Delivery of primary care services amid the COVID-19 pandemic


COVID-19 has wrought many changes, including how medical practices provide care and keep patients safe.

What is our new norm for the delivery of primary health care to the pediatric, adolescent, and young adult populations? How do we help our patients and families remain healthy and safe in a world that challenges each individual, each family unit, and all communities and populations every day? Dr. Schuman begins the conversation in his article entitled, COVID-19: A battle plan for pediatricians. Dr. Schuman suggests that the COVID-19 pandemic will most likely lead to novel primary care practice models. He provides a strategy for a ‘battle plan’ at the end of his article.

Telehealth and telemedicine: The new norm?

Many primary care practices have been trying to ‘hold down the fort’ using telehealth and telemedicine visits. Telemedicine visits offer unique opportunities to ‘see’ and evaluate patients in real time. Telemedicine visits are ideally suited for addressing specific clinical problems, eg, dermatologic conditions, behavioral problems, weight management, asthma management, mild upper respiratory infections without an ill appearing child/adolescent, among others. Telemedicine visits have the potential to support meaningful changes to practice via innovative planning and designs that can provide unique peripherals for the evaluation of infants and young children. For example, infants and toddlers who are not due for immunization updates, may have their visits via telemedicine using ‘to be developed’ peripherals that evaluate the infant or toddler in similar ways that are done in office settings.

Recently, as limited reopenings have emerged, providers are scheduling in-person patient visits with significant modifications to office organization and patient flow. Assessing the parent or caregivers and child for possible exposure to COVID-19 prior to entering the office with the child is step 1 in assuring office safety precautions. Providing masks to all parents and children aged older than 2 years, if the parent has not come with a mask, is also a must. Waiting rooms will no longer be filled with parents and children and as Dr. Schuman has listed in his battle plan, the parking lot is now the waiting room.

Concerns for the health and well-being of children ‘march on’ in this COVID-19 pandemic

COVID-19 has confronted pediatric health care providers with overwhelming and unwelcoming feelings of ‘uncertainty’. We had become dependent on our knowledge base and the ability to search the literature to find answers to puzzling problems. We were comfortable in applying the principles of evidence-based practice and clinical practice guidelines to achieve the best possible health care outcomes for our patients. Suddenly, the literature was non-existent. Children were presenting critically ill in the United Kingdom and in the United States. Unexpectedly and with a high degree of ‘uncertainty’ in best care management strategies for these children, a new syndrome emerged: multisystem inflammatory syndrome in children (MIS-C). See Miranda Hester’s discussion entitled, CDC issues preliminary information on MIS-Cand link to Contemporary Pediatrics webinar on MIS-C.

The challenges of uncertainty

Uncertainty is uncomfortable and unwelcome in professions driven by scientific investigations and years of data analysis to solve complex health care problems. Solutions will emerge. I am confident of that. What is no longer uncertain is the prodigious need for nurse practitioners and all health care providers to maximize their efforts to help communities reverse the disparities directly related to the social determinants of health. If nothing else, COVID-19 makes the case for meaningful change in the delivery of health care to improve population health.

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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