Healing Patients in a Time of Isolation
As the pandemic continues, healthcare needs to adapt to help patients.
Posted Jun 24, 2020
Nearly half of American adults are feeling socially isolated from family and friends and are struggling to maintain their health, according to the Social Distancing Survey by Harris Poll. Social distancing has had a negative impact on mental health for nearly 2 in 5 adults. One of the things most adults (7 in 8) miss most is spending time with friends. The survey was fielded online nationwide from May 5-8, 2020, and 2,051 adults, aged 18-plus years, participated in the survey.
Even before the pandemic, loneliness and social isolation in the U.S. were at epidemic levels.
A 2018 study by Cigna found that 47 percent of Americans often felt alone, left out, and lacking meaningful connection with others, and 47 percent felt isolated from others.[i]
Be Aware of the Dangers of Loneliness and Social Isolation
Evidence shows that loneliness and social isolation lead to chronic disease, an increased likelihood of dying early, more use of health care services, and higher costs among adults aged 50 years and older.[ii] A meta-analysis of 23 studies, for example, found that loneliness and social isolation increased the risk of developing coronary heart disease and stroke.[iii] Other studies have linked loneliness and social isolation to an increased risk of dementia and depression.[iv]
Loneliness and social isolation are also linked to more doctors’ visits, more hospitalizations, longer lengths of stays, and more readmissions for older adults. Medicare spends about $6.7 billion a year more caring for older adults who are socially isolated compared to other adults, according to a study by AARP, Stanford University, and Harvard University.[v] Few studies have looked at the link between loneliness and social isolation and access to health care, however, transportation, geographical location, and socioeconomic status all facilitate or limit access.
Talk About Loneliness and Social Isolation
You can begin to address loneliness and social isolation by talking about them during routine office visits. The HOPE (Healing Oriented Practices & Environments) note provides an easy way to do this and can be used during telemedicine or in-person visits.
The HOPE note is a simple patient-guided process to identify social and emotional components that facilitate or detract from healing, particularly if the patient has any chronic diseases.
Ask patients these questions about the social and emotional component of healing:
- How is your social support? What are your social connections and relationships?
- Tell me about your family and friends? Do you have someone you talk with in confidence and trust?
- Are there people you have fun with? How often do you just relax with others?
- How do you handle loneliness?
- Have you had any major social or physical traumas in the past? What was your childhood like?
Working through these questions helps you engage the patient in shared decision-making about health and healing.
Tools for Talking About Loneliness and Social Isolation
- The HOPE Note: A Tool for Adding Integrative Care to a Routine Office Visit
- The HOPE Note Guide (long and short versions)
- The HOPE Note Questions (template)
Use Virtual Group Visits to Connect with and Care for Patients
Another way to address loneliness and social isolation while providing safe and effective medical care is virtual group visits. Like telemedicine, virtual group visits are now billable. Also, it is easy to offer HIPAA-compliant virtual group visits. The American Academy of Family Physicians, CMS, and Medicare all promote group visits.[vii]
“Virtual group visits ease loneliness, help people share difficult times, and provide a sense of community,” says Jeffrey Geller, MD. A national expert in group visits, Geller is director of Integrative Medicine and Group Programs at Kronos Health and president and creator of the non-profit organization Integrated Medical Group Visits. He created the largest group visit program in the U.S.
Geller’s group visits—in-person and virtual—focus on improving health outcomes by reducing loneliness. “When you feel like part of a group, you reduce loneliness and feel special and important. When you feel special and important, you take better care of yourself,” he says.
Using Zoom, Geller conducts virtual group visits usually around an activity such as yoga or exercise or symptoms such as insomnia. Virtual group visits can also focus on a diagnosis, such as chronic pain, diabetes, or heart disease. Geller’s group visits include small group facilitated discussions, facilitated discussion among the entire group, the activity or education, short-targeted individual physical exams, and solution development.
Geller recommends Zoom for virtual group visits, which offers breakout rooms and makes HIPPA compliance easier. Most practices use a medical authorization disclosure form with a HIPAA clause, either annually or for each visit. A group of 6 to 12 patients is easiest to manage.
Tools for Doing Virtual Group Visits
- Virtual Group Medical Visits
- Documenting and Billing tips for Integrative Medical Group Visits
- Virtual visit HIPAA consent forms in English and Spanish
- Establishing and Maintaining Successful Chronic Pain Group Medical Visits Using an Empowerment Model, applicable to other chronic diseases
- Chronic Disease Management with Group Visits
Support Your Patients and Prevent Health Problems
As the pandemic and social distancing continue, loneliness and social isolation will increase. Tools such as the HOPE note, screening tools, telemedicine, and virtual group visits can help you support your patients and prevent or reduce further declines in physical, mental, and spiritual health.
[i] Cigna. “Research Puts Spotlight on the Impact of Loneliness in the U.S. and Potential Root Causes.” May 2018. Accessed 5/25/20.
[ii] National Academies of Sciences, Engineering, and Medicine 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Chapter 7. Role of the Health Care System. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663.
[iii] Valtorta, N. K., M. Kanaan, S. Gilbody, S. Ronzi, and B. Hanratty. 2016a. “Loneliness and social isolation as risk factors for coronary heart disease and stroke: Systematic review and meta-analysis of longitudinal observational studies.” Heart 102(13):1009–1016.
[iv] Blazer DG and Ryerson LM. The Health Care System Is An Untapped Resource In Combating Social Isolation And Loneliness In Older Adults. Health Affairs. April 30, 2020. Accessed 5/25/20.
[v] Flowers L, Houser A, Noel-Miller C, Shaw J, Bhattacharya J, Schoemaker L, Farid M. Medicare Spends More on Socially Isolated Older Adults. AARP Insights on the Issues. November 27, 2017. Accessed 5/22/20.
[vi] American Academy of Family Physicians. Using Telehealth to Care for Patients During the COVID-19 Pandemic. Accessed 5/22/20.
[vii] BILLING, CODING and HIPAA in the Group Visit Model,” Lifestyle Matrix Resource Center webinar. No longer available online.