Nurse Practitioner Cynthia McGee at WMCHC.JPG

Nurse Practitioner Cynthia McGee at White Mountain Community Health Center is seen with her telehealth setup, including one of the iPads for video chat the center purchased through a grant. (COURTESY PHOTO)

CONWAY — White Mountain Community Health Center was awarded a grant of $27,000 from the New Hampshire Charitable Foundation to buy telemedicine equipment.

Health center officials say the ability to have primary care visits over the phone or video chats has been critical during the pandemic, allowing the health center to continue to provide important health services to patients while minimizing the risk of spreading the COVID-19.

They say telemedicine has also turned out to be a wonderful new tool for providers that promises to permanently improve health care. The equipment purchased through this grant will make long-term use of telemedicine more convenient for providers and patients.

Director of Operations Julie Hill said: “Telehealth is facilitating a more patient-centered model of care. We are virtually meeting patients where they are, and have found that it is removing barriers to care. We have many patients who have transportation or childcare challenges, and we are excited about keeping telehealth as a part of our regular practice in the future.”

When the pandemic hit in March, the health center was able to quickly switch virtually all of its primary care visits to telemedicine, allowing patients to seamlessly continue most care. Appointments were rescheduled as either phone or video calls, depending on what was needed for that visit and on the patient’s access to technology.

The health center was already using telehealth to connect patients with hepatitis C treatment at Dartmouth-Hitchcock. This made the change easier for providers who had already been using the technology. For others, there was a learning curve, but the benefit was quickly apparent.

Nurse Practitioner Deborah Cross said: “Being able to offer telehealth services is one positive change to come out of this quarantine. I have found in some situations it is more effective than a face-to-face visit. I’ve gotten to see people in their homes, meet family members and even pets!

“Patients are loving not having to drive here, we’re able to do a lot better follow-up, especially on mental health. I like to check in with patients two weeks after I start a med, with telehealth I can do a really quick phone or video visit. Otherwise, people have to miss work or find childcare. Gas can get expensive, we have some patients who come from Freedom or Effingham. I’ve had people do a quick visit on their lunch break at work.”

Physician Assistant Lisa Cushing, who sees pediatric patients, said: “I’ve definitely gotten more used to it and more comfortable with it. It’s been nice to use the phone to just quickly check in. With depression, people used to have to take in some cases a whole half day off of work just for a follow-up after we’ve started them on meds. To be able to just talk with people over the phone is a lot more convenient for them. Some of my kiddos are in college, they might be in another state, and just being able to call me is so great.”

Nurse Practitioner Cynthia McGee said: “When this started, I was worried about how I could help my patients, especially those with comorbidities. It was a relief when I was able to continue their care uninterrupted, especially when we started doing video chats. They had been cooped up at home, and I hadn’t been able to see my patients’ faces, and we were just so excited to see each other again! Most importantly, it allowed me to help them continue to have the best quality of life. Beyond the care I provide, I can check in on them and make sure they have access to resources they need. Do they have enough food? Do they have their medications? Telemedicine allows me to stay connected with them without putting them at risk. It actually makes me more accessible than I was able to be before.”

Medical Director Dr. Sohaib Siddiqui added: “The biggest advantage is patient convenience. For providers it’s good because there are no missed appointments. It’s more efficient. You can spend more time with the patients who really need you … Mom calls with four kids with rashes, with telehealth I can look at the pictures, diagnose and treat.”

As the health center gradually resumed in-person visits this spring, telemedicine made it possible to continue to limit the number of people in the building. “Triaging has become more important, to figure out whose issues can be addressed over the phone or video, and who needs to be seen in person. That has become an even more crucial role now,” said Cushing.

With many patients still being seen through telehealth, providers can work from home, allowing each staff member in the building to work in a separate room. Limiting the number of patients allows for the extra time required for deeper cleaning between visits, and the fewer people in the building every day, the lower the risk. Cross said, “In general it’s better for everyone to be home, anyone who doesn’t need to be out and about shouldn’t be.”

The grant from NHCF was used to purchase laptops so providers can switch more easily between working from home and working from the office, tablets to use for video visits, and wireless internet upgrades for the facility. It’s also allowed the health center to purchase blood pressure cuffs so patients who normally would need to come in regularly to get their blood pressure taken can take it at home.

In addition to allowing patients to stay home, this produces more accurate measurements. Cross explained, “When people come here and get their blood pressure checked, it always runs a bit higher than at home. It’s called ‘white coat syndrome.’ I have people swear to me they’re not stressed, they’re totally fine, but they have high blood pressure. When they bring us their home blood pressure, it’s normal. At home, they can also check it a couple of times a day so we can average it, that’s a lot more accurate.”

The health center also purchased pulse oximeters, so that if there is a local surge in COVID-19 cases, patients with the disease can monitor their blood oxygen level at home. COVID-19 is notorious for dangerously lowering patients’ oxygen before they notice that they’re short of breath.

Telemedicine cannot replace all in-person primary care, of course. Providers listed many categories of visits and patients they prefer to see in person. In addition to annual wellness exams and those who need blood work, Cross included “people who need a breast exam, or a PAP, or a real physical complaint that you want to put your hands on and check out. People need to come in periodically so we can listen to their heart and lungs, especially those with heart disease and hypertension. They should come in every six months, maybe more often if their condition is unstable.”

“Almost all the cancer patients I like to see face-to-face, I just don’t feel comfortable,” Siddiqui added. “People who can’t hear, it’ll be worthwhile doing a home visit or having them come in.”

Cushing said, “I still like being able to see the kids’ face, to see their affect. Teenagers can be so tough, one-word answers.”

But for visits that can be conducted virtually, Cross said, “We’re hoping to continue, and expand. The more we can do it, the better.”

Cushing explained, “This whole time, I’ve been like, this is what we need to do for now but it’ll go back to normal. But now I’m realizing that telemedicine is now a part of medicine. And now it’s just taking this tool and using it to the best of our abilities.”

According to Siddiqui, “In the future we should keep 20 percent of our visits as telehealth. That’s what the literature’s supporting. The pandemic forced the issue, but this has been coming for a long time.”

Billing issues made telemedicine difficult for practices to use regularly in the past.

An executive order by Gov. Sununu early in the pandemic required insurance companies to cover telemedicine visits at the same rate as in-person visits, and the New Hampshire Legislature recently made that change permanent.

Telehealth has been popular with patients. In an anonymous survey of patients who had been seen through telehealth, all rated ease of use and ability to see and hear providers at 8 or above on a scale of 1-10. One commented, “This was a perfect way for me to check in with my new health-care provider. I would use this mode of communication even without a pandemic.”

Patients at White Mountain Community Health Center will now always have the option of telehealth visits.

Cross said, “This is making us really change health care to be more user-friendly.”

White Mountain Community Health Center makes high quality health care accessible to all and is accepting new patients. For more information, go to whitemountainhealth.org or call (603) 447-8900.

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