Abstract
Objectives
Barriers to healthcare among undocumented immigrants include fear of deportation, national policies excluding patients from receiving healthcare, and resource constraints, such as a lack of financial assets and transportation. The pandemic has exacerbated these barriers for community health clinic patients at St. Mary's Health Clinics (SMHC). Nutrition assessments are pivotal in providing holistic healthcare at SMHC, as high rates of food insecurity and chronic diseases exist, in addition to a unified need for education on culturally appropriate food selections for long-term health. The primary objective was to assess the barriers for SMHC patients when conducting nutrition assessments via telehealth versus an in-person clinic.
Methods
SMHC registered nurses (RN) triaged patients in need of nutrition assessment based on recent laboratory results or patient requests. The schedule was coordinated between RN, registered dietitian (RD), interpreter, and patient; the interpreter connected the patient to the telehealth appointment by providing call-in details or merging phone calls. The appointment was conducted via a secure virtual platform where phone or computer access was granted to all parties. Perception of barriers to telehealth were recorded by RD.
Results
Pre-pandemic, 6–8 nutrition assessments were conducted in-person monthly. Between the initiation of telehealth in July and December of 2020, 62 telehealth appointments were conducted, averaging 12.4 appointments per month. As a result of telehealth, the barrier of transportation to appointments was eliminated, nutrition assessment volume increased by 1.5–2 times, flexibility in appointment scheduling times increased, and the risk of spreading illness decreased. Challenges of telehealth were the inability to conduct nutrition-focused physical examinations, the presence of distractions in patient and/or provider home environments, increased coordination of care across the interprofessional team, and miscommunication/technology issues with the telehealth platform.
Conclusions
Telehealth has reduced some of the barriers to conducting nutrition assessments and has allowed for accessibility to a wider patient population, however, additional challenges unique to telehealth during the global pandemic were present.
Funding Sources
GHR Foundation Grant
Setting up and improving a community health clinic