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Andrew Montalvo · Mar 18, 2022

Helping your patients with chronic conditions during COVID-19

The COVID-19 pandemic has caused enormous hardships for our communities, with more than 900,000 lives lost since its beginning. COVID-19 has had an especially profound impact on those with chronic diseases. Many chronic conditions increase the risk of severe illness, including heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease, and obesity.1

COVID-19 has also had numerous indirect effects on those with chronic diseases. For instance, the pandemic has caused delays and disruptions in healthcare. It has raised patients’ concerns about safely accessing healthcare. Patients have also adopted health behaviors related to coping with the pandemic that are linked to increased risk of developing new chronic disease.

The result? This pandemic has made it significantly more difficult for providers to effectively manage their patients’ chronic illnesses.1,2

In this article, we will examine some of the challenges providers face in helping patients with chronic diseases during the pandemic. We will also present strategies for overcoming these challenges and share resources to help you help your patients more effectively.

Obstacles to effective chronic disease management

Medical Economics named treating patients with chronic conditions one of the top challenges facing doctors in 2020—even before the pandemic.3 Treatment of chronic diseases usually falls to busy primary care physicians, who often lack the time needed to provide their patients with the counseling and life coaching that chronic disease treatment often requires. On top of that, managing chronic diseases frequently involves difficult treatment plans that include both complex medication regimens and lifestyle changes.3

Successful management of chronic diseases requires strong patient engagement.4 A “high touch” approach is preferable, with regular check-ups, health coaching, and overall disease monitoring. This approach is designed to prevent patients’ diseases from escalating to the need for acute care by addressing smaller problems as they arise.5

With COVID-19, it is especially crucial to maintain care for patients with chronic disease to avoid a rise in morbidity and mortality.6 However, the pandemic has created significant challenges for people who are seeking medical care, including:2

  • Hospitals asking patients to delay non-urgent appointments
  • Safety protocols at clinical sites limiting patients’ access to healthcare providers, especially at the onset of the pandemic
  • Fear of being exposed to the virus
  • For some, loss of health insurance due to unemployment

These challenges have created a tremendous “health debt”—the accumulation of negative behaviors during the pandemic that will have long-term effects on peoples’ health.2

Step 1: Addressing patients’ fears

A significant obstacle to providing necessary care to patients with chronic disease is that, with COVID-19, many are fearful of entering healthcare facilities and therefore willing to delay care. One of the most important things providers can do to help their patients with chronic conditions is to help allay their fears so they can safely return to health care. To do this, providers need to:1,7,9

  • Respond to patients’ emotions surrounding COVID-19
  • Reemphasize the importance of chronic disease prevention and care
  • Explain how patients can safely access care
  • Communicate the details of mitigation efforts being made by the healthcare system, healthcare offices, the providers, and staff, and so on, to ensure that treatment environments are safe
  • Above all, remind patients not to delay emergency care

To feel comfortable in their healthcare provider’s office, patients need to hear how their providers are keeping them safe. Patients want to hear exactly what precautions are being taken and what safety protocols are in place, including the details. For instance, how many times are the surfaces cleaned? How will patients enter the facility? State whose guidance you are following when making decisions such as when to reopen and when to reinstate elective procedures, such as the World Health Organization (WHO) or the Centers for Disease Control and Prevention (CDC). By sharing this information, you can show that you’re taking safety seriously and help rebuild patients’ confidence.7,8

The Advisory Board has published a Resource Guide for Communicating with Patients Amid COVID-19 that outlines specific details that are helpful to share with patients.

A large part of reassuring patients is personalized messaging. Contact directly from the patient’s healthcare provider or healthcare staff is most effective.8

It’s also helpful to provide patients with guidance about telehealth, such as:7,9

  • Is it available? With which providers?
  • What sort of situations are appropriate for telehealth appointments?
  • How to schedule?
  • Typical wait time for appointments
  • Appointment length
  • Anything patients need to do to prepare

Here are some additional resources for making patients feel confident returning to health care:

Step 2: Improving patient engagement

One key to effective management of chronic diseases is fostering strong patient engagement.4,5,10

Patients who are fully engaged in their care and overall wellness are more likely to:4,11

• Adhere to their treatment plans • Reach out to doctors with questions • Engage in behaviors that will help prevent their illnesses from worsening • Have improved health outcomes

These behaviors help prevent chronic diseases from worsening and, as a result, help prevent the need for more costly and invasive interventions.4

As the healthcare industry continues to be more remote during the pandemic, it’s important for providers to switch their “high touch” approach to patient engagement for patients with chronic diseases to become more virtual. Fortunately, technology can make it easier for both providers and patients to stay connected and to manage chronic diseases.5

Step 3: Tools and tips for boosting patient engagement

There are several tools healthcare providers can leverage to help boost patient engagement:

1. Automated communication

Automated communication is an effective method for maintaining connection with patients. It’s also a method that gets high scores for patient satisfaction. Before the pandemic, 81% of surveyed patients reported being open to automated communications. This increased to 84% after the pandemic began.12 Automated communications include both text messaging and email. These can be used for reminders for appointment scheduling as well as for patient-provider communications and patient outreach.

