Primary care doctor: 'We should all be very worried' about plunging patient visits amid pandemic

The economic consequences of the coronavirus pandemic have affected almost every US industry.
And health care, including primary care, has been hard hit. If, according to doctors and experts, it is not resolved soon, there could be a so-called "second hidden pandemic" that he has to worry about: untreated chronic diseases.
"We know that primary care is very important for a very good reason, and the reason is that you pay the price for complications, heart attacks, kidney failure, and strokes if you don't do prevention," said Dr. Farzad Mostashari, Aledad CEO and co-founder, said recently during a conference call with the Commonwealth Fund. "We have seen a dramatic drop in primary care ... but we should all be very concerned about untreated chronic diseases."
Ginger Rae has her blood pressure checked by nurse Rachel Eisenberg during an exam. (Photo by Joe Raedle / Getty Images)
A recent survey conducted by the Primary Care Collaborative on June 5-8 found that 46% of patients have had at least one contact with their primary care practice in the past two months.
However, the same survey found that almost 65% of clinicians report some stress in caring for their patients. These strains include missing PSA (48%), downsizing (37%), fewer patient visits (78%) and rejected claims to telemedicine (18%). In addition, 63% of doctors say that their stress level is an all-time high. These numbers improved only slightly compared to an earlier survey at the end of March.
There are over 2.2 million coronavirus cases in the United States (graphic: David Foster / Yahoo Finance)
"So much that we have to dig ourselves up"
If patients cannot see their doctors regularly, things can fall through the cracks.
"Mr. Knows that so many of them need their visits to maintain chronic care and these children need their vaccinations and development visits and the like," Dr. Gary LeRoy, an Ohio-based family doctor and president of the American Academy of Family Physicians (AAFP). said Yahoo Finance. "There is so much that we have to work our way out of our patient visits and the necessary patient services."
This can exacerbate chronic diseases that were a growing problem in the United States before the coronavirus pandemic started. A 2017 RAND study found that 6 out of 10 of the approximately 252 million adults in the United States suffer from a chronic disease and 4 out of 10 with two or more. The Chronic Disease Partnership estimates that more than 30 million Americans have three or more chronic diseases.
A paramedic from the Anne Arundel County Fire Department measures the blood pressure of a patient who responds to a medical call on April 9, 2020 in Glen Burnie, Maryland. (Photo by ALEX EDELMAN / AFP via Getty Images)
Chronic disease treatment "is a burden on the health system," David Hoffman, an associate professor of ethics and health policy at Maria College, previously told Yahoo Finance. "As a result, health insurance is more expensive for everyone. Operating health facilities is more expensive due to demand."
According to the CDC, people with chronic or mental illness accounted for 90% of the country's $ 3.5 trillion health care spending.
"The interesting thing is when patients cannot and / or don't want to come to the office and then many employees sit around and say:" What can we do? We are slow. We don't see patients. The linchpin for us is to proactively reach patients, ”said Dr. Ryan Knopp, general practitioner at Stone Creek Family Physicians in Manhattan, Kansas, told Yahoo Finance.
Dr. Victor Perez with 60-year-old Sharron 'Kay' Thornton. (Photo by: Kerry Sanders / NBC NewsWire)
In other words, Knopp said, “We are calling our most risky and vulnerable patients for COVID and people with gaps in their healthcare, and we are asking our staff to contact them to educate them about the pandemic, to give guidance and to them help to understand how our office was functioning, answer questions, address healthcare needs, sometimes it even turns into a television visit. "
Dr. Jacqueline Fincher, a Georgia-based doctor and president of the American College of Physicians, said that if you can't check in with your regular doctor, it can cause big problems.
"Our local surgeon in our small town told me he saw two torn attachments in the three weeks after March that things were explained," she told Yahoo Finance. "He hadn't seen an appendix fracture in a few years, but he had two in three to four weeks because people were afraid to go to the emergency room."
Paramedics and firefighters from the Anne Arundel County Fire Department invite a patient to the ambulance on April 21, 2020 in Glen Burnie, Maryland. (Photo by ALEX EDELMAN / AFP via Getty Images)
"Three quarters of my practice went out the door"
When the corona virus was first used in the United States, governors called for non-urgent visits to be stopped. And although many of the practices shifted to telemedicine, there were still noticeable changes.
"Three quarters of my practice went out of the door or simply didn't come in because of this mandate," said LeRoy. “If you lose three quarters of your customers in a business like the restaurant service, you can only survive as long if you have full staff and a quarter of your sales, your customers, come in the door. Many of us marched forward because they didn't want to lay off or leave their staff, and tried to get our staff to do things and provide services to our patients remotely without having to fire them. "
Many of LeRoy's patients found ways to switch to telemedicine, although initially not everything was reimbursed by insurance companies and the Centers for Medicare and Medicaid Services (CMS).
Family doctor Alex Krist listens to Jane Duncan's heartbeat while visiting the office in Alexandria, VA. (Photo by Katherine Frey / The Washington Post via Getty Images)
"There was a big gap between picking up the phone and calling my patients or our staff who are calling our patients and providing refills and information to our patients over the phone and realizing that we are not being paid for it," said LeRoy. "We have been doing this with our patients for years."
And telemedicine does not work for everyone: Dr. Jacqueline Fincher said it was a "big problem" for some of her patients.
"I've been in practice for 32 years," said Fincher. "My practice has grown old for me, so I have a lot of patients over 65 who have limited understanding or most of them don't have a computer. Some of them have a smartphone, but I'm still telling you, flip phones are still very common in my region. You cannot have telehealth with audio and video unless you have a smartphone or computer. "
There are over 9 million coronavirus cases worldwide. (Graphic: David Foster / Yahoo Finance)
And there is still a need for personal visits when a patient needs a physical exam, especially when newer problems arise.
"That helps you with differential diagnosis, does it come from the GI tract or does it really come from the heart or whatever?" Fincher said.
A roller coaster ride
Although conditions are now at different stages of reopening, the number of coronavirus cases only decreases in a few cases.
In Arizona, Texas and Florida - three states that have reopened their economies earlier than most - coronavirus cases have been at their highest since April. And if some states are forced to close again, it could mean that universal service practices suffer another blow.
"We're going to do a long roller coaster ride here - as a clinic, as a healthcare provider, as a country, as a society," said Knopp. "Needless to say, it is difficult to predict what the future of this pandemic will look like, but I think we all understand that it will be a roller coaster ride."
Adriana is a reporter and political and health policy editor at Yahoo Finance. Follow her on Twitter @adrianambells.
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