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Telemedicine expands to primary care in Minot

Telemedicine: Once special to specialists becomes primary to primary care

Submitted Photo Trinity physician assistant Ginger Strand holds an iPad for conducting a virtual patient visit.

Telemedicine is being put to the test during the COVID-19 pandemic, and patients and providers are giving it passing grades in many cases.

As people have become accustomed to on-line meetings and family gatherings, they are finding they can get many of their health care needs met virtually as well.

Ginger Strand, physician assistant at Trinity Health South Ridge in Minot, finds telemedicine works well in her family practice with mental health concerns, diabetes management and dermatology issues. She also has used it to remotely monitor older patients with COVID-19.

Carmelia Carroll, a family nurse practitioner at CHI St. Alexius Health Clinic in Minot, has seen the value of telemedicine for acute illness visits and disease management. Patients have conducted their medical visits from their work offices, home and even their vehicles.

“It kind of just expands our capability to provide for the people in our community,” Carroll said. “It allows the patients to continue being seen, to continue on with their lives, making it easier for them and for us to still provide them with care.”

Prior to the COVID-19 pandemic, telemedicine, or telehealth, had limited use other than by certain specialists locally.

“But now, after COVID, we rolled it out for almost all providers to have the option to use that,” Strand said.

Strand said Trinity providers received training on how to use telemedicine with the appropriate patient populations before the roll out. Cameras were placed on providers’ computers for telemedicine appointments.

“The feature that I really like is I have two screens. On one screen I have myself and the patient. Then on my other screen, I can pull up their charts and look at things to discuss with them,” Strand said.

Carroll said CHI St. Alexius was not using telemedicine with primary care at its Minot clinic before the pandemic. Once introduced, staff received training and webcams were added to computers that lacked them.

Because she was willing to see patients while working from home on maternity leave, CHI St. Alexius sent its technology staff to see that she had equipment set up to visit with patients presenting with COVID-19.

“We actually have expanded it beyond COVID, which our patients are very grateful of,” she said. For instance, one of her patients who needed a visit regarding her hypertension was hesitant to come to the clinic because of the risk of being exposed to COVID-19. The patient was comfortable in completing her laboratory work, so with those lab results in hand, she and Carroll met virtually later in the day.

Those types of appointments work well when patients have home blood-pressure monitoring kits and can take their readings during the virtual visits, Carroll said.

She also gives the example of one patient who had difficulty working a clinic visit into her schedule. With the ease of a virtual visits over her noon hours, she brought her diabetes under better control.

“It was just us being available,” Carroll said.

In her own practice, Carroll estimates she has averaged about five virtual visits a week this fall, which is down from last spring when she was seeing about 10 patients a day virtually. Throughout the clinic, telemedicine appointments occur several times a day.

“We’re not telling our patients, ‘no, you can’t come in.’ We’re just giving them another option,” Carroll said.

“I’ve had several initiate it that have felt more comfortable doing that,” Strand said of her patients.

However, her patients in an assisted living center often have been hesitant about the technology. To ease concerns, nurses at the center assist residents in the virtual visits conducted via an iPad. At times, Strand has overheard patients as they’re logging out of the visit express their pleasure to the nurses about how easy and nice that was.

Providers also have been generally pleased with telemedicine.

“The only thing I miss in doing something like that is you need touch, emotional connection and some physical exam components that you can’t get,” Strand said. “But many of my patients I have seen for many years, and so sometimes just looking at them, you could say, ‘Oh, you don’t look very good. I think you need to come in.'”

Carroll also said the face-to-face interaction is the missing piece. Additionally, telemedicine doesn’t work as well for annual wellness exams because of the need for equipment to listen to the heart and lungs, she said.

Despite the limitations, both Strand and Carroll see a place for telemedicine in primary care into the future.

“I think it will be a component of medicine but I don’t think it will completely replace it,” Strand said. She also sees telemedicine finding increasing use in fields such as occupational therapy as part of home health and believes telemedicine could be an option for more care modalities.

Carroll sees telemedicine improving primary care.

“Just because it allows for more availability. It allows for patients to have another option. They’re not prolonging their care,” she said. “A lot of times we’re able to fit them into those same-day, acute visits because we have those available.

“I see St. A’s using it for the long haul,” she added. “As long as the patients are willing, and they feel like they are getting great care, they’ll keep using it.”

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