If you have ongoing health concerns, small children, or simply get a yearly check-up, then you are using a primary care doctor. In Lycoming County, some of the primary issues are obesity, substance abuse and mental health.
UPMC doctors, Matthew Meeker, division chief, and Jennifer Small, administrative director of Primary Care Services, spoke with On the PULSE and these and other primary care services.
What is primary care?
Matt Meeker: Primary care is the initial care you have that exposes you to the rest of the health system. Taking care of your general health maintenance, your wellness exams, and really just being the first touch point for a lot of patients to the rest of the health system. So helping to see if a patient should be seen by a specialist, managing chronic medications and medical problems …
Jennifer Small: We will see patients anywhere from a newborn until they’re hundreds. We do provide the family care. In some of our practices we see mother, father, brother, sister and all the siblings and that just helps to keep with a continuity of care.
How did primary care adapt during the COVID-19 pandemic shutdown?
J. S. We actually implemented telemedicine, which allows patients to do a visit with their provider over their phone or an Ipad or any kind of technology that they have at home or on their computer. That was something that we implemented within a week and across all our practices and nationally. You’ll see that a lot of primary care and family medicine practices do the same thing.
We can do telemedicine via face to face, through our special technology where it’s like an in-person visit, although you might not have that touch point like you do when you are in person. For other things, there’s also the telephone visit. If you say, ‘Oh, I have a sore throat and maybe I need an antibiotic,’ something simple that the provider can do just a telephone visit and provide that care to the patient. So it really helped us to keep seeing patients.
We did slack off quite a bit with not having patients come into the practices because they were scared. I can tell you that right now it’s OK for anybody to come into the practice provided they wear a mask and social distance and we are keeping telemedicine going forward so that is always an option. A lot of families who have little children found it easier because you could also do a telemedicine visit with your child as long as you had the MyUPMC app.
We did struggle a little bit with our elderly population just because they aren’t so tech savvy, but we are working through that. And we do help them. We can get them connected either with a family member or someone else that can help to provide that visit for them.
M. M. There was a period of time when we really had very few people coming into the doors. But once we figured out how to make sure that patients were assured we were screening and monitoring patients beforehand, so every patient is called before their visit as a check for some basic things like, are they having fevers, have they been exposed to anybody with COVID… In doing that, we were able to prevent people who are at higher risk to have COVID from coming into offices and protecting or helping patients.
And so we really utilize telemedicine as a way to keep those who could possibly have COVID homes where they wouldn’t continually spread it to other people.
There were probably two weeks of figuring out what the guidelines were – there were a lot of things in the beginning that were just unknown – the guidelines from the CDC, for the government, for the state were all very different and changing. When we got a handle on them, we were able to create more confidence in our patients coming in and even our providers felt safer bringing their patients in.
Are there changes to Primary Care due to COVID-19
M.M. In addition to having our patients wear masks to enter a building, and throughout their entire stay, we had openings of the offices or buildings screening for temperature and again asking questions about symptoms. For any patient that will be potentially positive, we’re using full PPE face shields and having those rooms set aside so everything can be properly cleaned. Having people go in through different entrances, doing car visits and all those types of things that keeps them separate from our helping patients.
Why is it important for a person to have a Primary Care doctor?
M.M. I think the traditional idea of primary care where you had a doctor you call if you had a problem you came in, you paid your copay, you left and that was it was really that was the model. What we’ve established is we’re part of that patient-centered medical home. We have case managers and nurse navigators, all people who are looking to make sure that your care is being done properly, making sure you’re getting to appointments to make sure that we’re keeping up with the typical healthiness and symptom framework for medications. So there’s a lot more involved than just the visit.
J.S. We have a lot of chronic patients that have a lot of complicated conditions and so helping them to manage their medications and manage those conditions so that they, one stay out of the ER and also stay out of the hospital. So having our patient-centered
medical home and that team-based approach definitely helps us to maximize our patient outcomes.
How much do you assess family life when working with a patient?
M.M. I think we can get into it as deep as we feel is necessary. As a good provider of healthcare, you have to look at those things you have to say, ‘OK, is the reason this person’s blood pressure not controlled… because they’re not taking their medicine because they just don’t want to listen to you, or is it because they can’t afford it? Or is it because the only food they understand how to eat is salty, high processed food.’ And so getting into those things is important because medicine, especially in primary care, goes beyond just the prescription and if you’re not tackling all aspects of the person’s life you’re probably not going to help their health.
J.S. We also have access to social services to help us. If patients are having issues because they don’t have health insurance, or if they need some kind of care and home at home, or even, maybe it’s a matter of education, especially with the high blood pressure diabetics, they might not eat properly. Even literacy-wise, they’re not able to totally comprehend or read the information that’s out there, and they just need some extra help.
What are the three primary health issues in this Lycoming County region?
M.M. When we talk about determinants, you’re definitely going to think about things like obesity, substance use, and that goes anywhere anywhere from illegal substances, like alcohol and cigarettes. And I think the other one would probably be mental health. I think that’s probably the other big aspect there that we deal with. People that come in and they say ‘I’m gonna say psychiatry.’ Most of mental health in this community is managed by the primary care teams. And only the real extreme cases make their way into psychiatry.
I think those are probably the three biggest ones that we tackle. Of course, from things like obesity and substance abuse you’re getting into chronic medical problems like heart failure and COPD and diabetes. But all of those things if you look at the actual root of the cause that’s usually coming from those types of issues.
How does primary care deal with knowing how, or when, to prescribe opiates?
M.M. Very fortunately, we’ve had a couple of providers who have gotten really involved in helping manage the opiate crisis and provide a lot of education to our providers. So at the very front of it is we do utilize a way for us to communicate between pharmacists and physicians to let us know where people’s prescriptions are coming from.
So you can find out if a person is going to multiple providers or are on substances that would put them at higher risk for an overdose. We were very fortunate that we got a grant that allowed us to give narcan, which is the opioid antagonist that helps people if they overdose. So we’re able to give that to patients on high doses of opiates.