Director of 10 clinics driven to improve care for patients

Reaching out to patients helped lift video visits, depression care in pandemic

A man's hands hold a tablet in this illustration for a telemedicine story

Andrew Larson has a passion to find new ways to care for patients at Sanford Health. That passion followed him from his start as a social worker in a psychiatric unit to his current work as director of 10 clinic locations.

“Creating other avenues for care for patients outside of the typical is something that is interesting to me and that I spend a significant amount of time doing,” Larson said.

For example, with a $12 million innovation award, he was part of a team that embedded behavioral health therapists into primary care clinics across the Sanford Health system.

For someone who values innovation, the coronavirus pandemic has surely encouraged it even more. It has required rewriting some of the “rules” about delivering health care to patients, because caring for their physical and mental well-being can’t stop during a pandemic. For some, it’s more essential than ever then.

Slow start to virtual care

One significant change propelled by the pandemic was virtual care. For a couple of years, Larson had been working on a pilot project involving team-based care and primary care. It incorporated video visits and Tytocare, which adds a kit of tools to virtually give the health care provider diagnostic information.

Until the pandemic, Larson had found some barriers to progressing with the virtual care part of the project. Patients thought it would be simpler to see their provider in person, rather than learning how to use a new tool. Providers, too, “initially were quite skeptical,” he said.

“It was tough to get people to adopt the idea that you can do a lot of these visits via video visits.”

But some early use showed how well it could work. “We had seen some success for our patients who have depression or anxiety, where you’re not really doing a lot physically,” Larson said.

“You can do those over a video visit, and they’re quicker and they’re more seamless,” fitting into everyone’s schedule easily.

However, Larson, who oversees the family medicine and internal medicine clinics in Fargo, North Dakota, had hoped for more participation. The roughly 20 to 30 video visits a week didn’t come close to his target.

Then along came a contagious disease that required social distancing and temporarily discouraged people from visiting health care facilities.

A quick boost to video visits

“Especially early on, to reduce the spread of COVID-19, we needed to basically reconfigure how we do operations in the clinic,” Larson said. Patients and health care workers could no longer mingle closely throughout the clinic.

“We had to figure out a way to do it where we could get it quickly up and running and create avenues for care for patients so that they don’t get sicker — and so that they don’t end up more susceptible to this virus because their conditions are poorly managed because they don’t have access to care,” Larson said.

Quickly, then, his clinics were driven to establish processes and provide equipment — for more than 100 providers — to launch virtual visits in a big way.

“To be able to see the teams adopt this and deliver care through virtual visits in the way that they did and at the rate that they did was pretty mind-blowing,” Larson said.

To help encourage providers, “early adopters” of virtual care described their methods and successes in Skype meetings with their colleagues. “I think that was very vital to the success of getting it rolled out without a lot of heartburn,” Larson said.

Providers received iPads to connect with their patients.

Also crucial to launching video visits: the people who schedule appointments with patients. Their role now included discerning which conditions a video visit could address, and which still required an in-person visit, Larson said.

Patients, providers now big fans

At first, having no idea how long the pandemic would last, many patients declined a video visit. They said they preferred to see their provider in person “when this is all over,” Larson said.

It turned the tide, though, Larson said, to have providers contact their patients personally to express their concern about maintaining their health.

Now, comments from patients and providers alike have convinced Larson that video visits will remain. Patients like how easy the visits go and how well they feel cared for. They don’t have to take time off work, drive to the clinic, go through the registration and rooming process, talk for just a short time with their provider, then drive back, Larson points out.

Larson sat in on a few video visits recently with a provider. He said each patient said essentially the same thing: “Well, this worked pretty slick, and it was nice to see you.”

Providers also like the convenience and the amount of time they can spend focused on the patient virtually. Meanwhile, they can reserve in-person appointments for people with conditions that require a hands-on/eyes-on approach, he added.

“The alternative is just to worry about how their patients are doing. … To be able to maintain that connection with a patient over this platform has been really important for the providers,” Larson said.

Now, the Fargo clinics average 800 to 1,000 video visits a day, with April 14 tallying 1,284. “That’s an incredible amount of visits,” Larson said. It certainly beats 30 a week.

Reaching out to mental health patients

Given his background, it’s easy to imagine how concerned Larson became when he found that patients’ visits with integrated behavioral health therapists “dropped off at an alarming rate in a time of worldwide crisis.”

Under the circumstances, he said, “you should see an influx of patients who are struggling with anxiety, depression, fear. … And the reverse happened.”

Larson worried about the patients who might have taken years to decide to talk to someone about their issues. Now, asked to isolate, they faced losing vital connections to other people.

Meanwhile, calls to the My Sanford Nurse line, where nurses assess a person’s condition and answer questions, doubled. Larson learned that many of those calls came from people troubled by worry and anxiety.

“So obviously there was a disconnect in patients who are struggling and having access to care,” Larson said.

Outreach, again, became the answer. Patients with a history of depression received screening questions. Based on their answers, integrated therapists have worked with primary care providers to call the patients who appear in distress. They check in to determine whether therapy or crisis counseling or another solution might work best for the patient.

“To me, the only way that we could try to do the best that we could to support people who we know are struggling in silence is to reach out to them ourselves,” Larson said.

It’s been working. Therapists have seen more patients, “refocused on the patients who are really in crisis and are really in a deep struggle, with the specific emphasis on reduction of suicide,” Larson said.

Virtual visits part of future

Larson predicts that innovations embraced during the pandemic will continue to enhance patients’ care.

“We’re going to continue to have this mix of virtual visits and in-person visits,” Larson said.

He sees video visits benefiting rural patients in particular. Deterrents for in-person appointments can include a long drive, time off work and child care concerns. Now, “you could literally be sitting at your job and take a 15-minute break and see your primary care provider,” Larson said.

“Hopefully that means that we have better access to those patients to be able to more closely monitor, manage their care, get them better care, simply because we can see them as frequently as we need to in a much more efficient manner.”

And if you become ill, Larson said, you may not have to go to the clinic and risk spreading a communicable disease. “We can now, because of virtual visits, do what it is that our mothers always told us: If you’re sick, you stay home.”

You’ll still get care, of course. “Don’t even get out of bed,” Larson said. “Schedule yourself a video visit. We will see you that way and get you better from the comforts of your own home — and not risk getting other people sick in the process.”

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Posted In Coronavirus, Faces of Sanford Health, Family Medicine, Health Care Heroes

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