Transcription:
Managing Chronic Illnesses During COVID-19 and Beyond

Caitlin Whyte: Many Americans live with at least one chronic disease like heart disease, stroke, cancer, or diabetes. Dr. Beth Weitensteiner is the medical director at International Community Health Services and is here to talk about how providers can address the needs of patients with chronic conditions during the COVID-19 pandemic.

Welcome to Together We Rise Wellness podcast from International Community Health Services. I'm Caitlin Whyte. So doctor, to start out on this conversation, what exactly are we talking about when it comes to chronic diseases?

Beth Weitensteiner, DO, FAWM, FAAFP: So chronic diseases, when we talk to our medical students or our residents about them and we talk to our patients, chronic diseases are typically defined as a disease that has lasted for longer than three months. And it's a disease that will potentially progress and worsen. And so our job, our goal is to control the disease at its most benign or where we first capture the patient with that disease and not to let it progress.

Chronic disease examples are diabetes, hypertension, heart disease, cancer, arthritis, depression, all of those things can be chronic diseases; side effects from strokes, they're with you for your lifetime. So they become a player in your day-to-day living, and we want to maximize your ability to kind of continue to thrive and enjoy the health at its most optimum level, knowing that this is now a disease that is a partner with you for the rest of your life.

Caitlin Whyte: So what should people with chronic illnesses be doing to better manage their diseases during this pandemic?

Beth Weitensteiner, DO, FAWM, FAAFP: I think the first thing we have to recognize for people with chronic illnesses is that it is hard to manage in optimal condition sometimes. And so when you're met with a pandemic, it increases that degree of difficulty. And so we have to be able to navigate the way a little bit for our patients and empower them and give them resources so that they can manage it at home, which became increasingly difficult for our ICHS patients during the pandemic, because the clinic is doing virtual visits and they can't connect, they don't have that technology. So do we leave them stranded? That doesn't sit well with anyone.

So it was trying to figure out how can we do that? How can we maximize that they can get their medications without having to leave their homes? So that requires mail order or delivery. How can we make sure that they have resources they need for just basic health, regardless of their disease state? They need food, they need transportation. How do we make sure they have all of that? How do we make sure they have power in their house? Because, for the most part, when the economy shut down, many of our patients worked two to three jobs. And so what are their resources now from a financial standpoint, to ensure that they just have food? So all of these things have to be weighted and you just have to say, "Okay, it's hard. And what can we as an organization do for you? And what can we as a community do for you?"

Caitlin Whyte: And then once patients get to your center, how has ICHS modified its care provisions to support patients with chronic diseases?

Beth Weitensteiner, DO, FAWM, FAAFP: What we did initially when the pandemic started is we turned from in-clinic visits, being the majority of our visits to virtual and telephonic visits. And we did that pretty much on a dime. It was an incredible opportunity to start to develop our regimen for telehealth and telehealth expanded exponentially over the past two years. And we were very honored to be selected as one of the community health centers across the nation to be involved in the NACHC Leading Change Program. And NACHC is the National Association for Community Health Centers and they funded a Leading Change Program for patients with chronic diseases so that those patients would have the tools to manage their disease at home. So they were provided with a scale, a blood pressure cuff, a way to monitor their diabetes, a thermometer to check their temperatures. And then they had health coaching from the clinic on a monthly basis to get them kind of like up to running with this kind of technology. And it was amazing that it empowered the patients to own a little bit more of their chronic care management, which is really rewarding because as soon as the terror of that first wave of the pandemic left and people felt more comfortable getting outside, they also felt comfortable in saying like, "Hey. I can take care of this for three months, and I'll do my own self check at home. You check in with me virtually," and then I'll come in and see you three months later, but it engaged them. And so it was really incredible to watch them develop that skillset of not relying on the clinic to kind of help and navigate their disease for them, but they owned a little bit of it, which is really kind of an incredible achievement on their part. And really kudos to our team of nurses and MAs in navigating that for them, again, in a multi-lingual clinic that we have. It was really an investment again of our staff. And I can't say enough about their investment to our patient care. Just really, really incredible.

Caitlin Whyte: You know, in our last episode, we talked all about diverse communities that we serve at ICHS. So how has COVID-19 affected these communities in regard to chronic illness specifically?

Beth Weitensteiner, DO, FAWM, FAAFP: The pandemic itself has impacted our patients exponentially in both socioeconomic way and a health standpoint. So our patients who are unable to get outside because of fear to come to the clinic or to be able to navigate technology, they were just essentially isolated. A lot of our patients live in multi-generational homes. And so as soon as they lost one income, they all suffered. And so the inability to purchase medications, and trying to navigate that for them.

I think we did a good job in developing our telehealth model. We are continuing to improve on that, but their sense of isolation and the impact on being able to manage their diseases for the people that we were unable to reach. We didn't get hold of everybody. I think we really felt that loss and that impact. And another impact that we noticed is in addition to chronic diseases, we lost that opportunity for preventive screening. And it was our patients who suffered not being able to get their colon cancer screening or their mammograms through no fault of anyone's. Essentially preventive screening was shut down during the initial parts of the pandemic. And so all of those things had an additive effect on our ICHS patients.

Caitlin Whyte: And wrapping up here, what policy proposals can we make on a state or federal level you think to prevent or manage chronic diseases and promote healthy behaviors during this time?

Beth Weitensteiner, DO, FAWM, FAAFP: I think one of our first things is really need to invest, as government, at the federal level and at the state level, is to invest in technology and equity in technology. And so that means infrastructure, so Wi-Fi access. You know, it helps if I'm able to communicate with a patient virtually, but if their Wi-Fi access is poor and the phone breaks up, or our video visit breaks up, then we've lost the opportunity. So developing that infrastructure and then finding a mechanism where technology and how you disperse technology equipment, smartphones, and advanced technology. Uh, Everyone. And this showed up not only in healthcare, but also in schools, you know, when kids are doing virtual visits through school. If they're, if their Wi-Fi access isn't good or their technology isn't good, then they suffer and inherently it is our patients who do that.

So I think an investment in infrastructure and investment in equipment, and then an investment in remote telehealth monitoring. Just the talent pool of technology and the development of being able to remote monitor where the patient does take ownership of their health and does their monitoring at home, but then having a mechanism to send that information to their PCPs office. So that then the PCP is also able to monitor and not relying on that phone visit or taking someone away from their work to be able to discuss or to monitor their condition. We've got that exchange of data across protected lines. So all of those things are great opportunities and regardless of the technology aspect.

The other aspect is to make sure that we have our food resources and our transportation resources aligned with the folks who really need it in that strata of patients that just are vulnerable because of social determinants of health, that we make sure that we have equity of access for those things that most of us take for granted. Just health relies on the basics, food, shelter, and water and clothing. And so if we take care of that, and then we add on to chronic care management, then we really have nailed it, you know? We've really got everybody set in a position to succeed and that's a super, super important

Caitlin Whyte: well doctor, thank you so much for all you have done and continue to do to keep our community safe and well during this pandemic. Learn more about us online at ichs.com. And thank you for listening. This has been the Together We Rise Wellness podcast from International Community Health Services. I'm Caitlin Whyte. Stay well.