BY KATIE IMBOREK (08MD, 11R) Director of Offsite Primary Care and Clinical Associate Professor of Family Medicine, UI Hospitals & Clinics
IN THE MIDST OF THE DESPAIR that accompanies this pandemic, I find myself leaning into the silver linings. There will be lessons that will change the way we deliver health care for the better. The face shield will become a standard piece of personal protective equipment during influenza seasons, and we will see decreased rates of health care employees out with the flu. We will recommit to providing masks for all our patients with respiratory symptoms for better source control. The waiting rooms in our walk-in clinics will be less crowded, because we will proactively manage them to decrease the proximity of patients with acute illness to one another.
Telehealth will remain a viable option, and in cases of potentially transmissible diseases—like respiratory viruses—it will be the preferred option. Providing care via a synchronous audio and video platform allows the provider to obtain a history and also gather important information about the severity of a patient's illness, all by just being able to see the patient on video—noting how they are breathing, if they have difficulty talking, and their overall appearance. Eventually, it will be commonplace for clinicians to access real-time objective patient data like pulse oximetry, blood pressure, heart rate, and temperature via wearable electronic devices. At this point, medicine will move, even more so, in a direction that focuses on access, convenience, and optimizing the patient experience.
BY EMILY KROSKA (14MA, 18PhD) Clinical Assistant Professor, Psychological and Brain Sciences
IN MENTAL HEALTH, psychotherapy services have been delivered widely via web- or phone-based platforms throughout the pandemic. As shelter-in-place orders became prevalent, providers were forced to adapt to alternate ways of meeting with patients. Much can be learned from these experiences.
Telemedicine solves health care access barriers that prevent many from seeking or maintaining psychiatric care. For those in rural areas, the travel time to appointments may be so great that weekly psychotherapy visits are impractical. In Iowa, where 35.7% of people reside in rural areas according to the State Data Center, a 2019 Carver College of Medicine study shows that most of the state's 99 counties are without a single psychiatrist. Telemedicine offers an avenue for care by phone or internet. Beyond rurality, there are many others who would likely have increased access to care with telemedicine services, including patients with disabilities that may limit travel capabilities, patients seeking specialty services such as a particular psychotherapeutic approach, patients with restrictive employment situations such as limited sick leave, or children and families with many competing demands.
Telemedicine may have rooted itself permanently in our health care systems as one viable solution to the large gaps in mental health care that a 2018 Pan American Journal of Public Health study shows exist in the Americas. While effective service delivery remains a priority in health care, the pandemic added the need for flexibility and creativity. These values must remain important, even in the absence of necessity.
BY KEITH J. MUELLER Director, Policy Research Institute Center for Rural Health Policy Analysis, based in the UI College of Public Health
THE PANDEMIC has shined a bright light on long-standing concerns for rural communities and health care providers: the precarious financial condition of small rural hospitals, shortages of health professionals, lack of broadband and other barriers to the use of telehealth, and the vulnerable populations represented (on average older, more likely to have multiple chronic conditions, low income, and with high-risk occupations). With more focus on those issues during the pandemic, we have seen additional investments in rural health and both legislative and regulatory change to start a path to a more sustainable system. I believe we have renewed momentum to deal with the long-standing problems of equity in our delivery system. Beyond just rural health care, we are seeing the importance of integrated services, including community-based social services and public health, which should be integrated with clinical care.
BY N. JANE STICKNEY (00MSN, 08ARNP, 12DNP) Assistant Professor, College of Nursing
RESIDENTS IN NURSING HOMES—and the staff who care for them—have been among the hardest hit by COVID-19. These facilities were vulnerable because their residents are typically older, require care with the most basic activities of daily living, and suffer from multiple chronic medical conditions. Life for them has changed. Visitors are not allowed, communal dining has been halted, activities have been limited—and the elderly have become more isolated.
The decline in physical and emotional support is taking a toll on the elderly. Nursing home staff have stepped up efforts to maintain a normalcy, but their success is limited due to chronic problems within these facilities— understaffing, poor pay, and a lack of appropriate facilities for a wide range of patients. There is hope that the pandemic inspires change. A shift in payment structures in Medicare and Medicaid that includes alternative housing options, such as assisted living and small group home environments, could focus on individuals' needs. The long-term care industry is heavily regulated, but its focus must change to the quality and accessibility of appropriate care for all frail members of society.
Many health care providers have temporarily replaced nursing home visits with telehealth. The technology helps maintain routine care and limit the spread of the virus. The future of telehealth in long-term care could be bright, addressing health issues in a timelier fashion and avoiding trips to the hospital. Remote patient-monitoring devices, in combination with video telehealth, offer many advantages by expanding access to care for both chronic and acute health conditions. Telehealth will not replace human interaction, but it will enhance care.