Hybrid Well Child Visits in the Age of Covid: How To Balance Shelter in Place with Primary Care?

The covid-19 pandemic has forced us to reevaluate how we deliver care to our patients How do we balanceShelter in Place orders with the need to provide well child care and vaccines? We work in an FQHC and serve alargely immigrant Hispanic community, many of our patients' parents are migrant and seasonal farmworkers We made many changes in our clinic to adapt to covid-19: an outdoor respiratory clinic and covid testing,telephone and telehealth visits to keep patients who are sick out of clinic, telephone outreach to addresssocial determinants of health (mainly food insecurity and housing), administering of free medications forthose uninsured patients who could no longer afford their medications Throughout these changes to addressimmediate needs, we limited our well child visits to 2 years and under to protect our patients, our staff andour limited clinic resources However, as we settled into this 'new normal', we quickly realized we needed arecovery plan to address the backlog of well child visits for all ages and vaccines that could be nimble enoughto withstand possibly repeated rounds of social distancing over the months to come That is how the hybrid clinic model came into fruition Our pediatrics team was committed to keeping our patients immunized and tosupport their growth and development during covid-19 We began reaching out to colleagues across the stateand country to nd out what others were doing, joined one of the AAP Covid-19 ECHO groups and researchingemerging best practices for how to deliver well child care during a pandemic We brought the model to ourCovid-19 incident command team and to our frontline medical providers for feedback and ideas Our currentwell child check model is in pilot stage and involves a combination of telephone and in person components We are learning and innovating how to best serve our patients As a Level 3 Patient Centered Medical Homeand a Federally Qualied Health Center, we already do quality improvement and quality assurance tracking onmany topics, including vaccines and well child visit adherence We will continue to use data to monitor oursuccess with this model and make adjustments along the way as needed The covid-19 pandemic is a globalchallenge affecting us all Technology, specically telephone and telehealth services have allowed us toinnovate quickly on how to deliver care-both acute and preventive- to vulnerable populations This time inhistory is highlighting the advances of hospital and ICU medicine to treat people suffering a new disease and,at the same time, it puts primary care into sharp focus as a critical safety net that must remain intact, evenduring a pandemic, to support our children An initial overview to train medical providers on how we will approach well child visits in clinic during shelter inplace orders related to covid-19 Summary of Well Child Visits Table depicting how telephone technology will be used to limit the amount oftime the patient is physically in clinic while attempting to maximize adherence to Bright Futures