LivWell Community Health Services: Maintaining Vital Connections to HIV Providers Through Telehealth During COVID-19
- Telehealth: A Lifeline to Treatment and Support for People with HIV in Kentucky
- LivWell Community Health Services: Maintaining vital connections to HIV providers through telehealth during COVID-19
- Matthew 25 AIDS Services: A Hybrid Telehealth Model That Allows for a “One-Stop Shop”
- Ushering In a New Era of Telehealth-Based HIV Services
LivWell Community Health Services in Paducah, KY, serves 43 largely rural counties across Western Kentucky and Southern Illinois. They provide a range of services for people with HIV, including HIV testing and treatment, primary care, nutrition assessment, a food pantry, transportation, housing, and financial assistance. About 90% of the clinic’s 415 clients live at or below the federal poverty level, and most who are insured are on Medicaid or Medicare.
When COVID-19 hit and the number of in-person visits plummeted, LivWell accelerated their long-discussed plans to integrate telehealth into their services, and the clinic was able to launch a telehealth platform only a few weeks after the pandemic began. From April to December 2020, LivWell’s providers and staff saw patients exclusively via a HIPAA-compliant telehealth platform.
The rollout of telehealth services required LivWell staff to quickly pivot and learn the new system while still working to maintain their standard level of high-quality service. According to Ashley Lynch, the clinic’s medical office manager, clinic staff had to navigate several challenges to get telehealth up and running for clients. For example, some patients encountered issues using the new technology—or, because of socioeconomic barriers, had limited cellular data plans or access to reliable Wi-Fi.
“Telehealth is a way to reach out to clients and say, ‘We’re still here, we’re still helping you.’”
– Donna Reeder
LivWell Community Health Services Executive Director Donna Reeder
LivWell staff worked with patients on a case-by-case basis to help overcome these kinds of technological obstacles. Staff began planning appointments differently and factoring in a “trial run” session to ensure a patient’s technology was working properly before their provider visit. “If they don’t know how to use the technology, that’s a major barrier,” Lynch says. “We viewed several YouTube tutorials in an effort to help patients adjust their phone/tablet settings to help initiate virtual appointments.” That kind of preparation helped allay patients’ concerns that their technology might not work during their virtual provider visit, allowing them to instead focus on communicating effectively with their provider.
Lynch says other patients worried they would lose the personal connections they had developed with providers, and that doctors “wouldn’t have eyes on them” in a meaningful way.
“Their biggest fear was, ‘This is how we’re going to see our doctor from now on’,” she says. “They were afraid they were never going to come into the clinic to see us in person again. Telehealth helped us reassure them that we are still here to support them, and it provided a convenient way to help them with medication adherence during a time without those physical connections.” Providers found that telehealth helps with adherence, in part because it enables patients to show their providers all of the medicines they are taking and how many pills they have left at home.
The LivWell team also became creative about engaging patients to remotely measure vital signs and undergo the lab tests required for ongoing, accurate care plans, often helping to arrange visits to other health or laboratory clinics that were open and accessible.
Denise Miller, Certified Pharmacy Technician; Doris Stone, Pharmacist; and Andrea Leonard, Ryan White HIV/AIDS Program Part B Manager, stand in front of LivWell’s in-house pharmacy.
Reagan Poe, Physician Assistant at LivWell Community Health Services integrates telehealth into patient care appointments.
LivWell began using telehealth in April 2020, as the COVID-19 pandemic swept the country and service disruptions and stay-at-home orders forced many people across the U.S. to forego visits to the doctor. Telehealth services had a tremendous impact on continuity of HIV care for the clinic: 89% of LivWell’s patients have been seen via telehealth since then. And despite some of the challenges posed by COVID-19, LivWell has maintained a sterling record: as of March 2021, 95% of their patients were virally suppressed. Staff are especially proud that percentage has actually increased in the past year, from 94%.
The new virtual format has helped LivWell providers improve connections with patients who previously faced challenges accessing in-person services or did not reliably show up for appointments, including people age 30 and younger, who have quickly embraced virtual visits. Telehealth has also helped some patients—especially those in nursing homes, people who are incarcerated, and people who recently had surgeries or have other health issues—overcome one of their biggest barriers to receiving care: transportation.
“Before the pandemic, sometimes nursing homes and jails couldn’t get clients to the clinic because they were short-staffed,” Lynch says. “Now they don’t have to worry about transportation.”
Because patients do not need to walk into a physical HIV clinic, telehealth has helped reduce the stigma that some patients experience when they access LivWell’s in-clinic services.
“Telehealth allows us to see our patients with HIV in their element—they’re at home, they’re more relaxed, and they feel like they can open up more,” Lynch says. “And as time passed, people have gotten used to it.”
“Our world has changed—telehealth is something that’s getting into our normal language,” says Andrea Leonard, LivWell Ryan White HIV/AIDS Program Part B Manager. “It has helped relieve anxiety in the pandemic. And by thinking differently about how we provide care, it’s allowed us to continue delivering high-quality HIV treatment that meets our patients’ needs.”
– Andrea Leonard
Ryan White HIV/AIDS Program Part B Manager, LivWell Community Health Services
Disclaimer: These stories do not represent endorsements by CDC of any organization or company mentioned.