With a drop in the number of patients seeking health care at military treatment facilities during the coronavirus pandemic, defense health officials are concerned that some patients may not be getting the care they need.
About 50 percent of available appointments are being filled at military treatment facilities, said Regina Julian, chief of the health care optimization division at the Defense Health Agency, during a town hall meeting May 13 held by the COVID-19 Military Support Initiative.
Officials have also seen a 30 percent decrease in the amount of prescriptions filled at MTFs and retail pharmacies, said Air Force Col. Mark Gmehlin, acting chief of DHA’s pharmacy operations division.
The demand for health care hasn’t necessarily dropped.
“We think patients may be delaying some care,” Julian said, adding that MTFs are now trying to reach out to patients with complex medical needs, or cancer screening or other screening needs, to have them come in for appointments.
During the pandemic, like other health care facilities, “we continue to provide medically necessary care,” she said. “We have plenty of access.”
The proposed Pentagon budget trims more than $1 billion from the health system account.
For those with medical needs that are not COVID-19 related, she encourages patients to contact their MTF through the secure messaging system; call the nurse advice line; book a telehealth appointment line, or call the appointment line. She notes that the process may start with a telehealth consultation, but if providers can’t address the issue through that virtual consultation, they’ll see the patient in the MTF, she said.
“If a provider needed to see you face to face, we have a deliberate way to have you come in to protect you and our staff,” she said.
“For patients, the thing that keeps me up at night, is delaying something longer than it needs to be, leading to a poor outcome.”Julian said. “Please give us a call. We want to address things early and often.”
With the 30 percent decrease in prescriptions being filled at MTFs and at retail pharmacies, Gmehlin said, he’s concerned that some patients with significant medical conditions, such as heart conditions, have stopped taking their medications. Some may feel safer staying at home than going out to get their medications. The mail-order pharmacy benefit hasn’t seen a drop.
Health officials need to figure out why people may have stopped getting their prescriptions, and learn how to better meet those patients’ needs, he said.
During a hearing of the House Appropriations Defense Subcommittee, top military medical officers warned of Defense Health Agency growing pains.
Asked about whether MTFs or pharmacies will be covering COVID-19 antibody testing for military members or family members, Gmehlin said there is no “end state” yet.
“Once we get more information on COVID itself, how it’s evolving, how we test for it, if we have some opportunity to spread testing out across clinics, but we’ll also have some pharmacy involvement. Pharmacies, where capable, will provide some of those services.” He noted that network retail pharmacies already do a good job with vaccines for beneficiaries.
Of the 9.5 million beneficiaries, 7.1 million use pharmacy services, Gmehlin said. The pharmacy supply chain has remained robust, he said, and there are no long-term outages forecast.
However, DHA has placed temporary quantity limits placed on some items because of increased demand. That included limitations on hydroxychloroquine, because of a 10-fold increase in demand sparked by initial interest that it might reduce the severity of COVID-19, he said. The drug is used mostly for treatment of lupus and rheumatoid arthritis, and officials needed to make sure there’s enough for those patients.
Veterans Affairs Secretary Robert Wilkie on Wednesday defended the use of an unproven drug on veterans for the coronavirus, insisting they were never used as “test subjects” but given the treatment only when medically appropriate.
Officials have also put limitations on quantities of albuterol inhalers, because as hospitals have switched to multi-dose inhalers in treating COVID-19, the supply dropped quickly.
In both cases, DHA will be taking another look at the supply situation within a few weeks to determine if they can remove the quantity limits, Gmehlin said.
Of the nearly 700 pharmacies at MTFs, the only one closed is the one at the Naval Branch Health Clinic Northwest in the Portsmouth, Virginia, area, primarily because of the deployment of the hospital ship Comfort and the current quarantine period for the service members after the mission to New York, he said. It will hopefully reopen soon, he said.
But there are currently six pharmacies at bases where retirees’ access is limited to certain days — Edwards Air Force Base, California; Moody Air Force Base Georgia; Beale Air Force Base, California; Joint Base McGuire-Dix-Lakehurst, New Jersey; Cannon Air Force Base, New Mexico; and Shaw Air Force Base, South Carolina.
Retirees and their family members aren’t currently able to get prescriptions filled at MTFs on Nellis Air Force Base, Neveda, and Goodfellow Air Force Base, Texas, so those beneficiaries are getting their prescriptions filled at retail pharmacies, or through the mail order pharmacy benefit.
Pharmacy staff members at MTFs are following safety precautions, such as providing curbside pickup with runners going back and forth between the building and cars to provide patients with their medicines, Gmehlin said.