ABSTRACT
Background: While there was broad adoption of telemedicine during the COVID-19 pandemic, optimizing the interaction for patients and the clinical team remained a challenge. We sought to optimize delivery of telemedicine services to provide more efficient and effective patient care. Target areas of concern for improvement were scheduling, staffing, communication, technical challenges with operating the platform, a high cancellation rate, and limited copay collections. Method(s): A team of 8 virtual Patient Service Coordinators (VPSCs), 8 virtual Medical Assistants (VMAs), and an RN clinical manager was created to work remotely from home to serve Providers at 8 clinics. VPSCs performed check-in duties, demographics, copay collection and technology trouble-shooting with patients. VMAs performed medical intake (medication reconciliation, depression screenings, and vital signs) with realtime EMR input. VMAs stayed in-touch with patients to communicate Provider delays. Standardized communication pathways connected virtual teams with in-clinic teams. The clinics selected to participate in the TMS program were conducting 29% - 50% of E&M visits by telemedicine. The goal of the TMS program was to reduce stress and burnout, as well as relieve in-clinic staff of telemedicine duties giving them capacity to address in-clinic COVID related staff shortages. Result(s): The TMS Program supported 15,500 visits (11/15/21 - 5/31/22) and increased upfront expected copay collection from 9% pre-program to 100% post program. The program reduced the time for first contact on video from 18 minutes to 1 minute and reduced the telemedicine cancellation rate by 3%. The supported TM cancellation rate was 7% lower than in-person visit cancellation rate. A geographically distributed work from home team was able to support a 66% increase in visits during inclement weather days which allowed visits to be completed that would have otherwise been canceled due to clinic closures. Additionally, the TMS program relieved workload for in-clinic staff and the VPSC and VMA positions proved highly desirable to the eligible workforce. Conclusion(s): The TMS Program improved patient connectivity and experience, increased upfront co-pay collection, decreased burden on in-clinic staff, allowed continuity of care during inclement weather, and was an attractive work option for staff. Due to its success, the program moved past pilot phase into an operational program.
ABSTRACT
Background: Psychological and social supports are essential to address the emotional impact of cancer. The Covid-19 pandemic exacerbated emotional distress for patients with cancer and impeded many of the traditional service delivery models for supportive services. An increase in patient reported distress from routine distress screenings highlighted the need to transition to virtual Social Work (SW) services. Methods: Patients were referred to virtual SW services three ways: Self-referral, distress screenings, and clinic staff. A virtual support group registration site was created to increase awareness which was promoted by our marketing team. Three different SW facilitated virtual support groups were offered: Stronger Together, Empower Your Recovery: A Program for Healing and Growth for Living Beyond Cancer ©∗, and Paving the Way for Your Journey: A Cancer Support Program (PTW). Of note, the PTW six-week psychoeducation support group curriculum was developed by six employed SW facilitators. Groups included closed and open formats with scheduled frequencies. In addition to virtual support groups, standard social support including, psychosocial assessments, Advance Care Planning, virtual counseling visits were offered virtually with patients via the VSee telemedicine platform. Results: Social Work referrals increased by 154% from 949 in 2019 to 2413 in 2020 due to positive distress screening. From March 2020-21, 14,948 patients received SW services which was an increase from 10,208 seen from March 2019-20. Of these, 372 received virtual psychosocial telemedicine services from March 2020-21. There were 4092 unique webpage views to the support group information and registration website. Total number of all virtual registrants in the 3 groups from May 2020 to February 2021 was 326. Conclusions: The COVID19 pandemic required us to use, technology and virtual tools to ensure continued patient access to psychosocial services and expand access to support groups, in addition to the in-person SW services that remained. Limitations of virtual support groups and telemedicine included lack of internet access felt to be from socioeconomic barriers. Further research is needed to evaluate the benefits of providing structured psychoeducational virtual support groups to patients with cancer. Virtual counseling and support groups may continue to benefit patients with cancer.