Based on an American Medical Association news article published April 24, 2020 and Sara Berg’s interview with Anthony Cheng, MD, Assistant Professor of Family Medicine at Oregon Health & Science University School of Medicine, Portland, OR.
Learn how primary care physicians at Oregon Health & Science University (OHSU) adapted to dramatic call volume increases then spread their knowledge.
Primary care physician case volume has seen a multifold increase during the COVID-19 pandemic. In the earliest days of the virus, queries related to it were crippling to primary care practices and health systems.
According to Anthony Cheng, MD, within a 3-week period as the pandemic was taking root, Oregon Health & Science University's (OHSU) primary care division received more than 10 000 calls and patient portal messages related to COVID-19.
“That meant we had to redeploy clinical resources to address those, oftentimes, worried-well [patient] questions,” said Dr Cheng. “And it meant that we had to stop a lot of the work we were doing, work that we think is critical for high value primary care. Reaching out to patients for cancer prevention and chronic disease management or spending 20 or 30 minutes on the phone in care coordination keeps our patients healthy and out of the emergency department. When COVID-19 hit, a lot of that work had to stop. But our patients, especially those with multimorbidity, need us now, more than ever.”
Developing the Intervention
With staffing and resources, academic health centers can play a role in helping to supplement primary care physicians during the COVID-19 pandemic. A recent JAMA article, co-authored by Dr Cheng, highlights how OHSU has implemented a 3-phase telemedicine plan.1
Phase 1: A local response
The first phase of OHSU's telemedicine response to COVID-19 was to set up telephone triage for OHSU patients.
The bulk of work on the phone triage is being done by nurses who were redeployed from other areas of the health system. When a patient calls the hotline—which has been funded by a gift from the Morris Singer Foundation—they speak with a nurse almost instantaneously. The patient is then assessed, and, if necessary, directed to nearby COVID-19 testing centers or a virtual visit. The nurses also manage COVID-19 test results which includes performing symptom checks at 2 and 7 days. Physicians are working as a backup resource for nurses on these calls.
Having handled nearly 2000 phone calls, the call center has allowed OHSU's primary care physicians and staff to get back to treating non-COVID-19 patients who, in some instances, require significant intervention.
“When you talk to nurses in our primary care practices, they will tell you it feels really nice to get back to their normal chronic disease management. It has allowed them to start doing proactive outreach. There's a noticeable difference in call volume, and it means we can do the work where primary care's value really is.”
— Anthony Cheng, MD
Phase 2: Physician support
With rural physicians encountering their first batch of COVID-19 cases, much of the knowledge that had been gained in treatment of the virus was unavailable to them.
In phase 2 of the program, OHSU created a hotline for primary care practices throughout Oregon, providing technical assistance with operations, logistics, and clinical questions. OHSU also partnered with Project ECHO, a telehealth organization that supports patients and rural physicians, to disseminate COVID-19 related expertise.
As part of this phase of outreach, primary care physicians from across the state participate in a weekly COVID-19 conference call. During those calls, physicians fill a chat box with questions that are answered by the Project ECHO teams. For the questions that are not answered, OHSU clinical faculty, residents, and medical students research and create responses. Medical students participating in the project are given elective course credit.
“They have answered hundreds of questions that come out of the Project ECHO chat box and from the hotline,” said. Dr Cheng. “It's created a really solid knowledge base that is available publicly. Sharing of expertise and knowledge is fundamental to what we are doing.”
Phase 3: Statewide support
The third and most ambitious stage to OHSU's telehealth patient assistance was to expand it to patients across the state. That launched in April.
If patients who call the hotline have a primary care physician, OHSU staff will triage the patient and work to connect them with their physician for a visit. If they do not, they are treated.
“While we at OHSU were able to create a light duty of pool nurses, who were not otherwise deployed and were able to answer our triage calls, we knew that other health systems without our type of workforce were unable to do that,” Dr Cheng said. “Our long-term goal is to support the state and keep primary care practices afloat.”