Has family practice care changed forever?

Roberta Heale, Associate Editor EBN @robertaheale @EBNursingBMJ

Virtual health care isn’t new, but it’s taken on a whole new meaning during COVID 19.  In Canada family practice with family doctors and family nurse practitioners moved to virtual appointments, including assessing over the telephone, or via a weblink if it was available to the patient.  After a strict triage, people are brought into the office only if it is impossible to deal with their issues virtually.  Childhood immunizations are one example of care that still requires a face-to-face.  However, such things as review of lab work results, does not.

When the pandemic hit and clinics moved to models of virtual care delivery, practitioners weren’t sure it would work, or whether they would like it.  However, after a few months of this new practice model, doctors and NPs appear to have taken to it quite well. In fact, there are rumblings that most will not go back 100% to the old clinic model of face-to-face appointments.

This is good news for some.  For example, parents with young children are relieved to know that there are options besides missing a chunk of work and battling traffic only to sit in an office with a fussy child for hours.  Now their child’s illness can be assessed through a video monitor, with diagnosis and treatment made, or further assessment arranged.

The virtual family practice model, however, isn’t meeting everyone’s needs.  A friend of mine, with several chronic conditions, isn’t confident in her ability to accurately take her own blood pressure.  She’s concerned that no one has auscultated her heart to listen for changes in her heart murmur.  She also described the difficulty in taking a ‘selfie’ of a rash on the back of her leg.  My own daughter, almost five months along with my first grandchild, has yet to have someone conduct a physical assessment.

Some people simply don’t have the resources, or ‘know how’ to participate in a video appointment and much can be lost by telephone alone.  Without actually seeing patients, or only visualizing them at the specific angle and place of their choosing, providers may miss the subtleties of changes in mental health status such as depression, or changes in cognition. Some people aren’t aware of the importance of symptoms, such as swollen feet for someone with heart failure, and won’t mention it to their provider. By not visualizing it, the symptom may be missed.

Without a doubt the world has changed and health care is no exception.  As we transition out of our homes, we’ll find that many things will never go ‘back to normal’.  The family practice is no exception.  Although better for some, virtual care will not serve everyone well and there’s potential for important issues to be missed.  As always, nursing has an essential role as this change to our system takes place.  Community health nurses, are in an ideal position to bridge the gap arising from virtual appointments.  Offering trusted health care expertise for over a century, home care nurses can provide the eyes and hands that are missing in virtual appointments. Nursing should ensure that no one is left out of this new health care reality.  Let’s not forget that we all have to adapt to the changing world and, sometimes we need to be a voice for patients.






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