Care Beyond COVID-19

by Julie Shannon | Oct 19, 2020
Care Beyond COVID-19

How medical providers throughout South Jersey have adapted to provide vulnerable patients with the care they desperately need.

Over the last six-plus months, COVID-19 patients have received a great amount of care and support, and rightly so. But there’s another population who need just as much, if not more care—vulnerable patients. Those who don’t have access to resources and services they need, cancer patients undergoing chemotherapy and radiation and those who have behavioral health and mental issues, to name a few.
Because of COVID-19 restrictions, health care practices have had to adapt how they provide services to this population. Additionally, providers say a big issue is patients not going to the doctor, not getting the care they need to treat any underlying medical conditions and many putting off routine tests until COVID-19 has completely passed.
“It’s very important everyone gets the care that they need, and it’s even more important for the vulnerable population because if they have an underlying medical condition, it can more quickly develop [into] a problem and if that goes undetected, it can have devastating consequences,” says Sam Weiner, M.D., a medical director at Virtua Medical Group. “Patients who have underlying medical conditions really can’t take a week or month off from taking care of themselves.”
Brian Sweeney, president and COO, Jefferson Health-New Jersey, agrees, and says while many patients are concerned about COVID-19, they can only wait so long and are at risk of potentially getting diseases if preventable tests like colonoscopies, mammograms and cancer screenings are deferred.
“In the beginning, a lot of patients deferred tests thinking at some point there would be a treatment [for COVID-19], but there’s not,” he says. “Routine tests that are done need to be optimized again and be part of the routine for people in the community, such as seeing primary care physicians and having discussions because of their age and appointments from a prevention perspective.”
Alka Kohli, M.D., chief population health and clinical officer, Inspira Health, says this is especially true for cancer patients and Inspira’s physicians can help its patients “create a treatment plan that ensures safety while providing medically needed treatment and testing.”
“We know that many cancer screenings have been delayed and this raises concerns,” she says. “The missed screenings will result in some cancers being caught at a more advanced stage when they can be more difficult to treat. For anyone living with a diagnosis of cancer, it is vitally important that they maintain regular contact with their cancer specialists. We continue to urge everyone to focus on their health, and recommended screenings are a proven way to maintain health and improve health outcomes.”
Underserved Population
Before COVID, one of the biggest ways Jefferson Health-New Jersey engaged with the community, especially with those who couldn’t access certain health services, was by hosting activities like health fairs and screenings. But the health care system has had to rethink how it can still provide these services in this current environment.
“Supporting underserved patients is part of our mission, it’s who we are,” says Sweeney.” With COVID-related challenges such as social distancing—a lot of programs and services where we had physicians, nurses and dietitians out and about everywhere—we’re having to rethink that in terms of what that looks like in post-COVID environment. What do health fairs look like in a post-COVID environment? Engagement with the underserved community is important. We’re still supporting them and have to continue to innovate and evolve.”
Sweeney says Jefferson Health-New Jersey’s data currently shows behavioral health, substance abuse and obesity, in addition to access to care, are the top three needs in the local community. The health system has addressed behavioral health needs by having its behavioral crisis unit at the Cherry Hill campus open 24 hours a day, seven days a week.
“The pandemic has had a huge effect on people’s stress and anxiety. It’s really affected people in a way that’s noticeable,” Sweeney says. “Everybody’s different in terms of what level of stress and anxiety is, and we are concerned about behavioral health and wellness at large and are continuing to focus there, as we see that as a real risk point for the community.”
Virtua has also had to make modifications on providing care to its vulnerable population.
“We have a responsibility to look out for these populations through outreach programs and preventable medicine initiatives,” Weiner says. “The pandemic provided us a reminder of the inequities that exist in health care. African-American, Hispanic and Latino patients are disproportionately affected by infection. There are a lot of reasons for that, such as housing and transportation problems that can lead to less access to care, oftentimes more preceding medical conditions in vulnerable populations. We have developed a number of ways to make sure we have kept in touch with the community and vulnerable population throughout this pandemic.”
One of those ways is repurposing Virtua’s Mobile Farmers Market into a mobile food pantry, where they have distributed over 85,000 pounds of food from January through August.
“We have been able to distribute nonperishable food and produce to the community at several sites per week and accommodate as many people as we can during our visits there,” Weiner says.
As a partner in several food pantries, Inspira Health has also ensured food distribution is continuing safely for residents, Kohli says.
“Throughout the pandemic, Inspira has continued to provide programs and support initiatives that address the social determinants of health,” she says.
Another population Inspira Health geared its focus toward is those who access its Quit Center—facilities across South Jersey dedicated to helping individuals quit smoking—from in-person individual and group sessions to virtual.
“Our Quit Center transitioned to virtual visits for both individual and group sessions,” Kohli says. “Quitting smoking or vaping has never been more important because people with lungs stressed by tobacco and other substances are at higher risk of severe complications from COVID-19.”
Inspira has also partnered with local school districts to assist them in reopening safely.
“From obtaining personal protective equipment to developing safety and monitoring protocols, our experts are helping schools navigate these unprecedented times,” Kohli says. “Our occupation health team has also provided free respirator fit-testing for school nurses.”
Dr. Jeffrey Millstein, associate medical director for patient experience for Penn Medical Group, says telemedicine has helped his outpatient practice in Woodbury Heights address its vulnerable population. In the beginning of the pandemic when offices were shut down, they were forced to use telemedicine and it was challenging for elderly patients who are less technology inclined.
“A lot of family members came to the rescue and it was a team effort,” he says. “By the time in-person visits were allowed, it went a lot more smoothly. In some cases we did telephone follow-ups, which at least gave us an opportunity to connect and see how patients were doing. Many people do remote home monitoring of blood pressure and vital signs, oxygen levels and checking blood sugar. Our mobilized office staff, family members and caregivers support patients, particularly the vulnerable ones that have chronic problems and have to have regular monitoring.”
Millstein says early on in the pandemic patients were not used to thinking of telemedicine visits as truly a replacement for an office visit.
“I think they viewed it as a Band-Aid or intermediate step and they withheld a little bit on talking about all of the issues and problems because they didn’t view it as a real visit, but that’s improved,” he says. “Technology is better and we know more of what we can and can’t do with it. Now when I have a telemedicine visit with someone, it’s just like any other visit where we can talk about anything you need, review anything and [it’s] no holds barred.”
Virtua was able to maintain several of its initiatives and early intervention programs through telehealth as well with children who have special needs, developmental disabilities or behavioral issues, and other high-risk patients.
“We know these families need our support, pandemic or not, and we have provided telephone outreach, in-home activities and telehealth visits,” Weiner says. “This can include teaching parents how to better help and care for children, providing supplies, food, diapers and toys for pediatric patients. We have also seen this on a larger scale outside of our pediatric population and perform outreach to our highest risk patients. Vulnerable patients who may have cancer or an underlying heart or lung disease, we have had a team of social workers, nurses and pharmacists make outreach calls to these patients, making sure they have access to food, medication and internet access.”
It’s just added proof that as the pandemic continues on, the South Jersey medical community is prepared to continue offering patients the highest level of care with health and safety as the highest priority.

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Published and copyrighted in South Jersey Magazine, Volume 17, Issue 6 (September 2020).

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Author: Julie Shannon


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