Dr. Francis Solano

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Dr. Francis Solano, President, Community Medicine Division, UPMC discusses the importance of receiving medical care despite COVID-19 and the extensive measures UPMC doctors offices and hospitals are taking to keep patients safe.

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Getting the Care You Need Despite Fears of COVID-19. Welcome to the UPMC Health Beat podcast. I’m Tonia Caruso. And joining us right now is Dr.Francis Solano. He’s the president of the Community Medicine Division at UPMC. Doctor, thanks so much for joining us.

– Thanks for having me.

– So you are an internist as well and you see patients and how would you say COVID-19 has affected how you see patients and really how many people are coming in?

– So initially at the start of the virus, we had a significant drop off and large number of cancellations in our division. We have about 500 physicians in the Community Medicine Division and we had significant declines. So we converted over 95% of our visits to telemedicine within the last two months now. And at this point we’re starting to reopen up and go back to traditional in-person visits. But we still think telemedicine is a great way to keep people healthy. Do Acute Care Medicine and keep people safe.

– So doctor when is a video visit appropriate and when is it better to see someone in person?

– Video visits are great for routine chronic care management. So if you have diabetes, high blood pressure, heart disease, you can continue to see your primary care doctor or a specialty care provider via telemedicine.

– Can anyone just call for a video visit? Or do you have to have a primary care physician?

– So if you’re established with a physician, whether it be primary care specialty, there will be offered video visits. We now actually have online scheduling for new patients and patients that are nervous about coming in can do video visits via online scheduling, or call our offices and you can be set up for an in-person visit or a video visit whatever your preferences.

– So even if I’m not connected with a particular physician at this point, if I decide I need a doctor’s appointment, I can just call an office and that could really be my first appointment.

– Yes you can. You can call any of our offices and get set up for video visit or in-person visit.

– Telemedicine is a good option for lots of people but there are lots of people that still need to come in. And let’s talk about that, and why it’s important for certain patients to come back in and have in-person appointments?

– So one of the concerns we’ve seen as physicians throughout the country is a drop off in the number of acute care visits. Even significant numbers in heart attack reductions, stroke reductions, appendicitis, diverticulitis. This is concerning. We think that a lot of people are riding these diseases out at home now, rather than getting appropriate care. And this is concerning to us, because right now, I would tell people, that this is the safest time to ever come into a hospital. Our hospitals are squeaky clean. Our nurses and our staff are very attentive, wearing masks, social distancing, washing their hands. I think this is absolutely one of the safest times to come in and get your acute care needs, whether it be in your physician office, or whether it be in the hospital, urgent care or emergency room if you need that. But our primary care offices, specialty care offices, are open for all of your health care needs at this point.

– And so acute care is one thing. What about preventative appointments and preventative screenings and that sort of thing?

– So one of the things we’ve also seen is a drop off in people getting preventive care, such as mammograms, colon cancer screening, prostate cancer checks, bone density testing, immunizations even. And it’s really important to continue to do your preventive care strategies and now is a safe time. We’ve reopened up all of our facilities, so that you can get all the care that you need. You can get your laboratory tests done, especially if you have diabetes or heart disease you need to get certain labs done. It’s appropriate to do that now.

– What are the long-term effects do you fear if people don’t come back for care?

– So one of the things that we’re concerned about is that we’ll start seeing what I would call the natural history of disease. So if someone has a heart attack at home, and they’re not treated appropriately, they’ve done themselves a big disfavor. You can damage that muscle and end up with irreversible problems like heart failure, where your heart muscle just doesn’t pump as well. So that’s just one example of what’s happening. We’ve also seen people who ride out appendicitis at home and come in with an abscess in their abdomen. So it’s really critical. If you’re having some acute symptoms, that you get in touch with your primary care doctor, and make sure you get the care you need and the appropriate place where you need it.

– Yeah, so acute symptoms again one thing, but what about even folks who at this point might just be delaying their regular check-up with their PCP. Why do you think that’s not a good idea?

– Chronic care management is critical to prevent complications down the road. I’ll just give an example of people who have diabetes. People have diabetes need to get the care they need. They need to get their eye exam annually. They need to get their feet checked. They need to get laboratory assessment of their control. All of the drugs and treatments we have for diabetes have reduced the complications tremendously over the years. I’m a little older and when I first started in practice, I saw a lot of people losing their vision, losing their limbs, due to diabetes. We’re just not seeing that nowadays because of the great therapies that we have. But if you delay care, don’t get those therapies, once again, you’ve done yourself a disfavor, and you could subject yourself to unnecessary complications that are preventable. We have great drugs now to prevent kidney disease. And kidney disease is still the number one cause of people going on to dialysis or transplantation. But if you get your blood pressure treated, you get the appropriate drugs, we can actually make a big dent in the progression of that kidney disease.

– So Doctor can a patient get a COVID-19 test at their PCPs office?

– So right now you have to get an order for COVID-19 tests at your PCP or specialty care office. We have several COVID testing centers set up within the UPMC network. Presently our COVID testing in Allegheny County is set up at the South Side hospital.

– And so Doctor there might be people out there who are thinking, sure it might be safe now because we haven’t had a high number of COVID cases in our region. But what happens is we begin to reopen and the number of cases rise. Do you feel that we still have enough safety precautions in place and a way to monitor the situation to make decisions and evolving and moving forward.

– So UPMC has done a great job in making sure our hospitals and our offices are prepared. We have all precautions put in place for safety. For example, if you come into a primary care office right now, you’ll spend little if no time in the waiting area. And if you’re in a waiting area, you’ll be appropriately socially distance. You will be asked the questionnaire about whether you have symptoms of COVID with cough, fever, chills, etectra. And then you’ll usually be taken right back to your exam room. Once you’re in the exam room, you’ll be seen by your physician and then your exam room will be cleaned thoroughly., so we can bring more patients in. So we have this process down pretty good right now. If there is a surge, we are still ready and able to deliver telemedicine care to you. But we can deliver in-patient care. So what we’ve decided in most of our Community Medicine offices, is to make sure we have a good armamentarium of providers to deliver not only chronic care, but acute care. So if you have these acute care issues, please, please, please make sure you get appropriate care. Don’t sit at it home, and have something terrible happened to you from a bad outcome perspective. So, we’re ready to take care of you. We’re here for you.

– Well Doctor, some very good information. Thank you so much for joining us today. We certainly do appreciate it.

– Thanks for having me.

– And thank you for joining us. I’m Tonia Caruso, this is UPMC Health Beat

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.