Health Services delivers care at a distance to the Concordia community

Concordia Health Services is looking very different these days.

While there may not be many patients in the waiting rooms, medical and health promotion services are still fully operational. Health Services has continued to deliver care to the Concordia community while adapting to the evolving situation and health recommendations in the face of the COVID-19 pandemic.

This makes it one of very few university health clinics in Quebec that stayed open and continued operations immediately following campus closures on March 16.

Keeping the clinic operational required a fast response, involving the entire team of family doctors, nurses, psychiatrists, services assistants, health promotion specialists and administrators.

“This wasn’t a planned closure like winter break, and at the time we didn’t know how long it would last. We felt we needed to continue to serve our patients in a way that was safe for them and safe for us,” explains Anne-Marie Lanctot, manager of community health services.

Thus, Health Services entered a steep learning curve and an ongoing period of innovation and restructuring to offer the remote delivery of services and to manage day-to-day clinic operations during COVID-19.

“This is really new territory — and we’re always thinking about how to ensure confidentiality and informed consent, and provide care that is sound and appropriate within our scope,” Lanctot says. ”This means completely rethinking how you manage, troubleshoot and communicate with patients.”

A day in the life

Health Services is a busy operation, addressing all sorts of needs among the Concordia community of students, faculty and staff. This includes urgent care and regular or preventative appointments for physical and mental health.

At the clinic, staff remain onsite to access patient files and ensure confidentiality when providing care over the phone. Patients’ first point of contact remains with the nurses and service assistants, who are answering phones from 9 a.m. to 5 p.m. every workday.

In-person appointments are reserved for patients who require specialized, time-sensitive care or urgent follow-up that can’t be managed over the phone. Nobody comes to the clinic before being screened for COVID-19 symptoms and contacts — once at their first assessment over the phone and again on the day of their in-person appointment.

To promote safety, all staff are required to wear masks in clinic common areas where a two-metre distance can’t be maintained. A rotational schedule allows for physical distancing, with about a third of the usual staff on-site each day. Daily Zoom video-conferencing huddles make certain that everyone is up to date and staying connected.

“We’re frequently changing and updating our policies to reflect our new virtual reality, since most policies and practices were based on face-to-face contact with patients. Moving to virtual care has been a huge paradigm shift requiring the creation of new forms and work processes for most patient encounters,” explains Lanctot.

Connecting over the phone

These changes have resulted in an examination of both the potential and limitations of telehealth — care delivered over the phone and through video. In addition to telephone consultations, Health Services has begun experimenting with secure video consulting platforms so that confidential video appointments can be offered by this fall.

While in-person exams and visual assessments are not easily replaced, remote services have the benefit of reduced wait times and easier access for many patients, often allowing for appointments within one business day.

“It’s actually amazing how much can be done by talking to patients,” says Cathy Lounsbury, a clinic physician.

“In med school, we learn that 90 per cent of the diagnosis is based on patient history and 10 per cent is based on the assessment to confirm our diagnosis. We find that the majority of issues can be addressed in some way over the phone.”

Nurse Louise Carline finds the opportunity to connect remotely with patients rewarding and necessary during a period when many are experiencing increased stress, particularly surrounding physical and mental health. “It’s a scary time for people and we find those who call us are always happy to speak,” she says.

“The community has been quite resilient and has adapted to uncertainty. We are happy to help and provide the best advice and resources possible.”

This need is pronounced among many students who are far from home and family support systems, who may be particularly vulnerable during a pandemic. Health Services plays an important role by offering accessible care that can be navigated in English. Within the first month of the campus closure, Health Services booked 710 appointments with international students alone.

Future directions

Health Services is looking to further adapt policies and procedures during the campus closure through an internal COVID-19 committee that is examining what an eventual reopening will look like and which services will continue to be delivered by phone and video, versus in person.

“Hopefully, we can keep some of these changes for the future, as a way to accommodate more patients,” says Josée Lavoie, another clinic nurse. “There’s nothing like a crisis to challenge how you do things.”

“Rethinking our role on campus and our model — including opportunities for outreach — will be ongoing,” Lanctot adds. “We anticipate increased interest in health education and vaccination. Our health promotion specialists and nurses have the expertise to help understand information that is new and changing.”

This work has already begun, as health promotion specialists Gabriella Szabo and Owen Moran deliver remote curriculum infusion about health and wellness topics and plan for more opportunities to deliver health education across the Concordia community.

“The team at Health Services has been phenomenal in their response,” says Gaya Arasaratnam, director of campus wellness and support services.

“Despite the uncertainties that COVID-19 brought, Health Services has moved quickly and decisively to support Concordians. As we look ahead to fall 2020, we look forward to serving in new ways.”
 

Reach Concordia Health Services by phone from Monday to Friday, 9 a.m. to 5 p.m., at 514-848-2424, ext. 3565. When instructed, press “2” to speak with a nurse or service assistant. Learn more at concordia.ca/health.