Take a few minutes to go through the activities below and identify whether they could be offered virtually now, and if not, when you would consider offering them again in-person (what would be your criteria)? Be sure to add services specific to your specialty to the list.
To help you in this, consider, if you only have a limited amount of PPE, such that you could see 10 people a day in-person, who would you see?
|Pre-assessment of patient concerns prior to any in-person care, including screening for COVID-19 symptoms||Virtual||Until vaccine|
|Cancer screening where above normal risk|
|Cancer screening when normal risk|
|Cancer surveillance post-treatment|
|Complex care including advanced directives|
|Flu shots for < 4 years or ≥ 65 years|
|Hormone injections3, Allergy shots and injectable meds4|
|Intrauterine Device consultations|
|IUD insertions, Pap recalls (abnormal)|
|Laboratory/Diagnostic Imaging or other test results|
|Mental health planning and check-ins|
|Normal adult vaccinations|
|Personal and cosmetic enhancement services|
|Prenatal visits (at Perinatal Services BC-guided intervals)|
|Prescription renewals and some initiations7|
|Requests for referrals8|
|Routine childhood vaccinations9|
|Sexually Transmitted Infection treatment10|
|Sick and insurance note requests|
|Skin conditions (e.g. rash, shingles, acne)|
|Uncomplicated Urinary Tract Infections|
|Vaccinations for high-risk patients|
|Well child visit (> 18 months)|
2Could be sent to a centralized physical examination clinic, if appropriate and available.
3Could be sent to a centralized physical examination clinic, if appropriate and available.
4Could be sent to a centralized physical examination clinic, if appropriate and available. Could offer orl alternatives for iron and B12 if appropriate.
5Send to the Emergency Department or centralized physical examination clinic (if available and appropriate). Given their nature, if not seen in-person there are risks of complications and delayed closure.
6Suspected significant trauma (e.g. fracture or dislocation) and back/neck pains (especially if neurologic symptoms are present) should be seen in-person.
7See the Telemedicine Practice Standard from the College for guidance on prescribing cannabis, narcotics, benzodiazepines and stimulants. Similarly, prescription changes for unstable or relapsed patients taking methadone or suboxone are not appropriate for virtual care (College of Family Physicians of Canada, 2020).
8While the College has recommended patient contact be minimized at this time, the College has also indicated that “Family physicians must avoid making specialist referrals via telemedicine without first fully assessing patients themselves” (CPSBC, 2020).
9Continue to promote regular childhood immunizations.
10While a virtual visit may be appropriate, it may be reasonable for your patient to pick up their medication from your office.
Check out the Doctor Technology Offices’ Back to Practice Guide for more tips on setting up a blended virtual /in-person practice.