• Telemedicine, Task Shifting Key to Caring for Patients ‘Left Behind’ Amid COVID-19

    COVID-19 has exposed gaps in health-care systems that must be addressed, both as the current pandemic continues and to prepare for future worldwide health emergencies, according to a state-of-the-art lecture presented Friday at the PCR e-Course.

    Chronic diseases account for as much as 75% of total health-care costs and the majority of deaths worldwide, David R. Holmes Jr., MD, of Mayo Clinic, Rochester, Minnesota, said in a lecture titled “Caring for the Patients Left Behind.”

    Holmes and colleagues wrote a paper summarizing their points that was simultaneously published online in EuroIntervention.

    “Optimal medical systems will need to develop strategies to care for the severely ill, acute care cases but, simultaneously, have approaches to continue treatment for patients with chronic disease,” he said in a press release accompanying the lecture. “Such strategies will involve early identification of patients, task shifting by nursing para medicals and pharmacists, as well as the foundational use of telemedicine.”

    The systems were unable to adjust to the rapid changes in demand caused by the high number of seriously ill COVID-19 patients who required weeks of intensive care. While the systems shifted focus, those with chronic disorders, such as cardiovascular disease, diabetes, hypertension and cancer, saw delays in their care of up to 3 months, Holmes said.

    Some hospital systems around the world delayed elective cardiovascular procedures during the worst phase of the pandemic, and outpatient clinics for chronic conditions were temporarily closed. In addition, Holmes said, some emergency rooms reported dramatic increases in general patient visits for strokes, transient ischemic attacks and acute coronary syndromes.

    Federal data indicated that as COVID-19 began to impact the U.S., non-COVID deaths were nearly double those attributable to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

    In Italy, the number of patients admitted during the week of March 12-19, during the height of the pandemic in that country, was 48.4% lower for acute myocardial infarction, 26.5% lower for ST-elevation myocardial infarction, and 65.1% lower for non-ST-elevation myocardial infarction, in comparison with the same week in 2019, according to a manuscript recently published in the European Heart Journal.

    Another manuscript published in The New England Journal of Medicine reported a 58% increase in reported out-of-hospital cardiac arrests in Italy between Feb. 20 and March 30 compared with the same the same period in 2019.

    Holmes said it is important to ensure that patients continue to have access to non-urgent care and emergent non-COVID care, during the COVID-19 pandemic. Some ways to provide this care are telemedicine, shifting health-system resources, and volunteer groups like the Red Cross. He added that prescriptions should be made available by phone or electronic means, that prescription validity periods can be extended, and restrictions on both the prescribing and delivery of medication can be eased.

    In addition, Holmes and colleagues wrote in their manuscript that in future pandemics, specialists who focus on chronic care may need to deliver more general care, whether that is in outpatient center or emergency rooms, for patients who are not infected.

    He added that it is important to launch campaigns to inform the public about the continued availability of services and the importance of seeking care when needed. The public also needs to be reassured about the risk of contamination as well as understanding that the death rate for acute MI is higher than the combined risk of being infected by SARS-CoV-2 and dying from it.

    “Working with what has proven effective regionally and locally, every society and healthcare organization needs to be mobilized with appropriate resources and reorganized to address the likely recurrence of the current epidemic as well as future pandemics but, equally as importantly, to manage the chronic disease conditions which often form the majority of clinical cases of ‘the people left behind,’” Holmes and colleagues conclude.

    PCR e-Course is the virtual meeting being held in place of the annual in-person EuroPCR congress, which was canceled because of the COVID-19 pandemic.

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