During these unprecedented times, we at Atkinson Family Practice have made it our priority to keep our patients and staff as safe as possible while still maintaining the level of service we are known for. We are so proud that we have been able to do this and thought it worthwhile to share with you what we have put in place and why. Michele Spirko, MD, head of our Covid-19 Task Force answered some questions for us so we could pass along this very important information to all of you.
AFP: In what ways have you seen the staff at AFP rally together to create a safe environment for our patients?
MS: The COVID-19 pandemic has brought changes that make day-to-day life unrecognizable when compared with just two months ago. At AFP, our entire staff meets every other month to discuss ways to improve the care we provide. We happened to have a regularly scheduled Staff Meeting on March 10, which was the morning after Amherst College announced that they were sending students home. At that time there was only one confirmed and 40 presumptive cases of COVID-19 in Massachusetts. Most of our staff were shocked at such a drastic decision by the College, one that proved to be the first of what became a universal protocol in higher education and eventually K-12 and nearly every other sector of our lives.
I had been following the impacts of the pandemic in Italy very closely for weeks, and knew that we could expect similar circumstances in the US in the near term. As the newly appointed COVID-19 Chair, I explained what we could anticipate in the weeks and months ahead. Many people were understandably surprised and confused; Italy was on lock down at that time, and it was hard to image that happening here. Regardless, several staff members from each department immediately volunteered to join our COVID-19 Task Force and were willing to take on additional responsibilities outside of their typical job duties. In that sense, it was similar to every other Staff Meeting, where our team spirit and collaboration is on full display. Eric from our Front Office championed cleaning tasks and became an expert in UV technology for disinfection. Jessica Jimison, FNP, our Functional Medicine expert, offered to research ways to support immunity in the event of COVID-19 exposure, which directly led to specific recommendations that our providers make to patients. She now offers a remote class on Zoom for Immunity Support in the COVID-19 Pandemic. These are just two examples among many that highlight continued innovation and a willingness to help among our AFP team.
AFP: As head of this Task Force, what do you think are the keys ways AFP has protected patients, staff and community from the brunt of Covid-19?
MS: AFP took very early steps to promote physical distancing. On March 11, we converted our PA Miranda’s practice to 100% Tele-Health. This allowed us to work out some kinks and sample different HIPAA compliant platforms. Within a week, the rest of our office care was converted to Tele-Health with very few exceptions. We felt this was important to keep our building safe, which protected both patients who needed in person care as well as our staff from inadvertent exposure. Like all outpatient medical facilities, we had limited access to PPE and were sharing what we had with inpatient facilities who needed it more. However, we felt particularly lucky to have access to a handful of disposable isolation gowns (go here to find more) which could be used for the most emergent cases. We only hoped that we had some more PPE that could be put to good use. As you can imagine, this drastically limited the services that we could offer in our building; for example, a spirometry test or a peak flow, which are often done during visits with our patients who have asthma, now became worrisome aerosolizing procedures that put our staff at risk.
We also adopted early door screening and required masks in our building weeks before it became widespread in medical settings. The local community has been incredibly generous in donating DIY masks that we share with our staff and patients. We have been recommending masks in public since late March, after learning the outcomes of COVID-19 transmission in nations with widespread mask use vs. those without. Via Tele-Health appointments, we have been able to appropriately triage acutely ill or injured patients and direct them to the most efficient facility for care if needed. Primary care providers played an enormous role early in the pandemic in reducing the volume of patients presenting to our local hospitals. This allowed our inpatient colleagues to devote their resources to caring for the sickest patients. Finally, we have been proactive about offering SARS-CoV-2 testing when access was limited in the Valley, and are actively exploring the appropriate role of antibody testing
AFP: Can you pass along any information on Covid-19 that would be important for people to know?
