Author: Beau Underwood, MPP, MDiv – IPP GRA
IPP Graduate Research Assistant and PhD Candidate Beau Underwood presented his work with Dr. Julie Kapp, Dr. Kathleen Quinn, and Kristi Ressel at the 2022 Institute for Public Health Annual Conference & Poster Session at Washington University in St. Louis, Missouri. His poster, titled COVID-19 and Enhanced Care Coordination in Rural Missouri outlines the pandemic-related findings from interviews conducted as part of the Health Resources Services Administration Medical Student Education Program – An Innovative Model to Increase Primary Care Physicians for Rural and Underserved Missouri (PI: Kathleen Quinn, PhD).
Like other health care services, the research team found COVID-19 strained care coordination models. Their interviews with providers revealed how the pandemic required adaptation of services, innovation in delivery methods, and perseverance through challenge.
Consider this quote from a leader with a behavioral health respondent. It references significant alteration of methods and wider adoption of technology in providing services necessitated by the pandemic:
"There was a short while, at the beginning [of COVID], where we were dropping things off on patients’ porches, talking to them, you know, through their doors, that kind of thing. But it didn't stop us from making those outreach efforts and it didn't stop us from, you know, following up and making sure they were able to transition to telehealth or something like that. But it just kind of changed the way it was being done."
Another respondent noted organizational resilience and focused on the use of new technologies to meet patient needs, though highlighted some limitations.
“During COVID we were certainly worried about all of the remote work that was happening telephonically and telehealth and [the patients’] comfort level with that. And that was something pretty well received, even better than what I had thought that it was going to be.”
“We were able to access hotspots and iPads and distribute those as needed to consumers [to] access their healthcare through more of a technology aspect than they ever have before. …Some of the negatives that I think that have come out of this is: it has been a really long time since some of our clients have seen their medical provider in person. We've been still doing remote psychiatry services and I think I’m really starting to see that impact. I think it's time to get back to more in person care at that level.”
A leader with a Federally Qualified Health Center echoed these themes, especially emphasizing the isolation patients experienced:
“We thrive so much on in person. I would say before COVID-19 probably 80% of everything we did was in person. So, it really did force us - when you look at the silver lining - it forced us to look at some other modalities to work with patients and to continue services with them. But it [was] also very isolating for many of our patients…And, so COVID 19 only worked to exacerbate that more. And, so, our case management…also became via phone, became via text, patient portal messages…So, as case managers, they had to really work around how do we address that isolation and separation for patients.”
A population health manager in a rural Missouri hospital saw similar challenges in their work.
“I would say the main hurt is people trying to stay in and not getting that face-to-face, one-on-one conversation with them. Having to reach them more by phone is difficult…not only that, then you've got the depression of not being able to socialize. So, we've had to address that a little bit with some of our patients. But mainly it's the lack of interaction and face-to-face connection with those patients, I think, was the hardest part.”
Overall, these quotes indicate how the pandemic both strained existing care coordination services in rural Missouri and spurred them to utilize new technologies and methods to overcome the challenges created by the pandemic, especially those related to patient isolation and the need for ongoing case management and care.
Questions on this project can be directed to Kristi Ressel at resselk@missouri.edu.