The coronavirus (COVID-19) has completely changed the way we do business as a Community Health Center (CHC). Turning on telehealth (including both telephone and telemedicine visits) in what feels like overnight has been a challenge for both staff and patients in all departments. Fortunately, life in a CHC almost by definition requires maximum flexibility and the ability to Plan Do Study Act (PDSA) new workflows on demand.
With the reduction of dental services from full scope prevention and restorative care to urgent care only, we were able to re-deploy several dental staff to tasks familiar to their scope – infection control, management of Personal Protective Equipment (PPE), and medical support. This was the largest group of redeployment by department.
As clinic nurses and medical assistants were exposed or presenting with COVID-19-like symptoms, public health nurses and dental assistants were trained to assist with patient intake (in person and telehealth). Behavioral Health Specialists, Public Health Nurses, Care Coordinators and Dietitians all transitioned to virtual visits in order to provide education and support to both patients during the perinatal stage of life as well as those with long term chronic conditions.
As specialty care services in the community were also reduced, medical record demands in our sites also reduced. We re-deployed medical records staff to serve as front door screeners, interviewing patients and visitors for COVID-19 symptoms.
CHCs also provide significant learning opportunities for students of health professions. In our CHC alone, we provided nearly 11,000 hours of experience for students pursuing careers as physicians, nurse practitioners, psychologists, social workers, counselors, dentists, dietitians, pharmacists, medical and dental assistants. For everyone’s safety, social distancing has required most CHCs to suspend student rotations until the COVID-19 curve is reduced in our communities. This is particularly distressing as so many of our students and future health care providers (and our CHC role models) are culturally representative of the communities we serve.
Unfortunately, in Yakima County, COVID-19 rates are still not going down, and many CHC patients have chronic medical conditions. Many (most) patients do not have home diagnostic equipment like blood pressure cuffs or A1c machines. Initial solutions include “hybrid” visits, where part of the visit is conducted via telephone and additional diagnostics and physical assessments are performed in our parking lots in the patient cars, where the exam room literally “drives away” after the visit. We are in the process of identifying sources to help patients obtain home diagnostic equipment.