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How has primary care shifted during COVID-19 pandemic?

Medical providers get creative with video appointments and drive-up services
Dr. W. Donald Cooke with Allergy and Asthma Specialists in Durango offers allergy maintenance injections via a drive-up service to help with social distancing during the COVID-19 pandemic.

FARMINGTON – Allergy shots delivered in your car, telemedicine calls with your doctor and physical therapy via video chat – primary care doctors and specialists are getting creative during the coronavirus pandemic to ensure patients receive care while following physical-distancing protocols.

Dr. W. Donald Cooke with Allergy and Asthma Specialists in Durango started implementing a drive-up system around March 22 to ensure patients received their necessary allergy maintenance shots.

Using two parking spots the city allocated to the clinic’s drive-up system, patients will park, text the clinic and staff will draw the necessary shot and deliver it to the patient waiting outside in their car. Cooke estimated his clinic provided about 70 allergy shots last week, about average for this time of year, pre-coronavirus. With the new drive-up model, Cooke said he has not experienced a drop-off in the number of allergy shots provided.

But other parts of his clinic have been hit harder, he said. The biggest challenge for Cooke and his clinic was the decision not to see new patients.

While he’s able to provide shots and telemedicine services to established patients, he decided to close the office to limit the possible spread of the virus. With a closed office, it’s not possible to intake new patients and do a skin allergy test, he said.

“Until we can start seeing new patients, money will be a concern,” he said.

Although Cooke said he applied for the federal Paycheck Protection Program loan, the funds ran out before his application was processed. But he said he has not had to cut his staff of four so far.

Dr. W. Donald Cooke with Allergy and Asthma Specialists in Durango provides an allergy maintenance injection to a drive-up customer. Cooke said his office immediately started changing services with the spread of COVID-19.

Primary care providers have also had to make adjustments to how they provide care, with many of them transitioning services to telemedicine.

The primary care providers with Southwest Medical Group in Cortez switched from zero services provided via telemedicine to almost exclusively offering the remote service in the span of four days, said Kerri White-Singleton, chief operations officer for Southwest Medical Group.

She estimated about 90% of the primary care offices have switched to telemedicine and about 45% of the specialty clinics, such as orthopedic surgery, have switched away from in-person services. With its telemedicine, Southwest Medical Group offers both video appointments through a secure app or phone call appointments for those unable to video chat, White-Singleton said.

White-Singleton also said the primary care physicians have the authority to decide which patients to see in person for emergent care situations.

Southwest Medical Group has also established a well lab for those without COVID-19 symptoms who need to get lab results. Patients stay in their cars and a lab technician, in full personal protective equipment as an extra precaution, comes out to draw blood.

Some specialist providers, such as physical therapists, have switched completely to telemedicine, but not without repercussions to business.

Although physical therapy was deemed one of the essential businesses, Mike and Amy Testa, owners of Advantage Physical Therapy and Wellness in Durango, ultimately decided to close its in-person services.

“It was a very hard decision,” Mike said of deciding to close the office and switch to telemedicine services. “It’s pretty hard to watch your business go from doing very well to almost no production.”

The transition to video services was fairly seamless, and the clinic continues to accept new patients, the Testas said. But they have seen a drop in the number of clients and in revenue. Although they are thankful to have received assistance from the federal Paycheck Protection Program, the Testas said there is still a lot of uncertainty, as the public health situation changes so often.

“It still feels like a risk,” Amy said. “Our business went from very successful financially to almost a standstill and hardly any income coming into the business.”

At the recommendation of their professional associations, many eye care and dentistry offices in both Colorado and New Mexico are closed, except for emergency or urgent needs.

SkyView Eye Care in Farmington said it has cut operating hours and is seeing only emergency patients or problem-oriented patients who are having severe headaches or have issues with their vision. For current patients, the clinic is renewing prescriptions over the phone and has pushed scheduling in-person eye exams until the middle of May.

On March 18, the American Academy of Ophthalmology issued a recommendation that practitioners see only urgent and emergent patients, and by the next week, the Four Corners Eye Clinic in Durango had adjusted its staffing and operating procedure, said Marianne Sloane.

In addition to seeing only urgent care patients, Sloane said the eye clinic has also split its staff and doctors into two groups, with alternating weekly schedules. Pod A will work a week and then be off the next week while Pod B works.

“With the week-on and week-off model, we always have a group of people that is unexposed,” Sloane said.

Sloane said the eye clinic is probably seeing 10% to 20% of the number of patients it would normally see. With a decrease in patients, she added the clinic was lucky to receive one of the Paycheck Protection Program loans.

“They’re getting 100% of their normal wage even though they’re working half-time,” Sloane said. “The program has made the difference between being able to keep employees.”

Many of the doctors and health care providers in the area said they are balancing providing care to their patients, maintaining a business and following best practices to minimize the spread of COVID-19.

“All medical offices are really trying to make sure they don’t put any patient at risk, but there’s people they have to see,” Sloane said. “It’s a hard thing to juggle, but everyone is keeping everyone’s safety in mind.”


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