We can all relate to the COVID-19 pandemic and how it has affected our lives. There are endless stories to share about personal experiences, at home, and at work, happy and sad. For quite a while, our worlds pretty much came to a standstill. Businesses closed, including hospitals for anything other than emergency treatment, travel was suspended, supply chains were practically non-existent for necessities like toilet paper, paper towels, and cleaning products. Face masks, gloves, and thermometers were a rare find. Some food items became scarce as people were laid off from the very jobs that help manufacture those items or deliver them to store shelves.
We hunkered down at home, unable to visit even our closest family members. Panic became an everyday experience, trying to determine how we could possibly survive this out-of-control situation like a scene out of a science fiction movie. I remember driving to work with barely another car on the road, except for others considered to be “essential workers.” We can all appreciate the fact that while health care workers and first responders are the first ones that come to mind as essential workers, they aren’t the only ones. As reality hit, it became clear that many more jobs and people are also essential to the lives and conveniences we had become accustomed to. Things are definitely looking brighter, but we are still not entirely out of the woods.
How the COVID pandemic altered patient education:
While the pandemic changed our personal lives, it also affected our professional lives, our patients’ lives, and the services we provide for all our patients. At one point, albuterol inhalers were included in the long list of shortages. That may have been due to delayed deliveries or stockpiling for fear of running out. It was likely a combination of reasons. How do you emphasize the importance of carrying a rescue inhaler at all times when the rescue inhaler is not even available? And lets at least give credit to the patients who were thinking ahead to keep their medications well-stocked. Fortunately, the inhaler shortage was short-lived.
Along with so many services being shut down, patient education also came to a standstill. In my situation, all outpatient appointments were canceled, including education appointments. We had to figure out ways to access our patients – think outside the box. So, we continued to provide follow-up care by phone. We asked if medications were filled, got an Asthma Control Test (ACT) score to assess symptoms and control, reviewed the patient’s current Asthma Treatment Plan (ATP), and discussed whatever else might help the patients and families endure the lockdown.
Settling into this temporary vacuum, we began offering virtual education via video platform to our patients. It sounded easy. So many social media and live meeting platforms were already being used. A professional environment, however, requires specific features, such as:
- A high-resolution platform
- Consistency throughout the organization
- Assurance to maintain patient privacy
- Protection of all health information
Then as restrictions began lifting, we thought we’d return to pre-pandemic methods, but many of our patients continued to request video education. Either they didn’t feel comfortable being out in public, still fearing exposure to COVID -19, didn’t have transportation, or now liked the convenience of completing appointments from home. In addition, parents with young children were saving time by not having to pack things up and travel to our offices.
It was working, so why not continue to offer the option? We find that some hard-to-reach patients are more willing to complete education if they can do it from home. Sometimes “high-risk” patients may be labeled such because they don’t show for appointments. Whether it is due to transportation issues, family dynamics, or other issues, virtual education gives them another option.
Challenges during post-COVID-19:
Returning to the pre-COVID-19 lifestyle has been quite a unique challenge. Now our everyday lives are taking on a new “normal,” something different than before, at least in some aspects. We are finding new ways to adjust.
It is a known fact that telehealth services had already been on the forefront well before the pandemic. The digital transmission of x-rays for interpretation has been successful for years. Clinics had already begun to explore the options of virtual appointments so patients could access a health care professional without ever leaving home. School clinics have been using specialized equipment to assess a sick student under the guidance of a distanced physician, nurse practitioner, or other appropriate health care professional. These types of telehealth, though, take expensive specialized equipment.
The virtual appointment:
Patients with chronic lung disease, for example asthma, may still require regular in-person visits with their health care providers to determine proper diagnosis and treatment regimens. Pulmonary function tests and allergy testing are examples of services best provided in person.
Yet, asthma is a disease that depends so much on lifestyle, making it a prime example where supplemented virtual appointments can help make a difference. Much of an asthma patient’s disease management is contingent on the patient’s (and family’s) understanding of the disease, medication rationale, and trigger avoidance. That’s where a trained patient educator becomes a valuable resource.
Certified asthma educators complement the work of the physician. We can focus on the family’s lifestyle and environment, helping the family search out things that may contribute to asthma flare-ups. A virtual appointment enables the patient or family to demonstrate good inhaler technique and allows the family to show potential triggers in the home. The Asthma educator can then give feedback on device technique and some personalized and feasible suggestions for improving the home environment.
Maximizing the virtual visit:
Maximizing the virtual visit requires good preparation. In addition to following the professional requirements, planning is imperative. Give information to the patient in advance to ensure the best use of their time:
- General guidelines of what to expect, including length of visit, having medications, delivery devices, and asthma treatment plan readily available.
- Send the link with instructions on connecting and a phone number in the event they have trouble or get disconnected.
- Suggestions to have someone help young children during the appointment and minimize background noises such as pets or televisions.
“Web-side manner”
More potential distractions come with a virtual visit, and we want to make this time as productive as possible. So, it is wise to follow some guidelines. Like many other organizations, my leadership team has developed some standards for our own “web-side” etiquette. Here are some highlights:
Environment:
- Minimize clutter around your staging area: clean up your desk, make sure your background is de-cluttered.
- Be careful of background light (like a window) that may create a washed-out or silhouette effect.
- Prevent interruption by placing a sign on your closed door to indicate a Telehealth appointment to prevent interruptions.
- Ensure a secured space to maintain patient privacy.
- Good lighting.
- Use of headset with microphone reduces PHI exposure and can improve sound quality.
Dress/Attire:
- Look presentable, professional. Follow the workplace dress code policy.
- Wear your ID badge, so it is visible to the patient.
Provider Presentation:
- Center yourself, close up.
- Introduce yourself, stating your name and role if they are not familiar with you.
- Make sure you and the patient can hear and see each other. Make any adjustments in the volume and camera before starting the education.
- Be interactive and engaging.
- Look into the camera, so you are looking at the patient.
- Inform the patient if you are looking away for charting purposes, e.g., “I’m looking up your current pharmacy” or “I’m looking up your information in the chart.”
- Be respectful of the allotted appointment time.
Engaging the Patient/Family:
- Verify that the person is who you’ve scheduled the appointment with
- They may feel awkward if not familiar with new technology or telehealth appointments:
- Older adults (such as grandparents) may not be familiar with the platform being used.
- Patients may be easily distracted, especially when in their own home, and may get off topic easily, so keep them focused.
- Patients may have distractions from children, other household members, or even pets.
- Ask questions, get their input on their self-management skills.
- Confirm understanding, summarize the visit and provide any follow-up instructions.
- Provide an after-visit summary to the patient following the appointment and document the visit in their chart.
Many of these suggestions are common sense but often taken for granted. Don’t assume that the patient understands your intentions unless you make them clear. Prepare for the unexpected.
Virtual patient education is opening up new and exciting opportunities in patient care.
Email newsroom@aarc.org with questions or comments, we’d love to hear from you.
Marilyn is a licensed respiratory therapist and certified asthma educator working for Akron Children’s Hospital Mahoning Valley in Youngstown, Ohio. She is the Asthma Education Program Coordinator in the Chronic Care Education and Support Center there.
