President’s Message

PRESIDENT’S MESSAGE to Members

By Dr. Jessica Triche 2020–2021 NCAFP President

COVID Perspectives

And Some Positives We've Learned from the Pandemic

By the time you read this we will be close to two years into a pandemic. As a state, we have lost over 18,000 patients/friends/family members to COVID. Our country has lost over 740,000 lives. We are all tired. We are tired of spending 15 minutes of a 15-minute visit explaining to patients the importance of the vaccine and debunking online myths. We are tired of losing unvaccinated patients, some healthy and young, to COVID. We are tired of being short staffed because we have lost staff due to burnout, or, more unfortunately, refusing to be vaccinated. I have to try really hard not to be snarky about patients who ask for ivermectin or other TikTok-approved COVID treatments. I know I am not alone. I have attempted to look at anything positive that has come from COVID. I have managed to find a few.

TELEHEALTH! Cheers to the medical world for recognizing telehealth as a valuable tool. Medicaid, Medicare, and private insurances recognized the value of telehealth. Thanks to family physician leaders, such as Dr. Shannon Dowler, Medicaid continues to value telehealth the same as in person visits. We have had the opportunity to see into our patients’ lives and connect. Our patients who “no showed” because of transportation issues now eagerly await our video visits. Patients who never bring in their medicines can now show us what they are actually taking. Viewing our patients’ homes and their lives help us figure out a care plan. I learned a patient couldn’t read and had a stutter after a virtual visit. Now I know what he is taking and why he doesn’t say much during his visits. He was much more comfortable speaking to me in his home environment.

Telehealth has helped us provide care to patients who work. I am sure I am not the only physician who virtually saw a patient during their lunch break. Did anyone else have to tell their patient to pull over and park in order to complete the virtual visit she was attempting to have while on her mail delivery route? Telehealth also allows us to see multiple family members at the same time. This is really helpful in learning how some of our younger patients deal with caring for their elderly family members. Telehealth is here to stay and, hopefully, will continue to be valued as an important and useful tool.

VIRTUAL MEETINGS! C’mon ya’ll...does anyone REALLY dress up for a virtual meeting anymore?? The “Zoom mullet” is a thing and I fully endorse it!

Dr. Triche attended UNC Chapel Hill for undergraduate studies and attended medical school at the Brody School of Medicine at East Carolina University. She completed her residency training at Moses Cone Family Medicine in Greensboro, NC, where she served as CoChief Resident. Dr. Triche is married and has two sons and enjoys life on the water in Bath, NC. She is currently working at Vidant Family Medicine-Chocowinity located in Chocowinity, NC. She enjoys seeing a variety of patients, as well as teaching medical students. She is a graduate of both Vidant's Physician Leadership Institute as well as the North Carolina Medical Society Foundation's Leadership College. Dr. Triche also completed their Health Care Leadership and Management (HCLM) Program in 2018. She is currently involved in several leadership roles within the Vidant system. She also serves on the Beaufort County Board of Health.

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Executive Officers President Jessica L. Triche, MD President-Elect Dimitrios “Takie” P. Hondros, MD Secretary/Treasurer Shauna Guthrie, MD, MPH Immediate Past President David A. Rinehart, MD Executive Vice President Gregory K. Griggs, MPA, CAE

At-Large Directors

Talia M. Aron, MD

Elizabeth B. Baltaro, MD

Jewell P. Carr, MD

Garett R. Franklin, MD

Nicole Johnson, MD, MPH

Brian McCollough, MD

Mark McNeill, MD

Ying Vang, MD

Academic Position Mark L. Higdon, DO (Novant FMR)

Resident Director Clayton Cooper, MD, MBA (Duke)

Resident Director-Elect Ryan Paulus, DO (UNC)

Student Director Hannah Smith, MD (ECU)

Student Director-Elect Morgan Carnes (Wake Forest)

AAFP Delegates & Alternates

AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate Karen L. Smith, MD Robert L. Rich, Jr., MD Richard W. Lord, Jr., MD, MA Tamieka Howell, MD

2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607

Collared or dress shirt...and pj pants! Joking aside, I think we have all learned that virtual meetings can be productive. Definitely easier and less expensive for organizations. I have noticed that some folks who never spoke up during in person meetings, have found their voice virtually. I find myself paying attention more to virtual meetings than in person. In a real meeting I would just text my friends about how boring the meeting was. But virtually, I felt I had to listen-probably because there was always that chance your face would be in the first Zoom box that everyone sees! The chat box is a useful tool that allows us to ask questions without interrupting the speaker. I know we all value in person meetings where we really form friendships and bond with each other. However, moving forward, virtual meetings can be useful for obtaining CME without leaving your family. In fact, the AAFP just announced that live CME is no longer a requirement for membership, although we still hope you will value the personal interaction you get at both AAFP and NCAFP in-person events. TAKEOUT INNOVATIONS! Don’t we all love the new food offerings?? Three years ago we would have never thought about picking up the local 5 star restaurant meal to go. Fast food or Panera-type restaurants were the only options. Well, now it’s a thing. Restaurants have upped their game and take out is at a new level. I mean some places come to your car window! Take out at fancy restaurants is here to stay. It allows us to get a decent and healthy meal, safely, any night of the week. Please remember to tip well!! GROCERY ORDERS! Who would have thought that our 80-year-old patients could have figured out online grocery shopping! The geriatric population became tech savvy in order to protect themselves. Many of my patients tell me they will only shop this way from now on as they don’t have to lift heavy groceries or worry about not being able to reach things on the top shelf. For patients with disabilities, grocery ordering has made a trip to the store an easier experience.

