Exploring the Implementation of Quality Care Programs for Patients with Myeloproliferative Neoplasms - Episode 9

Impact of Telehealth on MPNs During COVID-19

Bruce Feinberg, DO

Kathy Oubre, MS

Michael Reff, RPh, MBA

Jamile M. Shammo, MD

Ruben Mesa, MD

Jamile M. Shammo, MD, comments on telehealth and the impact on patients who have MPNs during the COVID-19 pandemic.

Bruce Feinberg, DO: Jamile, there is a lot of different stuff that has been said that I want you to react to, but in particular, I think about patients falling through the cracks. We then mentioned telemedicine, and we spent the last year with COVID-19 [coronavirus disease 2019] and a pandemic in which everybody is falling through the cracks. I am now curious about the lessons learned or the differentiation because this patient population is now like every other patient population in a way.

Whether you see telemedicine and telehealth as what can be critical and invaluable pieces of the solution for this patient population, and whether they are coming in for blood tests or are going to get them remotely because they cannot come into the institution, which might increase adherence if they do not have to drive the 45 minutes or whatever. I am curious about how you react to the fact that a lot of things were being developed because this population had some unique aspects that are no longer unique.

Jamile M. Shammo, MD: In reacting to the point before about falling through the cracks, to Kathy’s point, when someone gets hospitalized, we start to think, we do not remember everybody who was supposed to be coming to the clinic. Having an adherence program takes the pressure off of you as a physician to follow up on the patients who are supposed to be coming to the clinic but are not because they were hospitalized elsewhere. We need to be sure that they are taken care of and follow up on some kind of algorithm to make sure that you are following their hematocrit. I can see the merit of a program like that and to take the mental pressure off of the treating physician because, again, care is not linear. I love that, Ruben, by the way.

It just hit me, I kept thinking that we would need something like this that would keep tabs on the EMR [electronic medical record] to help us make sure that everything we need to get at certain points, is done. We do not have this at the moment to help. We are humans, but this would probably be a good solution for doing that.

Nevertheless, back to COVID-19; it has been such a problem for all of us, I do not think I need to overstress that. As it is related to patients with MPNs [myeloproliferative neoplasms], as with everybody with hematologic malignancies, it has posed a problem because those patients did not want to come to the hospital because they may get exposed. Having telehealth visits, to state the obvious, made it feasible for them to have a face-to-face encounter with the physician. We would typically get the CBC [complete blood count] done elsewhere. At least we would then be able to provide our services that way.

In a way, it got us through some difficult times. Now, has this affected the care that we would deliver otherwise? I would say that it is probably minimally so, because for the patient who had already been treated, the drugs that we utilize are not terribly myelotoxic. Those who had been treated and were relatively stable continued to do so, and we continued to get their blood count periodically. Again, getting the telehealth visits got us through this.

Most of the data about these patients has been retrospective. At ASH [the American Society of Hematology annual meeting], I am sure Ruben would probably tell you that he has been part of an endeavor about what to do about COVID-19 and treatments in patients who have MPNs. There are all kinds of guidelines listed on the ASH website relative to this. The treatment has truly not been different in that regard. But most importantly, that adherence to blood count optimization is what we have been trying to do, which means that you have to be more diligent about sticking to count optimization and treating patients appropriately. That is all I have to say, but it has definitely been difficult to do this the right way with fewer visits.

Transcript edited for clarity.