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Post COVID, we must strengthen primary care

By Nicole M. Tsoukalas, MSN, APRN, FNP-C - Guest Columnist | Oct 16, 2021

Nicole M. Tsoukalas, MSN, APRN, FNP-C

As we complete nearly two years with all our lives upended by the COVID pandemic, we’re seeing the repercussions in our primary care practice. We’re treating people who have not seen a health care provider since the pandemic began, or even longer. Some people come to us with their diabetes or blood pressure dangerously uncontrolled. They have missed critical cancer screenings.

Equally concerning, in my mind, are people, many of them young adults, experiencing depression, anxiety, and fear. They are not feeling like themselves in our new socially distant world – and most do not have the good fortune of knowing a time “before” social media became our foundation for social interactions. Throw in the fear surrounding the global pandemic and divisive social media and it’s no wonder people are suffering.

But the pandemic is not the only reason people are avoiding medical care. In New Hampshire, and throughout the nation, there is a shortage of primary care providers that has been exacerbated by the pandemic. People who are ready to resume their healthcare, or who have an acute need, are being met with nonexistent appointments – or their provider has left the practice. One person told me she was discharged from a practice because she had not been seen in their clinic for two years. We are in crisis.

Thousands of medical practices across the nation have closed during the pandemic – nearly one in five healthcare workers have quit their jobs. Stressed and busy providers have been pushed to the brink. I hear many people calling for us to now re-think our entire health care system in the wake of the pandemic. Some are calling for a transformation with new models of care and payment reform.

I believe that any path forward must strengthen primary care and recognize that primary care is the foundation of our entire healthcare system. Access to high quality primary care prevents minor health problems from becoming more serious. Carefully managing chronic diseases reduces hospitalizations, even death, and improves quality of life. A recent report by the National Academies of Sciences, Engineering and Medicine said, “Primary care is a common good, which makes the strength and quality of the country’s primary care services a public concern.”

I agree. We need to focus more on keeping people well, a move that would, inevitably, reduce overall health care costs.

We also need primary care that puts the patient at the center of everything. I hear frequently from people seeking a more collaborative experience with their provider. And they want time to discuss all their health concerns. I spoke with a gentleman who told me he finally went to a doctor after a year and a half to discuss three health concerns, but the provider only had time to discuss one of them. He left his appointment frustrated.

Altrix Primary Care – Nashua came to Nashua a year ago because we saw a clear need for access to quality primary care in the community. As family nurse practitioners, we focus on seeing the whole person, including physical and mental health – which are not mutually exclusive. When a patient comes to see me with symptoms of depression or anxiety, which is more common than ever, I take the time to validate these complaints and we work together to find solutions that improve the patient’s quality of life – first investigating other reversible causes, and then recommending treatment plans the patient agrees with. We need to return to the time where patients are our partners in their healthcare. It is what I want for myself and my family.

Our patients also want to talk about nutrition, and how they can live their healthiest. They want to discuss vaccinations – for the flu to shingles to COVID-19 – from a trusted provider who will give them objective information so they can make their own decisions. Now it’s especially important for people to know they can safely return for medical care – either in-person or virtually. We need to meet people in the middle.

As we think about what kind of health system we need going forward, let’s not forget that primary care provides the underpinnings of our entire health care system and must be strengthened.

Tsoukalas is the lead nurse practitioner at Altrix Primary Care – Nashua. She has worked in inpatient and outpatient care including women’s health and obstetrics, and chronic pain management. Prior to joining Altrix Primary Care – Nashua, Tsoukalas spent six years in geriatrics managing chronic disease and improving outcomes.


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