MS: AFP patients who have been infected with SARS-CoV-2 have done very well, but we don’t want people to get complacent about potential exposures. We refer everyone to the CDC website for the latest guidance and recommend vigilant hand-washing and use of masks when outside of your household unit. Act as if every human interaction is a potential exposure. Research indicates that aerosolized particles spread much farther than six feet during normal conversation, so we really encourage the use of masks. If you follow strict infection control practices, your chances of getting infected are low. Our providers are happy to meet individually with patients to review safety practices, discuss tricky isolation scenarios, (e.g., families with shared custody arrangements or with an elderly/immuno-compromised relative living in the home), and ways that you can strengthen your immune system in the event of an exposure.
An unfortunate consequence of the COVID-19 pandemic has been the inclination by many to delay treatment for other serious illnesses. Patients are understandably fearful about exposure to the virus in hospitals and emergency departments. We feel it is important to reassure our patients that all local hospitals are safe for acute care. If we suspect that someone is having a heart attack or stroke, they should still call 911 for immediate evaluation. Patients who have been encouraged to visit our local emergency departments have relayed that they received efficient quality service and felt safe in those settings. We want to assure people that their health is in our best interests, and using up to date equipment that can be found on the Butterfly Network, will keep patients safe during this time. Please call us and heed our advice if we recommend a visit to your local hospital.
AFP: What can patients expect when they are on a tele-visit? Will they be getting the same level of care and attention as they would in-person?
MS: Patients should expect to meet with an enthusiastic provider who is happy to see them! We are isolated too, and it brings us so much joy to see our patients. For acute concerns and routine follow-up on ongoing chronic medical issues, a Tele-Health visit is very successful. Patients comment that they enjoy the relaxed vibe of the visit and appreciate not having to leave the comfort of their home. We know that Tele-Health is here to stay. It offers convenience and flexibility for patients and providers and is easy to use.
Tele-Health visits sometimes require creativity! To help us assess their well-being, we have asked many patients to obtain some simple medical devices such as a blood pressure cuff or a pulse oximeter. We encourage everyone to have a functional oral thermometer at home. Patients who have an Apple Watch or other fitness monitor can provide us with useful heart rate data; it’s even possible to obtain an EKG from some devices. Most patients can easily learn how to take their own pulse. A flashlight or phone comes in handy if we need to look in your mouth.
There is limited access to many preventative services right now, for example, routine annual physicals have been postponed. Cancer screenings are necessarily on hold, and this will have lasting implications. These are systemic issues that we don’t have control over right now, and we are prepared to resume these services as soon as is safely possible. Many of our specialist colleagues are offering Tele-Health visits, though some have temporarily closed their practices to all but emergency care. Our colleagues have gone out of their way to reach out and offer valuable back-up to our providers.
Our building is safe, and if a provider feels it is necessary we may advise a patient to come into the office for in-person evaluation. Patients will not be permitted into the building if they have a fever or any symptoms of COVID-19. We continue to offer vaccinations (easy to access in the parking lot for most of our patients). We are still seeing our youngest patients for routine health visits and scheduled vaccines. We are grateful that we have been able to continue providing care even if it looks a bit different!
AFP: Is there any other advice you would like to pass along?
MS: COVID-19 is here to stay for months/years, and we are beginning to understand the repercussions of that reality for the economy, as well as for our physical and mental well-being. Right now we are helping many patients who are struggling with the emotional consequences of isolation. As an integrative medical home, we are depending heavily on our Dragonfly Team for mental health support, psychiatric care, in home virtual PT, fitness consults, and ongoing health coaching. Many patients have identified this as an opportune time to work on fitness and lifestyle goals that they may not have had the ability to focus on previously. We have many ways to support these initiatives. Our expansive assortment of group medical visits is now available via Tele-Health classes, and we have added new topics specific to life in the pandemic. Food insecurity has been a big concern for patients due to limited excursions and supply chain issues. We have seen an uptick in disordered eating and substance misuse and have specialized professional support for those impacted by these difficult challenges. Patients should know that we are here for them and continue to innovate and educate ourselves as the situation evolves so we can best support everyone in need.
Lastly, we are so appreciative for the ongoing support from our patients. All of us have heard directly from individual patients with words of encouragement and support, letters, endless supplies of DIY masks and headbands, donations of PPE, and gifts of snacks and food for our staff. We feel so loved and are incredibly grateful to live and work in this nurturing community.