Dr Navdeep Madan, general practitioner (GP) from Balgowlah Village Medical, gave us his insights on how he was able to provide deeper patient care towards managing patients with a chronic disease during COVID-19.
- COVID-19’s impact on daily consultations including telehealth, patient behavioural change and the common cold
- Practical measures on how GPs and practice staff can stay safe during COVID-19
- Using data and technology to manage chronic disease
How has COVID-19 affected your daily patient consultations?
There have been some positive aspects in the healthcare sector to come out of COVID-19.
I found that the willingness of both the government and GPs to offer telehealth to patients has fast-tracked the telehealth industry by almost a decade. For example, it’s been great to be able to liaise with patients through telehealth to discuss their blood pressure which may be regularly monitored at home, their blood results, or go through their chronic disease management more thoroughly.
I’ve also found that because people are more hygienic, there has been a reduction in the normal coughs and colds by a significant amount and that’s given me more time to actually focus on the nitty-gritty in general practice. For example, the management of patients with diabetes, chronic mental health illness or heart disease while trying to perfect their care during this time.
Patient Behavioural Change
Everyone seems to be more interested in their health condition now.
The media is always saying that people that are most affected by COVID-19 are people with chronic disease. This makes patients quite anxious and come into the practice, already keen to modify their behaviour.
There’s a lot of changes within the general practice that COVID-19 has brought about. Some diseases are getting better controlled, others are getting worse. For example, in my area, I’ve found that COVID-19 has caused alcohol/substance abuse and mental health illness to be on the rise while coughs, colds and flu are on the decline. Addressing these issues and trying to teach patients basic principles regarding safe alcohol consumption, damages alcohol can do to your system and the effects on cancer, weight gain, and liver damage have been rewarding.
The Common Cold
COVID-19 has allowed us to focus more on chronic disease management within general practices. This has been due to peoples’ increased hygiene and sensibility which has resulted in a reduction of the winter flu, coughs and cold season.
For example, this time last year, I would be diagnosing influenza cases every day or second day in winter. Instead, it has been very rare this year. This is turn has allowed us and our practice nurses to provide deeper patient care, do ECGs, and audit questionnaires. The increased time helps us to ensure data is complete within our patient files e.g. for smoking history, alcohol history or GP Management plan.
Limitations of Telehealth
Telehealth has helped bridge the gap but there are some limitations.
In my opinion, you can’t reliably assess patients with certain things on telehealth but I do think that this will improve over time. For example, you can’t look at a patient’s ear or have a listen to their chest.
Benefits of Telehealth
It’s been great to be able to liaise with patients before they start getting really sick for prevention health.
For the majority, we have been able to tele-consult people when they’ve just started getting a scratchy throat or a runny nose.
We are able to assess the patient early, get a COVID-19 swab done and isolate depending on results. After a negative result, a practice appointment can be booked and we can review to see if treatment is needed in case their symptoms have worsened.
Telehealth has helped keep GPs and patients safe. It’s important patients aren’t exposed and are not exposing other patients to viruses in the GP setting, where we see vulnerable patients.
You’ve used this term “deeper patient care” before. What is deeper patient care?
At the end of the day, it’s about the doctor being a conduit for the patient in the health care system.
In general practice, our role is to empower patients to be in charge of their own health and direct them into resources that can help them improve their health. Through liaising with them remotely, we can see this happening and it has been quite rewarding
Has COVID-19 impacted your practice revenue? If so, how?
If you are a clinic that’s predominately seeing patients with viral illnesses then I’d assume your revenue has been impacted significantly. But, there’s always an alternative form of health conditions that are on the increase which you can focus more on, e.g. mental health illness, substance and drug/alcohol abuse, lifestyle changes.
It’s about identifying what needs to be worked on and finding ways to improve practice impact within the local demographic.
How can GPs stay safe during COVID-19?
Recently NSW Health has issued a directive for all doctors to wear masks in hospitals all the time. This also includes patients and visitors entering the hospitals so our practice policy is looking at the use of masks and limiting time where you see respiratory patients to a certain block in the day. For example, my practice sees any respiratory patients at the end of the day with strict hygiene and infection control measures, preferably after they’ve tested negative at one of the COVID-19 clinics. This has been working well at our practice.
Practices usually have their own specific protocol and there may be variations within the practice between doctors. Some doctors may have chronic health conditions or may be elderly so they would only be doing telehealth consultations.
It could also be very area-specific so GPs working in Queensland could be more relaxed than GPs working in Victoria right now.
What is your perspective on using data and technology to manage chronic disease?
It is a growing and valuable field.
If you look at a chronic disease like diabetes, data will help you decide what is the risk for this patient for developing complications based on different factors e.g. their HbA1c levels, their sugar controls, and what medications they’re on.
It will also allow you to contact the patient remotely and work through certain aspects that they may not have completed in their diabetes cycle of care.
For example, using data you can identify patients who haven’t had their flu shot that have diabetes, or are obese, or are smoking and have diabetes and send them relevant information automatically through AI technology. Having accurate and complete datasets allows you to do this and makes for improved healthcare for the patient and time-saving for the doctor.
Good practice policies to record data from the practice and liaise with patients suffering from diabetes can empower you to improve your patient outcomes.
You can also send patients who are smoking and have diabetes information on the significant increase risk of having a heart attack if they have both of these conditions.
This will ultimately help to empower patients to manage their own health.
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