Although the stores will not be fully stocked for quite a while, and the substitutions made can be hilarious (dry beans for canned, sliced deli ham instead of a whole ham), the concept of ordering online groceries is here to stay. DENTAL & ACNE COVER UPS! I have had several patients tell me how they love wearing a mask because it hides their dental issues. For a few, it was poor dentition. For “As the year comes to an end, I do think it’s worthwhile to others it was lack of dentition. Many patients struggle to get dentures due to cost. They reflect on the positive things enjoy hiding behind the mask. that we have learned or In fact, sitting at a kids soccer gained from the COVID game, I had a granddaughter pandemic.” of a patient show me a picture of her grandma. She was so excited to get her dentures back after losing them in a house fire. She showed me her photo, no mask, and I laughed. I had NO idea she was missing her dentures when I saw her in clinic! Her granddaughter told me she loved wearing a mask for this very reason! Although masks are irritating and can cause “maskne” (mask acne), they are also useful for covering up acne. I clearly remember seeing a young patient for the chief complaint of “acne”. When I walked into the room, I was surprised as I saw an acne-free masked face. But, lo and behold, when he removed the mask I saw a terrible case of pustular acne. During the visit he told me that the mask helps his social life as nobody can see his acne at school or work. As a child of an almost teenager, I can see how the mask can be useful for hiding stubborn zits. As the year comes to an end, I do think it’s worthwhile to reflect on the positive things that we have learned or gained from the COVID pandemic. I am sure there are more examples than those listed. We all need to continue and try to stay positive as we push through the COVID pandemic. We have done a great job so far. Stay strong and stay safe!

Mitigating Second-Order Impacts of the COVID-19 Pandemic

The devastating consequences of the COVID-19 pandemic have no doubt left a lasting impact on the world as COVID-related deaths continue to climb. While COVID-19-related deaths and hospitalizations are the most notable immediate effects of the pandemic, second-order impacts (i.e., situational health consequences resulting from pandemic-era restrictions) are also plaguing individuals around the world, both worsening many health conditions and creating new ones. Recognizing and understanding many of the most common second-order impacts will help physicians and practices better care for current and future patients.

Below we explore six common health-related consequences of pandemic restrictions and provide actionable advice to address them.

1. Delayed screenings

Medical professionals know that delayed diagnosis can lead to adverse outcomes—that fact is nothing new. Unfortunately, with pandemic restrictions, screenings for many common medical issues were put on hold, directly affecting physicians’ ability to detect diseases for early intervention. 2. Delayed “elective” surgeries and procedures

While many surgeries and procedures may have been considered non-urgent in the early stages of the pandemic, leaving these issues unaddressed can lead to worsening conditions. The burden of disease can continue to accumulate while patients await surgery, sometimes leading to advanced issues and even death. 3. New and worsening mental health disorders

According to a U.S. Census Bureau Household Pulse Survey, more than 40% of adults have reported symptoms of anxiety or depressive disorder during the pandemic, up from 11% in 2019. A KFF Health

Tracking Poll from July 2020 also revealed an uptick in specific negative mental health and wellbeing impacts due to worry and stress over the pandemic. 4. Delayed childhood vaccination

According to a study conducted by the National Center for Biotechnology Information (NCBI), nearly one-quarter of parents surveyed reported a delay of more than one month in the immunization of their child, with 60% citing fear of COVID-19 infection as the most common reason. This delay in childhood vaccination leaves children vulnerable to many vaccine-preventable diseases. 5. Increased instances of downstream health impacts associated with food insecurity

During the pandemic, many Americans have suffered from financial hardship and/or an inability to access nutritional food. According to Feeding America, the low overall food insecurity rates seen in 2019 were upended by the pandemic, and recent projections predict a continued trend of elevated levels of food insecurity across the nation. 6. Care interruption for patients with chronic diseases

As a result of pandemic-related restrictions, most practices saw a reduction of chronic care activities, and this care disruption left many patients vulnerable to new and worsening issues associated with their chronic conditions. Resources in practices and hospitals shifted toward an effort to contain the pandemic and minimize direct consequences, translating to reduced access to necessary chronic disease management.

HOW DOCTORS AND MEDICAL PRACTICES CAN ADDRESS SECOND-ORDER IMPACTS

To effectively address many of the above concerns, it’s critical for practices to reengage their patients and follow up with missed and cancelled appointments. EHR and EMR patient management systems can help track cancellations and no-shows while monitoring patient conditions. Telemedicine also remains an effective tool for physicians to meet with patients. However, it’s important for practices and providers to keep in mind that licensure requirements, waivers, and payment parity may be affected in weeks to come.

With necessary follow-up and greater accessibility, it’s possible for physicians and practices to address second-order impacts and ensure patients remain healthy in the post-pandemic era.

If you have questions on this topic, call 800-662-7917 to speak with one of our experts right away.