Chronic conditions, other health issues have worsened during the pandemic, physician survey finds

• Primary care practices have found that their patients’ health is deteriorating during the pandemic.
• Responses have included more screening for social determinants of health and increased virtual visits.
• Health systems are promoting their disease-control protocols to lure patients back for essential in-person care.

Physicians have seen a deterioration in their patients’ health during the pandemic, including with respect to underlying chronic conditions, according to a new survey.

More than 580 primary care clinicians (68% of whom were physicians) surveyed by the Primary Care Collaborative (PCC) reported a broad deterioration in their patients’ health, including:

• 85% have found worsening mental health
• 31% have found increases in addiction
• 37% have found chronic conditions getting “noticeably worse”

Those trends came as 56% of surveyed clinicians reported an increase in negative health burdens due to delayed or inaccessible care.

One clinician in Pennsylvania told surveyors that his practice has seen more patients with uncontrolled diabetes and new cases of diabetes.

“They prefer telehealth yet [have] no access to glucose monitoring or blood pressure cuff[s],” the provider said.

The findings come amid a resurgence in SARS-CoV-2 infections and diagnoses of COVID-19. That has led many state and local governments recently to initiate lockdowns and other restrictions. Unlike during the spring surge, states have generally avoided bans on elective surgeries and left the decision to suspend such procedures to hospitals. Many in the hardest-hit areas recently have initiated various elective surgery suspensions.

The provider survey found 60% have had an increase in COVID-19 illness in their communities.

“Yet respondents continue to rate the level of ‘unusual strain’ on their practices due to COVID-19 at around the same levels” that the ongoing series of surveys has found since late August, said a PCC analysis of the survey.

Findings on how practices have changed their care delivery in response to the pandemic include:

• 38% use video visits for at least 1 in 5 of their patients, and 35% use phone visits at the same rate
• 69% use telehealth for managing chronic conditions
• 61% use telehealth for mental health visits
• 60% rely on telehealth to screen patients prior to visits, preventing unnecessary population exposure

Practices also have responded to the worsening health of their patients with several steps, including:

• 22% have increased connections to community organizations
• 17% have added mental healthcare capacity
• 27% are more involved in helping patients who have poor access to food, housing or employment

Practice finances may be improving

Financial challenges as reported by the primary care practices may have lessened.

The survey found 6% of respondents are unable to pay some of their bills, compared with 58% in an August iteration of the survey.

Payment rates for virtual visits have improved, with just 7% of surveyed clinicians reporting that they would like to use video-based care more often but can’t because of low payment rates. Similarly, 15% say the same for phone-based care

A bigger obstacle for practices has been trouble hiring new staff, as reported by 35% of respondents.

Other challenges include testing for COVID-19, with 44% reporting that results take more than two days to receive and 26% reporting they cannot get patients tested as often as they think they should.

Additionally, 23% said low amounts of personal protective equipment (PPE) or reused PPE have made them feel unsafe at work.

Health system-owned practices voice similar concerns

The survey responses included 42% from health system-owned practices, and those larger organizations shared the concern about deteriorating patient health.

“Like health systems across the country, we saw significant drops in preventive care during the initial height of the COVID-19 pandemic,” said Carrie Nelson, MD, vice president and CMO of population health and health outcomes for Advocate Aurora Health System. “We are still seeing patients hesitant to return to in-person appointments, and we are concerned that people are putting off screenings, lab tests and immunizations, which can mean a delay in necessary and needed care.”

The health system, based in Illinois and Wisconsin, has promoted a “Safe Care promise” to reassure patients via additional measures like masking, screening, social distancing, enhanced cleaning and virtual check-ins.

“But certainly, delaying recommended healthcare services can have an impact on maintaining wellness and can have a long-term impact,” Nelson said in an interview.

Diagnoses involving chronic conditions such as heart disease, COPD and diabetes require continued appointments, lab tests and medications to avoid deterioration, she said.

“However, it is also critically important that all patients are screened and evaluated for cancers and chronic diseases,” Nelson said. “The consequences of a delay in care can be significant and long-lasting. Patients should not wait until their healthcare provider calls them but instead reach out and get the care needed.”

The health system’s care management teams identified the patients most vulnerable to deterioration based on clinical data and on screening for social determinants of health. Its clinicians have used expanded virtual visits — surpassing 750,000 in 2020 — in an effort to maintain care.

The health system hopes such efforts will prevent widespread deterioration in patient health, which could affect its 2021 performance in value-based payment models.

The system participates in a Medicare Shared Savings Program accountable care organization, Medicare Advantage and the Medicare Bundled Payments for Care Improvement Advanced program. Its exposure to financial risk will expand through a recent partnership with Quartz to launch a joint Medicare Advantage plan for 2021.