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Hilary DuBrock, MD - phaware® interview 397

Dec 20, 2022

Pulmonologist and PH clinician from the Mayo Clinic, Hilary DuBrock, MD reflects on the impact the COVID-19 pandemic has had on her clinical pulmonary hypertension practice both in the outpatient and the inpatient setting. 

Hillary DuBrock, MD:
Hi, I'm Hillary DuBrock, and I'm a pulmonologist and PH clinician at Mayo Clinic in Rochester, Minnesota.

Today I'd like to talk to you about a reflection on the impact of the COVID-19 pandemic on our clinical pulmonary hypertension practice.

We're now at the end of 2022, and we've all been through a few years now of the COVID-19 pandemic, which has really changed, I think, how we practice medicine, both in the outpatient and the inpatient setting, and how we care for our patients with pulmonary hypertension.

I think to focus on the positive, we certainly could go on and on about all of the negative impacts of the pandemic, but to focus on the positive, I think one thing that has changed with our practice is the openness to telemedicine and telehealth, which I think is certainly much more convenient for patients. There's still value in seeing patients in person, and we see the majority of our patients at Mayo Clinic in person for face to face visits, because I think that's really important, seeing patients on a regular basis.

We are certainly now more open to both phone follow up visits and video medicine follow up visits, which is a great opportunity for checking in with patients to see how they're doing without them having to travel back to the hospital, particularly for some of our patients that live far away or it's hard for them to get into clinic.

I think that's been a real opportunity that we have taken advantage of that's been very valuable. Patients tend to express satisfaction that they are able to see us and check in, and we can make modifications or tweaks to their regimen and really just feel like they don't need to wait until their next appointment to come back and see us or talk to us about an issue or concern related to their medications or other factors. I think that's been a real advantage to having more openness to telemedicine.

In addition to telemedicine health visits, things like remote pulmonary rehab programs, where during the pandemic pulmonary rehab really shut down because of concerns regarding patients and COVID-19, and concerns regarding transmission of infection. People have kind of taken that and developed different kinds of remote pulmonary rehab programs, which is really important so patients can remain engaged in exercise and physical activity without needing to go to a specific center, which might be both inconvenient and also expensive to travel to places if they don't have a pulmonary rehab center nearby.

That's actually one of our areas of research that we're looking at is, how can we optimize remote pulmonary rehab programs to help our patients with pulmonary hypertension? We're doing a study on that right now and also doing a survey, trying to get patient perspectives about remote pulmonary rehab. We still have a lot to learn about how to use telemedicine in the management of pulmonary hypertension and things like pulmonary rehab, but I think it's a big opportunity for our patients to just have more convenient care.

During the pandemic, people were reluctant to come in and may have also been reluctant to adopt telehealth options. There are certainly patients we had who might have gotten kind of lost in the shuffle in that they needed follow up and didn't have an opportunity to be able to come in. The majority of our patients though, we were following up with them either over the phone or on video, and they're on long term medications, so we're monitoring them. I feel like we did our best to keep a close eye on all of our patients so they didn't fall through the cracks. I think that was really important. A challenging aspect of medicine during that time is you weren't seeing patients in person, but they were still out there at home and needed to be taken care of. So how we did that, I think, was a learning experience.

Probably the biggest disadvantage with the pandemic and access to care was for patients with new diagnoses, because they weren't getting in for new clinic appointments. They didn't have an established provider. It was hard to get in for specialists and even primary care appointments. I think we don't know, but certainly the pandemic could have impacted overall delays in diagnosis, because patients who didn't have an established PH diagnosis didn't have a care team or someone to really reach out to them. That is a major problem with the pandemic that we don't really understand the impact of, but I suspect there were delays in diagnosis.

I think moving forward, finding ways to improve those delays in diagnosis are really important so this doesn't happen again. Not just telehealth, but varied remote monitoring tools will be really important in pulmonary hypertension moving forward. That could be things like your Apple Watch telling you what your oxygen saturation or your heart rate is. Being able to do things like remote six minute walks and having an app where you log your symptoms or your quality of life and that is uploaded to your provider.

Knowing how to incorporate those into our clinical care, I think is an ongoing area of research. How do we use this information? But I think it's really important that we develop ways to use it, because it reflects a patient's daily life. It reflects how they're living at home. Not just when they see you once every three to six months in clinic. So finding ways to incorporate that into our clinical practice and reflect their overall daily lives and what they're doing at home and how they're living and functioning on a day to day basis, is obviously important to how we're treating and managing their pulmonary hypertension. So the remote six minute walks and remote pulmonary rehab and apps and devices… it's kind of information overload, but I think it's important to have a way to incorporate that into our clinical care of patients.

I think the pandemic affected mental health in an interesting and surprising way in some patients. Certainly I had patients who just felt very isolated and that led to depression. Particularly Minnesota in the winter, couldn't go to the gym, were less able to do physical activities. I certainly had patients that had worsening depressed mood and just feeling like they didn't want to do much anymore. I think it was because of the social isolation and not being able to be as physically active, it just impacts your mood.

But on the flip side, which I did not expect, was I also had some patients who I think appreciated time at home with family and actually felt less stressed, which I never would've predicted. But I do think that there were some patients who had the opposite of what I expected to be a response to the pandemic, in that they actually had improvement in their mental health because there was less external stressors to them. It was just kind of a spectrum, I think, of responses in terms of mental health and depression. But I certainly was surprised by some patients actually feeling like they were more connected to their family, less external pressures and responsibilities and stressors, and actually felt like they could focus on their disease management, but also their home life more. Again, I like to focus on the past, but that was kind of a positive, unexpected, finding.

Thank you for listening. My name is Dr. Hillary DuBrock, and I'm aware that my patients are rare.

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