2. Secure direct messaging

Secure direct messaging through the patient portal is another effective tool for chronic disease management. Healthcare providers can use direct messaging for a variety of purposes, all of which help maintain the patient-provider relationship. For example, direct messaging can be used to:4,5

  • Answer patient questions
  • Remind patients of an upcoming health check-in
  • Give health coaching tips or encouragement for a new health behavior
  • Ask patients about any irregular data obtained from a remote monitoring device or wearable
  • Fine-tune a patient’s treatment plan between appointments

To use secure direct messaging and other electronic communications most effectively and securely, it is important for providers to discuss the available communication channels with patients, to help set realistic expectations. Discuss with patients what types of requests are appropriate to send electronically and let patients know the standard timeframe they can expect to wait for their providers’ response.5

3. Educational outreach via the patient portal

Studies show that having education information on the patient portal can boost chronic disease management by up to 10%. Presenting educational material via the patient portal can help fill gaps in care, which can be a problem for patients with chronic diseases, especially those with complicated medical conditions.4

Targeted patient education can be delivered by sending at-risk patients educational modules via email to communicate information about preventative care. Educational information can also take the form of various screening functionalities. For example, targeted interactions can allow the patient to learn if they should go to the office when experiencing minor abdominal pain or if there is a way to address the issue at home. These interactions help the patient and provider to treat the disease one small step at a time.4

4. Telehealth

Telehealth provides an alternative way to access healthcare for the many patients lacking frequent access to in-person care. It’s an effective tool for increasing patient engagement and it’s an effective way to improve patients’ treatment adherence. Together, these help to improve patient outcomes.10

Telehealth is being used more and more commonly since the arrival of COVID-19 when many patients couldn’t or wouldn’t access in-person care. It provides an effective means for patients to receive care without exposing them or their healthcare providers to a highly contagious virus.13 Video visits allow clinicians to provide their patients with chronic diseases with health coaching and education. They can develop and share treatment plans with patients; they can also use telehealth for managing patients’ medications. All of these lead to better healthcare outcomes at lower cost.10

As with all medical treatment, telehealth is more effective when the provider can forge a strong bond with the patient; however, having a computer screen separating patient from provider can make that connection much more difficult. By using digital communication strategies, providers can improve the provider-patient connection and, ideally, enable more meaningful healthcare engagement. Experts recommend that providers:5,13

  • Continue to dress the part during a telehealth visit, wearing professional, solid, and non-distracting (preferably light blue) colors
  • Conduct telehealth visits in a quiet, organized, private space with good lighting
  • Avoid looking into the patient’s eyes, or looking at the monitor, during the visit, as this gives the appearance of downcast eyes; providers should look directly into the webcam instead
  • Explain how they are taking notes
  • Continue to utilize the communication skills used in physical appointments, such as working to be empathetic, friendly, and encouraging
  • Be prepared to solve technology problems

Reviewing the best practices for virtual communication will help providers maintain high patient satisfaction with their care, even online.13

Here are some additional resources to help you make the most of your telehealth practice:

  • Practice Fusion telehealth features for your virtual practice
  • Practice Fusion’s response to COVID-19 including telehealth
  • The future of telehealth: How COVID-19 transformed the virtual office
  • The future of telehealth: Making it work for your practice
  • The future of telehealth: Advantages beyond COVID-19
  • Cheat Sheet: Telehealth in Chronic Care Management (Advisory Board)

5. Remote patient monitoring devices

Remote patient monitoring have numerous uses, such as:5,10

  • Measuring vitals
  • Monitoring treatment adherence
  • Sending alerts or reminders

Patient monitoring devices help clinicians collect patient data and monitor disease state from a distance. They usually interoperate with the patient portal or electronic health record (EHR), allowing clinicians to view patient health data and identify any irregularities. They can then intervene when needed.5

Many types of these devices exist, ranging from blood glucose monitors to Bluetooth blood pressure cuffs to a Bluetooth pill box that reports each time the patient opens it to help detect medication non-adherence.5 However, they do come with challenges. There can be a financial barrier since these devices aren’t standard equipment for most patients. In addition, not all patients with chronic diseases are willing to use this type of device. They may feel that a monitoring device is like “Big Brother” looking over their shoulder, or resist using them for other reasons.5 In the right situation, though, remote monitoring devices can be an extremely effective way to help monitor and manage chronic disease symptoms.

