Bone Health During COVID-19: Important Information for Patients and Caregivers
On June 10, NOF’s Board President and Chief Medical Officer reviewed important information via a live webinar about how to manage your bone health during the Novel Coronavirus (COVID-19) pandemic. NOF recently surveyed its patient and caregiver community to ask about access to care, availability of medication/treatment, and other healthcare concerns. Our experts shared highlights from the survey and responded to some questions and concerns raised during a Q&A session at the end.
Ask the Expert: Dr. Lewiecki Shares Invaluable Insight on Best Telemedicine Practices During the Pandemic
E. Michael Lewiecki, MD
Director, New Mexico Clinical Research & Osteoporosis Center
Director, Bone Health TeleECHO
Vice President, Board of Trustees, National Osteoporosis Foundation
The COVID-19 pandemic and mandated social distancing have forced healthcare providers to quickly determine how to use technology to provide patient care. A recent NOF survey revealed that more than 60 percent of healthcare providers are offering telemedicine visits by phone or videoconference. Since March 2020, more than one third (36%) of patient respondents have participated in technology-driven appointments. Overall, the feedback has been very positive with 77 percent indicating that their telemedicine appt was easy, convenient, a good quality visit and safe. NOF’s Dr. Lewiecki shares excellent insight and perspective on what patients can expect from this new form of healthcare.
Q: How should a patient prepare for a telemedicine appointment?
A: With restrictions imposed by the COVID-19 global pandemic, televisits have become commonplace as a replacement for the traditional office visit. As restrictions are lifted, more patients will be able to return to having face-to-face office visits, but some may still prefer televisits. Here are a few things to consider for a televisit:
a. Scheduling. Be sure you have the right date and time. With a televisit, you may be in a different time zone, so keep that in mind. Be certain you have provided the most current insurance information for billing purposes, along with all of your contact information details. For a televisit, it must be clear in advance whether it will be by phone or video.
b. Medical information. Please provide all necessary records and reports before the appointment. There may be forms to fill out with your medical history, list of medications, symptoms and concerns. Depending on circumstances, these may need to be mailed, emailed, faxed or hand delivered.
c. Technology. If the visit is by telephone, be certain you have a good connection. For a cell phone, ensure your phone is charged and that you have a strong signal. For a video visit, you should decide what device you will use – smartphone, computer or another device. If you have never done this before, conduct a test beforehand. If there is a link access to a website, be sure you have this available when you need it. If you need to download an app or program, complete this step-in advance and know how to use it. There are many different systems, so be sure you are using the right one for the appointment.
d. During the televisit. You must have the microphone, speaker and camera activated. If you are not sure how to do this, practice in advance and get help from someone who knows. Speak clearly and stay in front of the camera. If you want a family member or friend to participate, have them sit beside you. Be prepared with questions and important medical information and take notes, if needed. At the end, be certain you understand next steps such as whether a follow-up appointment is necessary; are lab tests needed; is a prescription necessary; etc. Be sure you are well aware of how next steps will be executed.
Q. What can a patient expect from an osteoporosis telemedicine appointment?
a. Initial consultation. There is some important medical information that is needed for the first visit. Please provide as much as you can in advance. The following lists some components of your medical history that could come up in discussion:
i. Previous evaluations for osteoporosis
ii. General health
iii. Falls – past falls, fear of falls, balance problems, physical therapy
iv. Fractures (broken bones) – which bone, what side, when and how
v. Surgery – especially for bones or intestines, organ transplant
vi. Family history – especially those with broken bones or bone problems
vii. Medications for osteoporosis – what, when, if you stopped why you stopped, side-effects
viii. Medications for other conditions – especially prednisone and anti-hormone medication for breast or prostate cancer
ix. Treatment for other conditions – especially radiation therapy for any reason
x. Bone density tests – when, where, reports, results
xi. Lab reports
xii. X-rays, CT scans, MRIs of bones – especially the spine
xiii. Intestinal problems – trouble swallowing, ulcers, heartburn, indigestion, food intolerances, digestion difficulties, diarrhea
xiv. Cardiovascular disease
xv. Kidney disease
xvi. Any special concerns
With a video visit, it is possible to have a limited physical examination. For example, balance testing can be done while someone watches on the screen. You may be able to show your teeth and any skin rashes of concern. At the end of the visit, be sure to discuss the plan for additional evaluation, treatment and follow-up.
b. Follow-up televisit. Be prepared to provide an update for all of the above, especially any new tests, falls, broken bones, difficulties with medications.
Q. What has your overall experience been conducting telemedicine with your patients?
A. I prefer a face-to-face office visit, especially for an initial consultation. When that is not possible, a video visit is my next best choice. As all of us have more experience with this type of televisit, it will probably become more comfortable and useful. A phone visit is my third choice but has the advantage that anyone can do it and no special computer skills are required.
Q. Do you have any top-line advice or key learnings to share?
A. Regardless of how you connect with a healthcare professional, effective communication skills are required on both sides. Be sure you are sharing all the information your provider needs and that your concerns have been expressed. Just as important, be sure you understand all that has been discussed. You and your provider should be working as a team to optimize the health of your bones.