Getting the Right Care in the Right Place Starts with Primary Care By Jill Jesso-White on June 11, 2020 in Community Health News Deciding what care is needed and where to go to get that care was complicated by COVID-19 contagion concerns. Community Health Associate Medical Director for Express Care Dr. Jennifer Hanson said the broad categories still apply – Is this a chronic care visit with my primary care doctor? Is this an Express Care visit where I can I just walk in? What is an emergency situation that needs a higher level of care and should be seen in the emergency department at a hospital? Would a virtual Telehealth visit with a smartphone or computer be sufficient? As a result of the pandemic, Hanson said there were safety and health modifications providers needed to make so they began to see patients outside, which became known as the “car clinic.” “At our two Express Care sites which are designed for walk-in patients, those who have possible COVID symptoms are seen in an outside setting through our car clinic. And are cared for there,” she said. If warranted, testing was ordered as necessary for the patient. The same protocol took place at other Community Health sites where patients are seen outside in their cars to make sure patients and staff are safe. Hanson said patient safety is always a priority. As health care adapts to the changes in technology and access, there are numerous options available to those seeking care, including primary care health providers like Community Health, specialty clinics, urgent and express care centers and emergency departments. You may ask yourself, where should I go? And that is a good question because the answer is: It depends. Today, the range of patient concerns vary, starting with simply stepping outside of home for the first visit to a provider since the shelter in place order went into effect. Then there are the essential workers who have been out and about and mindful of state regulations but want to keep up with their own health care. Families who have children are asking how to keep them safe while trying to maintain well child visits and immunizations. We are fortunate to live in an area which provides all levels of care,” Hanson said. “Each place has its own function, although there can certainly be some overlap. Understanding these differences can help people seeking health care get to the best place for their needs. —Dr. Jennifer Hanson “In general, where someone goes when they are sick depends on the kind of illness they have and the severity of that illness. A good place to start is with a primary care provider. Calling a primary care provider is still a really good approach,” Hanson said. “Patients may wonder what to do and we really encourage the office to help guide them to the right place and the right time,” Hanson said. “If you are uncertain about where to go, they will be able to help direct you to the best place for care.” Primary care is the best place to go for wellness visits, monitoring chronic health conditions and following up from hospital visits. It’s also a good place for acute visits that do not require an emergency visit. “People recognize what is an annoyance but not rising to the level of a visit and what is perhaps more critical, and you need to take care of it now,” Hanson said. When everyone was very nervous and concerned people were making slightly different choices about what they need to be seen for, she said. “When you are talking about more long-term health issues, diabetes, heart failure, COPD, hypertension, those need regular check-ins to make sure people are doing well. Those are the types of things that people probably did push off for a while and we are encouraging them to come back in and make sure everything is under control,” Hanson said. Sometimes illnesses are more severe, and the best place to go is the emergency department. These sites can provide more extensive services and can coordinate with specialists if needed. Health problems requiring this level of care include serious accidents such as car crashes and bad falls, chest pain and drug overdoses. It would also include illness such as severe, persistent abdominal pain, coughing up blood and significant shortness of breath. “From a safety point of view we are encouraging patients who may have put off going to their doctors to be re-establishing care. We are continuing our telemedicine visits. We continue to see walk-in patients for a variety of reasons. We see patients in a combination of settings in the building then out in our outside system based on specific complaints. We have done a lot of careful thinking about how to keep patients and staff safe,” Hanson said. The pandemic forced patients to think about their health status and the urgency of their issue, all the while thinking about their own safety and the risk of being exposed to COVID-19. “In Vermont there is currently a pretty low prevalence of COVID- 19,” Hanson said, “and the state is doing a good job of identifying the virus through increased testing, tracking and tracing contacts.” There is still a percentage of regular medical visits that are done though telemedicine, and at Community Health, a very large portion of behavioral health is done through telemedicine, including patients wanting to check in and those struggling with mental health issues. “Shortly after the COVID crisis began, we transitioned all behavioral health providers to a telemedicine-only format,” Community Health Behavioral Health Manager Christopher Chadwick said. Since the second week in March, Chadwick said behavioral health providers were ahead of some of the other community agencies because of the Telehealth infrastructure set up throughout the Community Health network. One of the most significant changes post-pandemic is that right place now does include telemedicine. “It’s not only an Express Care same day walk-in or scheduled visit, but a visit that’s done thru telemedicine,” Hanson said. Calling in is still a really good approach. Patients may wonder what to do and health care staff in the primary care practice can guide them to the right place and the right time. “We are fortunate to live in an area which provides all levels of care,” Hanson said. “Each place has its own function, although there can certainly be some overlap. Understanding these differences can help people seeking health care get to the best place for their needs.” Dr. Jennifer Hanson is associate director of Community Health Express Care, Community Health’s fastest growing service line. A native of Middletown Springs, Vermont, she is a graduate of Vassar College and The University of Vermont College of Medicine, was a middle school teacher and is a trained midwife. Community Health is Vermont’s largest FQHC (Federally Qualified Health Center), a network of primary care, pediatric, behavioral health, dental and pharmacy services with offices in Rutland, Brandon, Castleton, West Pawlet and Shoreham. Community Dental offices are located in Rutland and Shoreham, Community Health Pediatrics is in Rutland and Behavioral Health services are available at all of our locations. Community Health Express Care centers are located at the Rutland and Castleton Community Health Centers.