6. Mobile health applications (apps)

Mobile health apps can help improve communication with patients and increase patients’ overall engagement with treatment. They help empower patients to monitor their illnesses themselves and make self-management easier.4,11

Some of the functions mobile health apps can fulfill include:4

  • Helping patients track diet and fitness
  • Providing alerts to remind patients to take medications
  • Providing reminders for patients to schedule health screenings
  • Providing reminders and prompts to help patients with lifestyle changes
  • Providing patients with motivational support
  • Providing timely access to relevant health information
  • Facilitating communication between patients and providers

These functions can help improve patients’ treatment adherence. They also enable providers to detect potential problems while they are still minor, when treatment is less difficult and less expensive.11

Research shows that mobile health apps can be very effective. A study published in the Journal of Medical Internet Research reports that mobile health apps can help remind diabetic patients to build better health habits and, as a result, improve chronic disease management. Through automatic messaging, the app reminded patients to eat healthier and get more exercise. This resulted in a 0.53% decrease in HbA1c levels and decreased patients’ risk of mortality, myocardial infarctions, and microvascular complications.4

Caring Voice, a nonprofit patient support organization, has published a list of free apps to help patients manage chronic disease, including apps for medication management and health tracking.

Improving chronic disease management during COVID-19

During COVID-19, it is more important than ever to help your patients with chronic diseases to manage their conditions. It is also more difficult than ever. However, with the right strategies and tools in place, you can 1) help encourage your patients to continue or resume care for their chronic illnesses and 2) improve patient engagement, which will help improve their health outcomes.

The Practice Fusion EHR is designed to enhance patient engagement. Its cloud-based patient portal gives patients easy access to:

  • Personal health records, medication lists, and diagnoses
  • Treatment plans and educational resources
  • Scheduling, secure online messaging, and more

If you have any questions about how Practice Fusion can help you help your patients with chronic conditions, click here.

References:

  1. Hacker KA, Briss PA, Richardson L, Write J, Peterson R. COVID-19 and Chronic Disease: The Impact Now and in the Future. Preventing Chronic Disease. 2021;18:210086. doi:http://dx.doi.org/10.5888/pcd18.210086.
  2. Ruth L, Alongi J, Robitscher J. Confronting The Health Debt: The Impact of COVID-19 On Chronic Disease Prevention And Management. HealthAffairs. Updated September 17, 2021. Accessed January 6, 2022, https://www.healthaffairs.org/do/10.1377/forefront.20210914.220940/full/.
  3. Top Challenges Number 7: Treating patients with chronic conditions. Medical Economics. Updated December 23, 2019. Accessed January 6, 2022, https://www.medicaleconomics.com/view/top-challenges-number-7-treating-patients-chronic-conditions.
  4. Heath S. How Patient Engagement Supports Chronic Disease Management. xtelligent HEALTHCARE MEDIA. Accessed January 7, 2022, https://patientengagementhit.com/features/how-patient-engagement-supports-chronic-disease-management.
  5. Heath S. Top Remote Technologies for Chronic Disease Management. Patient Engagement HIT. Updated July 8, 2020. Accessed January 6, 2022, https://patientengagementhit.com/news/top-remote-technologies-for-chronic-disease-management.
  6. Chudasama Y, Gillies CL, Zaccardi F, et al. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr. September-October 2020;14(5):965-967. doi:10.1016/j.dsx.2020.06.042.
  7. Greevy H. Get ready for the rebound: How to make patients feel safe enough to come back. Physicians Practice. Updated June 16, 2020. Accessed January 7, 2022, https://www.physicianspractice.com/view/get-ready-rebound-how-make-patients-feel-safe-enough-come-back.
  8. Revive Health. Q&A: The right (and wrong) ways to talk with patients who are frightened to seek care. Advisory Board. Updated May 20, 2020. Accessed January 7, 2022, https://www.advisory.com/blog/2020/05/communication-strategy.
  9. Market Innovation Center. Resource Guide: Communicating with Patients Amid Covid-19. Advisory Board. Updated May 19, 2020. Accessed January 7, 2022, https://advisory-prod.azureedge.net/-/media/project/advisoryboard/shared/research/mic/resources/2020/covid19_communicating-with-patients.pdf.
  10. League J. Cheat Sheet: Telehealth in Chronic Care Management. Advisory Board. Updated January 4, 2021. Accessed January 7, 2022, https://www.advisory.com/Topics/Classic/2015/08/Telehealth-Primer-Chronic-Disease-Management.
  11. Gruessner V. Mobile Health Apps Improve Adherence, Reduce Hospitalization. xtelligent HEALTHCARE MEDIA. Updated November 3, 2015. Accessed January 7, 2022, https://mhealthintelligence.com/news/mobile-health-apps-improve-adherence-reduce-hospitalization.
  12. Heath S. COVID-19 Highlights Need for Automated Patient Communication. xtelligent HEALTHCARE MEDIA. Updated August 3, 2020. Accessed January 11, 2022, https://patientengagementhit.com/news/covid-19-highlights-need-for-automated-patient-communication.
  13. Heath S. Communication Tips for a Good Telehealth Patient Experience. xtelligent HEALTHCARE MEDIA. Updated April 9, 2020. Accessed January 7, 2022, https://patientengagementhit.com/news/communication-tips-for-a-good-telehealth-patient-experience.