A 2020 Reflection as All Care Looks to the Future

Clinical Director Report, December 2020

A D A P T A B I L I T Y. If we had to pick a word of the year that best described All Care Health Center and the team behind it, we would have to pick “adaptability.” Webster’s dictionary describes adaptability as “capable of changing or being changed to better suit a situation.” While adaptability is a necessary skill for leaders in the health care industry, never before did it have such influence on day-to-day operations and with such a degree of urgency. In March, the COVID-19 pandemic changed our world. Up until that point, our priority as health care providers was to treat patients, in person, for any need they may have had. In the seemingly blink of an eye, COVID-19 turned this model on its head. We all had been asked to “stay home” and “social distance”. How can operations continue with the current care delivery model? The status quo had changed overnight. All Care would have to quickly adapt if we wanted to continue to carry out our mission.

And adapt, we did.  One of the first realizations we discovered was the need to communicate as an organization, with local partners, and our patients. The team at All Care quickly adapted their personal lives to begin work ten minutes earlier than usual to attend daily all staff huddles. These huddles were vital to getting communication out regarding the ever-changing COVID-19 symptomology list, testing capacity, schedule adaptations, etc. The list could go on and on. These daily communications kept our team informed and kept us moving as one functioning unit. After realizing the value of these daily huddles within our team, we branched out and began to have regular weekly communications with the Pottawattamie County Public Health Department, all in efforts to stay informed and adapt any operations that were required.

All Care would see its successes with adaptability as a primary medical care office, dental office, behavioral health office, and pharmacy as both the year and the pandemic went on. Our clinic completed over 21,000 patient visits. We were successful in serving 3,674 individual medical patients, alone, with 41.6% of those patients receiving a telehealth visit. Telehealth provided a gateway for All Care to reach patients for mental health visits with 67.7% of all mental health visits conducted as a telehealth visit this past year. Prior to the pandemic the idea of telehealth was a just a vision of the distant future. We didn’t know we could implement a telehealth platform, workflow, training, and implementation within two weeks. While telehealth was a great option to continue to be able to connect and provide care for our patients, our team had to quickly learn how to conduct a telehealth visit that meets the highest quality standards for medical and legal purposes. We began to offer door side lab services and mail colorectal screening tests to patients. We started to utilize glucose monitoring devices to obtain blood glucose data virtually. All efforts to adapt the experience of a telehealth visit to an in person visit as much as possible.

All of these efforts have paid off when we look at how many patients we have been able to serve with a nominal transmission rate of COVID-19 within our clinic. We have adapted our patient care environment to the meet the highest level of infection control and risk mitigation practices. The implementation of universal mask wearing in the early phases of the pandemic, eye protection, physical barriers, upgraded HVAC filtration system, remote work, and conducting as many meetings as possible thru virtual means, has helped to keep our staff safe. To date, there has been no work-related exposure of COVID-19 in any of the 13 employees who have tested positive and successfully overcome the illness.

The adaptations made within the COVID-19 testing environment have been extraordinary over the past nine months. When the pandemic first presented itself in our community, we had been shipped five testing kits that could be used for COVID-19 testing. Five testing kits for a health center that serves over 5,000 people a year. Five testing kits that could test for an illness that had everyone on pins and needles, fearing every cough and scratchy throat was COVID-19. Providers had to add COVID-19 to their list of differential diagnosis for what seemed like a salad bowl of symptoms. It was difficult to understand who was to get one of these coveted tests and who was to leave empty-handed. We eventually were able to get a limited supply of testing supplies from our private lab and adapted swabs used for alternative medical purposes into COVID testing. Once access to testing became more stable, getting results to tests in a worthwhile time frame became a focal point. Ten days or more became standard turnaround time for a COVID-19 test. This wasn’t at all effective and we were relegated to figuring out a more reliable solution and our partnership with Test Iowa commenced. The initiation of Test Iowa created its own set of challenges but drastically increased our testing capabilities. To date, there have been 4,579 tests conducted thru our Test Iowa team and of those, 805 have been positive, yielding a 17.6% positivity rate. With a positivity rate goal of less than 5% to control the pandemic, we have more work to do.

To that end, more work is being done at All Care in efforts to control the spread. The team at All Care put the work in to become a COVID-19 Vaccine provider and as of 12/23/2020 twenty staff members rose to the occasion and took the first shot of the Moderna COVID-19 vaccine. These staff members were willing to do what us primary care providers recommend – work to prevent illness and disease. As one of very few employers to offer the COVID-19 vaccine in Pottawattamie County, this is a proud moment for us, and a testament to our dedication to our own team, patients, and community. We look forward to partnering with the Pottawattamie County Public Health Department over the next few months to be a vaccine provider for all three phases of the immunization distribution plan that has been outlined by the state. We anticipate administering over 600 COVID-19 vaccines to health care workers, essential workers, and those living in community dwellings over the next 1-2 months.

Our pharmacy was not left out of having to adapt to the ever-changing environment. Year-to-date, over 20,000 scripts have been written for patients of All Care. Thousands of these 20,000 scripts were either walked out to the parking lot by a pharmacy team member, or delivered directly to the patient’s door to ensure safety. A second full-time pharmacist has now joined our team and we look forward to the clinic adapting to a model that now includes a dedicated clinical pharmacist to work with patients who are at higher risk for poor health outcomes.

This ability to successfully adapt to our circumstances is positioning All Care in a favorable light for our future. Our world, and particularly the health care industry, is always changing and requires us to meet these changes to remain competitive, or be left behind. This past year has shown us that our community relies on us more than we had ever imagined and it cannot afford the latter. The team at All Care looks forward to continuing our mission in 2021. This team would like to thank our Board for their hard work and their adaptability over the past year. Thank you for your diligence in ensuring All Care is a clinic that the community can be proud of. Thank you for allowing us to serve. I can undoubtedly say this team looks forward to adapting to any new challenges that come our way and continuing to successfully meet the needs of our community in 2021.

Respectfully submitted, Teresa Dowling, ARNP, FNP-BC, PMHNP-BC, Co-Medical Director