At the beginning of pandemic in 2020, many doctors’ offices temporarily closed and transitioned to telemedicine out of concern for the rapid spread of the coronavirus.
Pediatric Partners of the Southwest in Durango shut down at the end of March and was closed through early May as the clinic’s medical care moved to telehealth visits. While the clinic reopened in May, routine care took a back seat to COVID-19.
Pediatric Partners of the Southwest ordinarily has a routine wellness visit rate of around 92%, but over the course of the pandemic that figure dipped into the low 70s, according to Cecile Fraley, Pediatric Partners of the Southwest’s CEO and a board certified pediatrician.
“Wellness visits, which is the bulk of routine care in pediatrics, fell away,” Fraley said. “We’ve kind of been playing a catch up ever since.”
During the pandemic, medical providers in Durango and Farmington saw a drop in routine health care visits, driven in part by misinformation and the United States’ system of health care and health insurance. As the pandemic enters a new phase, doctors are seeing an influx of patients as they catch up on preventive care. After two years of delay, they are now trying to remind patients why routine care is critical.
“We’ve seen even as recently as the delta wave and the omicron wave, health care and hospitals in our community canceling appointments that were made for individuals prior to the spike, because they did not have the resources to deliver prescheduled care,” said Liane Jollon, executive director of San Juan Basin Public Health. “There’s a lot of things that have happened over the last two years that have had the potential to interfere with someone staying up to date with preventive or routine care of any type.”
Medical providers noticed a dip in routine medical care during the pandemic, both driven by patients seeking care less often and the limited services many clinics could offer.
As clinics closed at the beginning of the pandemic, telehealth visits served as a bridge, allowing patients to communicate with their doctors and keep up with their prescriptions. The transition to telehealth helped mitigate some of the impacts of the pandemic on routine care, but doctors were unable to complete many physical exams or address behavioral health concerns.
Dr. Luke Casias, chief medical officer for Axis Health System, said limited access to these in-person services and the cost-benefit analysis many patients entertained between risking potential exposure to the coronavirus or not seeking care led to a slide in routine care.
“There’s definitely been a drop in care for preventive measures and routine maintenance care from patients, just due to a combination of fear and a little bit of some misunderstanding,” he said. “And there are a lot of practices that were not able to provide PPE where folks were unable to protect staff so that they could actually continue seeing patients on a regular basis. That all contributed to individuals either not seeking care are having difficulty getting into their routine level of care.”
Since the beginning of the pandemic, preventive measures such as cancer and cardiovascular screenings have declined while standard visits for conditions such hypertension or hypothyroidism have also lagged, Casias said.
“A lot of clinics actually let (those visits) go a little longer realizing people couldn’t get in because of the pandemic,” he said.
Dr. Quincy Sa’Ena, a physician with San Juan Health Partners’ family medicine office in Farmington, noticed that fewer patients with chronic medical conditions were visiting the clinic.
“We saw less patients with those chronic medical conditions, less follow-ups on diabetes,” he said. “We even saw other patients with autoimmune disorders like rheumatoid arthritis who are at increased risk for getting COVID-19 who have been dealing with pain and neurologic issues for most of their life that were unfortunately considered nonessential and (were) not being followed up on routine biweekly or once monthly injections.”
San Juan Basin Public Health had to suspend some of its health care programs, including its school-based dental program, which provides dental cleanings and screenings for children with limited access to dental services in Dolores, San Juan, Montezuma, La Plata and Archuleta counties.
“That program was suspended until just about a month ago and we’re now in the schools catching up on all of these kids,” Jollon said.
These delays and lapses in routine care during the pandemic stem from misinformation and the nation’s system of health insurance and health care, according to Jollon and Casias.
Vaccines are an important part of routine care for children, yet as misinformation surrounding COVID-19 vaccines has proliferated during the pandemic, public health officials have seen more families postpone childhood vaccinations that protect against communicable diseases like measles.
“There’s been such an increase in spreading poor, inaccurate information about vaccines (through) social media and in other ways,” Jollon said. “This is showing up in fewer children getting routine immunizations that communities rely on to keep kids safe from a multitude of childhood diseases.”
