This is a very fraught question but one of importance. This blog will not answer the question, but make some observations about what has changed already. The wider question of how health delivery will function with changes wrought by the pandemic will be undertaken by wiser, smarter people than I and I look forward to deliberations that bring together the best and brightest to explore a new reality.
I have been watching the environment closely to understand how we have failed, but in doing that “Lessons Learned” exercise, I have seen some interesting things unfold. Some things were unexpected, but some reflect human behavior at its best in answering to challenges unseen before.
First, clinicians have been much more willing to make untraditional choices in patient treatment. Examples abound, but one of particular significance is the willingness to utilize a much wider range of drugs to meet patient needs. In the intensive care environment, the demand for paralytics and coma inducing drugs to sustain patients on ventilators has exceeded the supply of “usual first line drugs”. Clinicians have been very resourceful in finding less used drugs to accomplish the same clinical need. What has been viewed as a relatively narrow path to quality clinical care has broadened some which may lead to changes in cost and access which may have been limited by the narrowness of “gold standard” care. Studies will reveal whether the clinical outcomes are comparable and provide evidence for change where appropriate.
Another positive outcome has been the rapprochement between the clinical community of medical providers and public health practitioners. There has been a long history of relative estrangement between these two groups of important health providers. In general, the public health community has been focused on population health and societal drivers of health status, and medical providers have focused on services for individual patients. During this event they have come together and recognized the importance of both approaches if we are to meet the health needs of our Nation. Raising the health status of our people requires medical services, informed by population dynamics, to act in concert with community health staff who are trusted messengers in and for the community.
Another innovation of note has been the expansion of virtual medical care (i.e., telehealth) access during the pandemic. As a matter of necessity, social distancing forced the issue. It has had salutary effects in providing medical and behavioral health assistance to individual patients. This sets the stage for expanded evaluation of what works well using this approach, and what doesn’t work as well. This will create greater utilization of virtual services in all likelihood which may increase access to needed services heretofore less available.
So, in the midst of challenge, some basic changes have emerged in our understanding of what we may expect or need from the public health and medical services delivery folks. I am certain that there will be much study, some speculation, and real changes ahead.