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The Nurse Practitioner Blog

A forum for discussion on recent news and developments in healthcare and the NP field.

Friday, January 8, 2021

Opportunities and challenges for healthcare in 2021

The coronavirus disease 2019 (COVID-19) pandemic has unveiled several healthcare-related issues and key topics that we will need to confront in 2021 and in the coming years.

Impact of reduced routine care. With routine care either switching to telehealth or not happening at all for much of last year due to the legitimate fear of contracting COVID-19, healthcare workers will likely deal with sicker patients. Delayed or omitted care can increase morbidity and mortality related to various health conditions, including chronic and acute ailments. Data from health insurance claims demonstrated that many people decided to omit or delay preventive care visits, be it routine annual exams or mammograms and colonoscopies. Childhood vaccinations also declined over the course of the year. Health officials are concerned about the long-term impact of such missed and delayed appointments, which providers will face first-hand this year and in the coming years.

Mental health. Another issue of concern is mental health, with a third of Americans experiencing anxiety or depression as a result of COVID-19, according to a survey conducted by the U.S. Census Bureau and other federal agencies last spring. The likelihood of depression and anxiety was higher among women, younger adults, people with lower education levels, and Black and Hispanic individuals. Healthcare workers are at increased risk of mental health consequences due the physical and mental toll of caring for patients and their families at an unprecedented time, long work hours in high-stress environments, staffing shortages, and lack of personal protective and other equipment. Add to this the fact that the pandemic has hindered or reduced mental health services in 93% of countries, as evidenced by a WHO survey conducted last fall. Lack of critical mental health services at a time when we need it most has emphasized the importance of access to mental healthcare, a sector that has remained routinely underfunded.

Telehealth. One of the more positive things the healthcare industry has seen during the pandemic is widespread acceptance and adoption of telehealth services. Virtual doctor's visits through videoconferencing and remote home monitoring are being employed by providers across the board during this public health emergency to reduce the spread of COVID-19. This has been further motivated by the Centers for Medicare & Medicaid Services' allowance to bill for telehealth services regardless of location. Clinical trials are also considering fewer in-person interactions and more remote monitoring of patients. All of this opens the door to expand telehealth options and update the technology (both on the provider and patient sides) to make it a more mainstream care delivery method post-pandemic.

Messenger RNA vaccines. I think any health professional would agree that if there were a silver lining on the COVID-19 cloud, it is the unprecedented an expedient production of not just one, but a few, and possibly several highly effective vaccines – trialed and brought to market in record time. Both Pfizer's and Moderna's vaccines—the two vaccines approved for use in the US today—use novel messenger RNA (mRNA) technology, which provides genetic code for human cells to produce viral proteins against which our immune system produces a response. mRNA is much simpler to produce than manufacturing the proteins or creating attenuated forms of viruses that are often used in vaccines, which represents untold advances for science and the promise of expedient manufacture of vaccines in future outbreaks.  

Health preparedness. The COVID-19 pandemic did more than probably any other event in the past decade to shed light on the many failures of the US healthcare system, including lack of preparedness, dearth of public health funding, and inexcusable healthcare inequities. A CDC report early during the pandemic found of that hospitals faced serious challenges with regard to severe shortages of personal protective equipment, ventilators, logistic support, testing, and other supplies; extended wait times for test results; difficulty maintaining adequate staff, support staff, and hospital capacity; inconsistent guidance; and increased costs and decreased revenue. In addition to increasing funding for public health, scientific research and development, and healthcare infrastructure and resources, we need to invest in telemedicine and broadband access to ensure health equity for all.

Another focus needs to be the improvement of disease surveillance, which will greatly enhance our response to epidemics. The Council on Foreign Relations underscored the limitations of the existing framework for surveillance and monitoring of epidemics, both in the US and globally. Data collection gaps as well as lack of a single repository to gather public health data hinders early detection of threats and prevents learning from the experiences of other countries. In the US, disease surveillance is carried out by multiple federal agencies, which makes it harder to consolidate data from various states and ensure consistency.