Primary Care During COVID-19

Primary care doctors now wearing face masks during pandemic

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Covid-19 has disrupted many aspects of our everyday lives, and how we access our primary care is no exception. The challenge facing providers has been how to balance protecting the health of the public while still offering quality care.

Anthony Poole, PA-C, chief clinical and quality officer of Fetter Health Care Network – formerly Franklin C. Fetter – a federally qualified health care center serving Charleston, Berkeley, Dorchester and Colleton counties, shared the company’s experience working on the pandemic’s front lines.

Fetter serves roughly 20,000 patients annually, providing primary care, pediatrics, OB-GYN, dental and behavioral health services, as well as operating three pharmacies across the Lowcountry. They serve everyone, insured or not, “whether they have $2 or $2 million,” said Poole, who oversees Fetter’s quality program as well as the nursing and lab staff. He also supervises clinical operations and outside initiatives, including special programs such as their COVID-19 testing sites, the Health Care for the Homeless initiative and the Migrant/Seasonal Agricultural Worker health program.

He ensures Fetter provides the “same level of care to anyone who walks through the door, regardless of their income.”

When the virus first hit, Poole recalls that, like everyone else, they had to establish their priorities. For Fetter, it has been keeping everyone safe and continuing to serve “as many patients as possible,” while implementing measures to protect patients as well as employees and their families.

The future is telehealth

It started with devising the necessary protocols to protect patients, then the focus shifted to continue providing care to patients who were unable or were being discouraged from coming into the health center – thus the expansion of Fetter’s telehealth capabilities. Pre-pandemic, Fetter had not provided any external telehealth services since it was not being reimbursed through the state. So they had to develop and build out telehealth capacity and get patients on the system. During the pandemic, South Carolina has, out of necessity, shifted to reimbursing federally qualified health centers and rural health centers for telehealth services, and Poole hopes the state will continue to support telehealth beyond COVID-19.

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Moving to more telehealth services has minimized patients’ exposure to the virus exposure and their risk of being infected.

“In order to stay operational, we had to get telehealth going,” asserted Poole. “The future is telehealth – great and viable way to provide access to care.”

The New Primary Care Normal

Fetter has adapted clinic procedures to safeguard everyone against COVID-19’s spread.
Staff manning the front doors ask virus-related screening questions and take temperatures, and the procedure is the same for everyone, from CEO and patients to the mail delivery personnel.

Inside, they have created barriers to keep people 6 feet apart and erected screens to protect staff. All employees wear the appropriate personal protective equipment.

From a patient-care perspective, Fetter has been prioritizing high-risk patients suffering from underlying medical conditions such as diabetes and cardiovascular disease. The pandemic realities make in-person care risky for vulnerable populations, but telehealth is at least giving Fetter staff a more secure means to monitor their patients’ medical symptoms and responsiveness to medications and offer them health education and guidance.

Mobile testing sites

Fetter has been offering COVID-19 testing sites, including no cost testing to uninsured patients, since April 6. They initially partnered with Berkeley County to set up a drive-through site that they operated for about six weeks before transitioning to mobile testing sites. As COVID-19 began to spread across the state, Fetter partnered with the Charleston County Emergency Management Division to launch the first walk-up testing sites in South Carolina. Beginning in early May, Fetter and Charleston County launched a mobile drive-through and walk-up testing site that traveled to different underserved communities each day. As of June 9, Fetter had two clinical teams that partner with Charleston, Berkeley, Dorchester and Colleton counties to hold mobile testing events across the Lowcountry.

“We are very thankful for our county agencies and community partners for all of the support they’ve provided to make this happen,” said Poole.

At the time of this writing, Fetter has screened more than 5,000 patients for COVID-19 and tested over 4,600 patients.

“The number of positives started out pretty low, but, as things have begun to open up around the area, we’ve seen our number of positives increase significantly since Memorial Day Weekend,” observed Poole.

Fetter has developed a patient portal at its website where patients can register for online COVID-19 screenings and discuss any potential symptoms with a physician (fetterhealthcare.org or fettercovid19screening.org). They offer same-day screenings for COVID-19, or you can call ahead. This streamlines the process because during screenings, individuals are given a code that they bring to the testing site, saving them significant time.

As states continue re-opening businesses and expanding service capacity, Poole advised that people continue social distancing and wearing masks.

And he encourages anyone, even those displaying only minor COVID-19 symptoms, to use pre-screening options like the one Fetter offers.

“Asymptomatic cases are real. We’ve had dozens of positive cases where patients were asymptomatic or only experiencing mild symptoms such as nausea and diarrhea, or muscle aches for one to two days, and their test comes back positive without them ever having a cough or fever,” stated Poole.

By Colin McCandless

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