PMC:7276834 / 31321-35171 JSONTXT

{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/7276834","sourcedb":"PMC","sourceid":"7276834","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7276834","text":"5.3.1 Presenting issues\nThough we anticipated that patients would be primarily focused on COVID‐19 once we resumed services, many were ready to “get back to work” on their primary issues and were not as focused on the pandemic as we had been anticipating. For new referrals, however, a primary driver was often the current pandemic (anxiety, panic attacks, worry about COVID‐19 risk, etc.). Common stressors for our lower‐income patients included loss of employment, or being furloughed, and financial strain. The increased presence of children in the home was stressful for some families. Many of our patients also had chronic health conditions and had been worried about being more vulnerable to the worst COVID‐19 outcomes. In addition, some of our patients included those without consistent housing or food sources, and one reported being homeless and living out of their car. They worried about the risk of a total shutdown (e.g., not being allowed to be on the street at all, even in their car) and being unable to find shelter.\nEven when working on the primary behavioral health issues that preceded the pandemic, there were new twists and problems that were exacerbated. Of significant concern was the exacerbation of intimate partner violence as a result of the additional risk factors associated with being unable to leave the home as often and increased stress. For our patients with substance use and depression particularly, discussing engaging in behavior substitutions and enjoyable or pleasurable activities was especially difficult with the stay‐at‐home orders. Individuals who were trying to quit smoking often found themselves returning to a higher level of smoking. Similarly, individuals who were working on a plan to lose weight by reducing calorie consumption and increasing exercise tended to have more difficulty adhering to those plans.\nIt became clear that our underserved patients with chronic conditions were being dissuaded by social distancing policies and the crisis mode of the medical community from having routine care visits with their physicians at their primary care clinics. Combined with the reduced availability of other safety‐net services in the community (e.g., social services, food banks), many of our patients began reporting a feeling that they had been left behind or deemed a lower priority during the pandemic. Our clinicians noted that patients often expressed relief and gratitude that we continued to be available for our usual level of services—and that we were even more accessible now that they did not need to travel to the appointment.\nWe found that a subset of patients actually preferred telepsychology services to the in‐person visits we had only formerly offered. That meant we were able to reach patients who had previously declined services because of transportation issues. One partner clinic, in particular, focuses on high utilizing patients who have a high number of chronic medical conditions (at least seven to qualify for the clinic). Our trainees at that clinic historically had trouble getting patients to come in for longer, behaviorally focused sessions, and no‐shows were common. After the shift to telepsychology, the number of appointments soared and no‐shows became a non‐issue. Similarly, another clinic where the physicians are very invested in making referrals to behavioral health saw an increase in the number of patients accepting referrals because the barriers became lower for attending these sessions. As a result of this lesson, we already plan greatly to increase our telepsychology offerings after the pandemic recedes. We have discussed how it is probably best to have the first session occur in person, where rapport can be built and assessment instruments can be easily filled out, and then offer to hold future session on the phone or 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