Wednesday, Sep 9, 2020

Lessons from the Pandemic to Address Disruptions in Care


The COVID-19 global pandemic brought a sudden and overwhelming disruption to the practice of medicine. While the healthcare ecosystem rightly focused on the immediate needs of patients infected with the virus and on finding a medical solution, the management of other diseases unfortunately frequently moved to the back burner. Seeking to keep their patients safe, systems and practices stopped a huge proportion of in-person doctor-patient interaction, and this was only partially offset by the significant increase in telehealth.

The change has been significant for patients with chronic inflammatory and autoimmune conditions, who typically see their providers regularly to manage their diseases. Crohn’s patient Tina Aswani Omprakash shared how she has been feeling in a recent blog post for Everyday Health titled, “Immunocompromised in the Age of Coronavirus.” She describes her reaction to getting an unexpected email from her gastroenterologist that said, “Hunker down, Tina. Don’t come in, but take your meds on time. We will chat over telehealth and discuss your labs.” Her reaction reflected the fear and uncertainty many of these patients currently feel: “To me, it felt like game over.”

Postponing care has already had an impact on patients. A May KFF Health Tracking Poll revealed that nearly half of adults surveyed (48%) had delayed receiving healthcare services due to the pandemic, with 11% reporting a condition worsening as a result. Physicians concur. A July survey from The Larry A. Green Center in partnership with the Primary Care Collaborative reported that, while 46% of clinicians are offering preventive and chronic care management visits, patients are not scheduling them. They note 36% of patients are requiring more care due to exacerbation of existing health issues from lack of access during the pandemic.

These statistics are troubling. Patients with chronic inflammatory and autoimmune diseases, in particular, have progressive diseases for which disruptions in care may mean irreversible damage to their health and wellbeing. Conditions like rheumatoid arthritis, lupus, ulcerative colitis, psoriasis, and many others require constant vigilance from patients and caregivers, and are painful and debilitating, even when well controlled. The ongoing work patients must put into treatment – monitoring medications, diet, sleep, and exercise; limiting symptom-exacerbating stress; making and managing frequent appointments – increases their mental load. On top of that, their “invisible” diseases mean they regularly invest time advocating for themselves to insurance providers, employers, schools, government agencies, and more, often just to prove that they are sick and need care.

Finding lasting solutions for patients

There are, though, some reasons to be hopeful. While the pandemic is changing our world, our response to it has also demonstrated that, when the situation demands, we can swiftly respond and we have seen the acceleration of certain trends that promise to improve patient care.

All around the world, we have seen thoughtful and resourceful problem-solving. Take for example Japan’s decision to enable direct delivery of medicines by mail or the first time, allowing patients to get the prescriptions they needed, or state regulators in the US issuing emergency rules that removed barriers and enabled patients to continue on their treatment. Some of those solutions, initially devised as quick fixes to help patients who would otherwise have suffered, have worked so well that they deserve consideration for the long term, and certainly if we face a second wave. Below are four areas that I believe warrant prioritization:

  • Double down on digital – While treatment has been impacted all along the patient journey, with new diagnosis and initiation particularly hard hit, some help came from the rapid adoption of telemedicine. A recent report from Decision Resource Group shows that the number of rheumatologists using telemedicine went up from only 6% in 2019 to as much as 46% in 2020. This is undoubtedly a good thing, but we must make sure that everyone can benefit. As more and more people use digital technology to overcome barriers to care, we have also seen others left behind due to socioeconomic challenges such as lack of access to high-speed internet connections, smartphones, laptops, as well as understanding of how to use them. For telecare to reach its full therapeutic potential, we must address these issues. We must also make it easier for physicians to offer this as an option, which means smart policies that tackle reimbursement of telehealth visits on par with office visits. It is worth considering whether the temporary provisions that CMS made to enable patients on Medicare to receive care virtually are worth making permanent.
  • Rethink site of care – While telemedicine can help with continuity of treatment, early data suggest that it’s harder to get patients diagnosed and initiated on treatment virtually because of inability to conduct diagnostics and necessary tests. That’s why it’s important to rethink site of care. Must we see a patient at a hospital or HCP’s office to get a diagnosis? Can we create tools and diagnostic kits and work with nurses to enable patients to get care at home? What about at the pharmacy or mobile clinics? How can we support pharmacists more in their increasing role in disease management? I am confident we can find answers to these questions by applying the same thoughtful and resourceful problem solving that happened during the early days of COVID-19.
  • Understand the impact of COVID-19 on chronic conditions – One of the most important things we can do is to help ensure the medical community can collect and analyze real-world data to understand how COVID-19 affects patients with chronic diseases. That’s why I’m proud Pfizer took swift steps to support large-scale patient databases and registries that will help this community understand how the virus impacted patients with autoimmune diseases. For example, we supported the SECURE-IBD Database, an international pediatric and adult database monitoring outcomes of COVID-19 occurring in patients with inflammatory bowel disease. This database, and the cooperation it represents, will help generate the data and understanding physicians and patients need to make informed decisions about their medicines and care. That brings me to my last point.
  • Break down the silos - The healthcare ecosystem is complex. We have witnessed unprecedented levels of collaboration among industry, governments, and academia to find vaccines and therapies for COVID-19, with Pfizer leading the way with our five point plan to collaborate. I believe we’ll need that kind of systemic collaboration and partnership to make sure patients with chronic diseases continue to receive care if a second wave or resurgence in cases results in further disruptions to care.

Above all, we must put the interests of the patients first. Once we are past this current crisis, we must consider how we can sustain access to care for people with chronic diseases everywhere – not just during a pandemic. If any positives are to be drawn from the experiences of the recent months, one may be that we learned ways to make our systems better.

About Richard Blackburn, Global President, Inflammation & Immunology at Pfizer: A thirty-two-year veteran of the pharmaceutical industry, Richard Blackburn is currently the Global President of Inflammation & Immunology at Pfizer. In this role, he oversees a portfolio of important medicines that address the needs of patients with autoimmune and chronic inflammatory diseases. He also directs the commercial development strategy for an industry-leading pipeline of oral, biologic, biosimilar, and topical treatments for autoimmune and chronic inflammatory diseases with a focus on Rheumatology, Gastroenterology, and Medical Dermatology.

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