Transition of a Nurse-Managed Mobile Primary Care Clinic to Telehealth during COVID-19

The COVID-19 pandemic suspended operation of the University of Maryland School of Nursing’s (UMSON) Governor’s well-mobile nurse-managed mobile clinic as it prepared to resume services in Prince George's County. Clinic staff and driver positions were reconfigured following program contraction in Fall 2019. In the interim, the family nurse practitioner (FNP) and bilingual outreach worker provided primary care to undocumented Central American and African immigrants at a temporary community site. Empaneled patients depended on the clinic as an entry point for primary care and a gateway to specialty consultations. Effective March 16, 2020, UMSON and the program complied with campus and state orders to transition to a virtual environment; the electronic health record (EHR) acquired in in 2018 did not include a telehealth option. The patient population do not have access to computers and rely primarily on mobile phones for communication, and older patients do not have email addresses. Lack of fluency in spoken and written English and general low literacy in both native and English language further limited communication options. This poster details actions undertaken over a two-year timeframe at the interpersonal, organizational, and governmental policy levels to sustain continuity of care. Strategies including envisioning alternate visit options to ensure adherence to treatment plans, maintaining prescription renewals, assessing vulnerability to COVID-19, assessing exposure risk and symptoms of infection, and providing guidance for seeking will be detailed. Activities undertaken included cancelling the upcoming weeks’ appointments and rescheduling to telephone appointments with the FNP and bilingual outreach worker. Persistence of pandemic restrictions necessitated a pivot to new strategies. The impact of professional networking, technical innovations, and policy development resulting in a series of interim, transitional, and aspirational alternates to in-person visits will be outlined according to timelines. Examples include insights based on webinars hosted by ambulatory care industry leaders, the impact of policy changes by the Office of Civil Rights during the COVID-19 nationwide public health emergency, and acquisition of additional technologies. Patient-centered, personnel, and operational challenges during the initial transition to implementation of non-public facing virtual platforms and eventual EHR-integrated virtual visits will be detailed. Enumeration of encounters using the respective technologies will be displayed. The presentation will conclude with an analysis of current state of integration of telehealth technology with clinic operations and functionality and acceptability by providers and patients.