraging the collective wisdom of the primary care community and being responsive to the individual needs of clinicians, the COVID Just-In-Time ECHO for Primary Care series has become an integral part of the pandemic response for hundreds of primary care clinicians across Colorado.

We may not solve the central issue of our system’s broken mind-body connection during this pandemic, but we can certainly optimize our information-sharing by connecting the expertise of those who are creating guidelines and conducting research with that of those who are at the bedside. If you are interested in learning more about Colorado’s COVID JiT ECHO for Primary Care series or how your state’s Project ECHO group can address COVID-19, please feel free to reach out for more information.

Kyle Leggott, M.D., is an assistant professor of family medicine at the University of Colorado, where he recently completed a fellowship in health policy and politics. You can follow him on Twitter @KyleLeggott.(twitter.com)

Leah Willis, M.S., is director of programs at ECHO Colorado, based at the University of Colorado. Connect with her via Linkedin.(www.linkedin.com)

Ariel Kiyomi Daoud, B.A., is an M.D. candidate and aspiring family physician at the University of Colorado School of Medicine. You can follow her on Twitter @ArielKiyomi.(twitter.com)

Posted at 07:45AM Nov 18, 2020 by Kyle Leggott, M.D.

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