Health care for many residents of Southwest Colorado and northwest New Mexico is also tied to employment, she said. At the beginning of the pandemic, as people were losing their jobs, they were also losing their health insurance and their point of access for routine care.
Though people who lost their jobs during the pandemic could move to Medicaid and government health insurance, the transition can be lengthy and few health care options in the region can further suspend routine care.
“It is great that there has been an extension of Medicaid benefits to people affected by the pandemic, but that doesn't necessarily mean that they live in a community that has providers that are open to new Medicaid clients,” Jollon said. “… They may not have been able to get care because we do have a shortage of primary care (doctors) who are open to Medicaid patients here in Southwest Colorado.”
For some patients, the wait for routine care during the pandemic could be months, she said.
The U.S. health care system, which is often based on responsive rather than preventive medicine, also compounded health insurance challenges for routine care. Patients in the U.S. are already less inclined than those in other countries to pursue preventive care such as wellness visits or screenings, Casias said.
“The U.S. has never really emphasized the preventive care model and that really came to light with the pandemic,” he said. “We are a system that’s more structured on taking care of things when they arise instead of trying to prevent them.”
More patients began returning to routine care when vaccines became available at the end of 2020 and beginning of 2021. But amid the delta and omicron waves, routine care oscillated, falling off during waves of infection and coming back as transmission slowed, Jollon said.
As the pandemic has transitioned into a new phase after the omicron waves, medical providers and a mass of patients have begun returning to routine visits.
Both Axis Health System and San Juan Basin Public Health are charting a return to their usual dental services as they try to keep up with the demand.
“We’ve seen hundreds of kids in the last month to catch up,” Jollon said.
As patients return to routine care, they are also meeting with doctors in person. Many of the routine visits doctors at San Juan Health Partners’ family medicine office in Farmington saw during the pandemic were through telehealth, but as the pandemic has eased patients have begun visiting the clinic.
“A lot of our virtual visits have transitioned to in person,” Sa’Ena said. “We rarely see or talk to patients over the phone.”
For two months, the clinic has been bustling with patients seeking care.
“It’s busier than ever,” he said.
Like San Juan Health Partners, Pediatric Partners of the Southwest has returned to in-person visits. In April 2020, telemedicine accounted for nearly 100% of care, but they now only serve around 10% to 12% of patients, Fraley said.
The resurgence in routine care has in part been driven by medical providers as they reconnect with patients who may have deferred routine care during the pandemic.
“What we’re seeing is probably instead of people actively going out and seeking care, I think there’s more of a push from the clinics themselves trying to attract these individuals back to get preventive care,” Casias said.
Many medical providers are making a concerted push to rekindle their relationships with patients recognizing the toll the pandemic has taken on behavioral health, the risks that diseases such as cancer still pose and the reality that many patients have been disconnected from medical care during the pandemic.
“There is a little bit of a surge in us trying to get these folks re-engaged and a lot of that’s actually the messaging, getting (the message) out to the patients to say, ‘You really need to do these services. They are important,’” Casias said.
But this push by medical providers has also been met by the constraints of the region’s health care system. Routine care continues to lag as more patients seek care from limited medical resources, Jollon said.
“There is still evidence that people are behind on cancer screenings, cardiovascular screenings, routine checkups,” she said. “We have to recognize that there isn’t necessarily enough health care capacity to absorb all of the pent-up need.”
For rural communities in Southwest Colorado and northwest New Mexico, a return to the routine care will take more time than urban communities that have a greater health care capacity. With fewer providers and access points for care, it can take people longer to finally return to the doctor’s office.
“When you have limited resources to catch up, it lingers a little bit longer. It’s harder to get broader outreach to get people in for the services,” Casias said.
While patients can still face delays, Sa’Ena said patients should not let the wait deter them from re-establishing their routine medical care.
“I would highly recommend patients start seeing their primary care providers again and getting those regular follow-ups for diabetes, hypertension, high cholesterol that they weren’t getting during the pandemic,” he said.
The move back to routine care will require adjustment from both patients and medical providers as they reacquaint themselves with one another and the preventive medicine that is key to improving and sustaining personal health.
“It’s sort of a reboot that we have to do,” Casias said.