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Arizona Primary Care Providers Are On The 'Front Lines' Of Virus Response

By Bret Jaspers
Published: Sunday, March 29, 2020 - 7:48pm
Updated: Monday, March 30, 2020 - 7:54am

Elizabeth Lopez-Murray, a physician’s assistant in Glendale, has a routine when she returns home at the end of a workday.

“I take off my scrubs, put it in the washer and I take a shower,” she said. “Then I have contact with my baby and my husband.”

As a worker at Clinica La Familia, a primary care office, Lopez-Murray is on the front lines of coronavirus response. Until last week, her clinic was seeing patients in the office and evaluating symptoms in-person. Now, they are doing most of their work via telemedicine. 

The change came after Arizona Gov. Doug Ducey issued an executive order that health insurance companies “must reimburse health care providers at the same level of payment for a telemedicine visit as they would for an in-person visit.”

Lopez-Murray said they are doing almost everything via telemedicine, except for special cases like a child needing a vaccine or a physical exam.

“Of course, we ask those questions, have you traveled recently, is the child or the patient sick, do they have any symptoms?” she said. “Any symptoms and they will not be allowed [to come in]. It will be a telephone or a video call consult.”

The quick transition to telemedicine was overwhelming, but now, “it’s working for us,” she said. Her coworkers are all separated in different rooms during the workday. 

That doesn’t mean Lopez-Murray is not nervous about getting sick. Like everyone else, she might contract the coronavirus even outside her clinic.

“I definitely am scared because I have a three-year old,” she said. “My husband, he’s a cardiologist, so, same thing. I’m always worried about his health, mine, and bringing it home.”

The state Department of Health Services (DHS) released guidance for primary care physicians last week advising them to conserve personal protective equipment like masks, face shields, gloves, and gowns. The department expressed concern that if primary care clinics close, the 'front lines' of health care would then become hospitals and emergency rooms, and that would overwhelm the system. 

DHS also wants primary care offices to discourage testing for COVID-19 for most patients, due to the lack of testing supplies in Arizona and around the country.

“Clinicians should consider removing this diagnostic ‘tool’ from their toolbox and managing patients with respiratory conditions as if they have COVID-19,” wrote Dr. Cara Christ in a letter to primary care providers. Christ is head of DHS.

Dr. Raymond Valdivia’s thoughts on testing are similar to those expressed in Christ’s letter, which says the treatment regimen for a positive COVID-19 diagnosis is not any different from how you would treat a person with similar symptoms but no positive test result. 

“You’re still going to treat the patient based on his complaints and his symptomatology,” said Valdivia, a primary care doctor in Tolleson. “At this point, it’s a question of the progression of the pneumonia and the respiratory issues.”

His patient load has dropped as more people avoid the doctor’s office.

“I’ve been seeing probably half the patients I normally see,” Valdivia said. “I think most of the patients are just assuming we’re closed and they’re realizing ‘you know, I’m not really that ill. I’ll stay home.’ Which is a smart way of thinking about the situation.”

He is trying to keep his sick patients isolated, but has no idea what might be coming. The state said the worst case scenario is that coronavirus illnesses peak in mid- to late-April and hospitalizations peak in May.

“I don’t know what’s going to happen next week. I don’t know what’s going to happen the week after that. Am I going to be bombarded with 50 patients [in the] same day?” Valdivia asked.

But he sees this crisis as a moment for people to start practicing better health habits, something he constantly encourages his patients to do.

“When are you going to start being healthier? That’s the whole point of this, right? The whole point of this is, can we be better, not be more afraid. In 10 years it’ll be something else, in five years it’ll be something else,” he said. “When are we going to learn? [Again,] wash your hands and cover your mouth.”

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