When the COVID-19 pandemic broke out last year, Helen (not her real name) took all the right steps to protect herself. The 74-year-old self-isolated, wore a face mask, and practiced social distancing.
Helen stayed safe from the virus during this time, but she put her health at risk in another way: for nearly two years, she didn’t see her primary care physician. Nor did she go to the eye doctor to replace the glasses she lost or contact her dentist when she had tooth pain.
Even in late spring, when COVID infection rates fell, and many in her community received vaccines, Helen still didn’t venture out to see her doctor. She was too afraid, she said, of catching the virus.
Patients like Helen present an immense challenge to the health care system right now. Our research at SCAN Health Plan shows visits to doctors’ offices by seniors in our network dropped by 15 percent from 2019 to 2020.
The result accords with a summer of 2020 Centers for Medicare & Medicaid Services finding that 21 percent of Medicare beneficiaries needed health care for something other than COVID-19 but didn’t get it because of the pandemic.
I worry that unless we find a way to reengage these seniors with their primary care physicians and other doctors, they may face serious health consequences.
Our research shows sharp declines in the number of seniors going for diabetes care, colonoscopies, and mammograms. This suggests many seniors have seen a significant worsening of chronic conditions over the last year and have foregone preventative tests. As a result, we could very well see a spike in heart disease and cancer among older Americans.
It’s critical that we persuade older Americans that it’s safe to see their doctors if they’ve been vaccinated.
This month [July], we began an outreach effort to tens of thousands of seniors, urging them to reconnect with their doctors.
Working with health care practitioners and analyzing our own data, we identified seniors who have missed or skipped medical visits since the pandemic began and categorized them as high-, middle- and low-risk patients.
For the high-risk group, we are conducting what I call an “active” outreach campaign, involving one-on-one outreach through phone calls and voicemail messages. We stress the importance of resuming visits to a health care provider, either through telehealth or an in-person appointment. We assure them it’s safe to go to their doctor’s office and describe in detail what their visit will be like. We also provide roundtrip transportation when needed.
With middle- and low-risk individuals, we are deploying a slightly different outreach campaign, where we rely on social media, emails, and postcard reminders. We’ve had particular success asking individuals to post pictures of themselves at their doctor’s office on their social media feeds and then share them with their followers.
Outreach to community and religious leaders, community health workers, and health care practitioners is also vital because they are the figures patients trust most. We’ve also designed the campaign to be multi-lingual and attuned to cultural differences.
When dealing with a patient like Helen, the best approach can sometimes be engaging them in conversation. When a SCAN peer advocate called her, they talked about Helen’s favorite recipes, the latest TV shows and movies, and fond memories of her childhood.
Helen described herself as a “bit of a loner,” and her social isolation only grew worse during the pandemic. It became clear that Helen just wanted someone to talk to.
After several weekly phone calls, Helen began to open up about her fears of catching COVID and acknowledged her various health conditions. Eventually, the advocate coaxed her into going out and buying glasses and seeking dental care for what had become a very painful situation.
I am pleased to say that she’s also booked an in-person appointment with her primary care physician.
This is hard and time-consuming work. The trust of every patient must be earned and their concerns and worries addressed. But if we want to forestall a new health crisis among older Americans, we have no choice but to do it.
Romilla Batra is an internal medicine physician.
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