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November President’s Message – Responding to COVID-19

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As a continuation from last week’s message on the primary health care’s pathway on COVID-19, we have invited back Dr. Adam Vyse with a call to action for family physicians of Alberta. Dr. Vyse’s account of how he and his primary care colleagues are responding to the outbreak reinforces just how impactful the family physician-patient relationship is to the health of a community and to avoiding unnecessary hospitalizations.

Please read his article below and join us December 8 for our Virtual Doctors’ Lounge, at which time Adam will briefly connect to answer any further questions.

Vishal Bhella, MD, CCFP
President
Alberta College of Family Physicians


Call to Action

I’m a family doctor in High River Alberta, just outside of Calgary. I’m not an epidemiologist, but I’ve been invested in COVID-19 as a Primary Care Network (PCN) leader in early 2020, and then out of necessity when our town got hit with the Cargill meat-packing plant outbreak in April. Currently, cases are spiking everywhere, and population restrictions are likely. I am writing this because as family doctors, I believe we can make an impact. If ever there was a time our population needs help on a different angle of this pandemic, it’s now.

I have written several articles and have been quoted in several others over the last few months. My message is derived from the experience of a few dozen Calgary and High River area physicians and PCNs. It has not been peer-reviewed nor is there evidence yet. However, here it is, a best practice opinion: The involvement of a family physician or primary care clinic in a COVID-19 patient’s acute illness makes an immediate impact on many levels. By involvement, I mean virtual care. This can be telephone or video. Avoid in person visits to keep infected patients at home. Immediate impact is the sense of relief when your patient gets a phone call from their doctor’s team to guide them through the illness that the entire world is gripped with. In my opinion, family doctors are the best-equipped segment of our profession for this task, as pre-pandemic, we assessed community respiratory infection every day. 

Until now, we have not been an easy group to reach in order standardize our provision of care. The Covid-19 Primary Care Pathway changed this. We now can all use a common tool to assess the acuity of a patient’s illness. The history is the most important part of any patient encounter, and the history is readily obtained by virtual visits as most of us have seen by now. In our experience with the Cargill outbreak, clinical deterioration was detected accurately using the Pathway’s red flag analysis. Those patients who deteriorated and needed escalation to acute care were identified accurately. Specialist Link is a great resource if we needed help. Strikingly though, the vast majority of patients were well enough to be reassured to stay home.

Flagging Social Safety Nets

The Pathway is more than just clinical. It helps identify social safety net red flags. These may be the most important factors that you can be involved with. Many of those that have mild illness have social issues that will drive spread of infection. It is amazing how many people we talked to who were about to head out to buy groceries, to go to the bank, or even to go to work. A bit of problem solving goes a long way to facilitate social supports. These interventions allowed patients to successfully follow isolation rules that they may have otherwise broken. Advice is different when it is received from a patient’s healthcare provider as opposed to an anonymous contact tracer. The actions of each individual, taken as a whole, determine the shape of the pandemic curve. You can help affect these actions one patient at a time. 

A Collective Impact

There are approximately 5,300 of us family physicians across the province. There are 1,000 new cases a day. We have the capacity to reach each and every one of these patients. PCNs partnership with AHS Public Health is resulting in positive COVID results being delivered to family physicians immediately. The system is labour-intensive (a huge shout-out to PCN staff making it happen) but improving weekly. With timely results, we now have the opportunity to act.

So, this is a call to action. You can be part of the solution. Make yourselves familiar with the COVID-19 pathways (see the Pediatric version too, links are below). Make sure you know your templates for your EMR that make tracking patient visits simple. Reach out to PCN leadership. Get to know your PCN nurses and Panel Managers to build your team. Discuss with your clinic colleagues how you as a group will manage your COVID-19 positive cases. Find out who local agency contacts are. If you have questions or uncertainties, sign up Wednesday’s AMA webinar Adapting to Increasing COVID Care Needs in your Practice.

Finally, make that first phone call to the first positive patient and listen to them. Walk them through the journey. Connect with them and support them. You will be amazed at the immediate impact you can make. 

Thanks for listening,
Adam

LINKS

For Additional pathways, Tools for Practice, and links to AHS source of truth visit the ACFP COVID-19 Resources Page:
https://acfp.ca/tools-resources/covid-19-resources/

Adult Pathway link: https://www.specialistlink.ca/files/CZ_COVID_Adult_Pathway.pdf

Pediatric Pathway link: https://www.specialistlink.ca/files/CZ_COVID_PediatricTestingIso_Pathway.pdf

4 Responses to “November President’s Message – Responding to COVID-19”

  1. Great message- thank you!
    Agree that family doctors are best positioned to connect and advise their patient and may also Identify local patterns of spread/ contact tracing during that interaction.
    Appreciate your article very much.
    All the best.

  2. Thanks for your thoughts Adam. As the numbers are increasing I have reached out to a few of my COVID+ patients over the last week. They have all been very happy to hear from me and appreciated that I could review their isolation requirements, contact tracing and what to expect as the illness progressed. I agree, we are an important component in the COVID care pathway.

  3. Thanks for some great ideas, Adam. I have had three positive patients in my practice (that I know of) and despite them giving my information to AHS and contact tracers, I did not know that they were positive until they contacted the office. The most recent was a patient who had been in the office the day before she went for her test. She contacted us three days later when her test came back positive. I did not here anything from AHS until the following week when I was contacted by the contact tracers. By this time I had already been tested (negative) and had been self-isolating for five days. I never received a COVID test result from the lab. I have received many negative results and I wonder why I have not been getting the positive ones as I would have reached out to those patients to provide advice and reassurance. I wonder how many more I have been missing.

    • Posting a response on behalf of Dr. Vyse:

      Lee-Anne,
      I know this has been very frustrating, and a longstanding issue. We finally have some traction. Believe it or not, Lab, Public Health, and AMA IT reps launched a significant solution to labs originating from testing sites late last week. Patients can choose their family doc on the testing intake form. You should be getting results directly, although I know there are some kinks to work out when the swab is from other sources. Lab result flow has been a key piece in waiting until now to socialize this concept of family doc engagement with COVID-19. Obviously family docs cannot engage patients if they don’t have positive results. In the meantime, here is my plug for CII/CPAR. Get signed up – we need a critical mass so we can use CPAR 🙂
      Let us know if you continue to have this issue.
      – Adam

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