July 2020

COVID-19, Athletic Trainers, and Social Determinants of Health

By David Gallegos, MA, ATC, Cert. MDT

COVID-19 has created a unique situation where demand for traditional athletic training services for those in athletic endeavors has decreased.  At the same time, the need for best practices in interprofessional collaboration, upstream primary care triage, and return to activity guidance amidst a healthcare crisis are in high demand.  Innovation and redefining of historical practices are creating new opportunities for the athletic trainer to play a significant role in healthcare and public health initiatives.1

On the national level, unified efforts of the healthcare system are driving change to protect the resources of our hospitals in preparation for our most in need and to support new policy in triage and primary care to assist in preventing unnecessary urgent care and emergency room encounters. Coupled with the expansion of telehealth policies, athletic trainers are leveraging their training in acute care and musculoskeletal (MSK) triage. In many situations, athletic trainers have been at the forefront of assisting patients with MSK needs and helping direct pre-hospital options. Education on self-care, directing care to physical therapists, physicians, and other providers, as well as mental health and social support options, have fit well within the domains of athletic training professional education. Healthcare economic research has previously identified the ability of athletic trainers to divert care from emergency rooms and expedite follow-up care.2,3 This model of upstream triage has proven useful in assisting in the COVID-19 response and will likely be a role of athletic trainers in the healthcare system moving forward.

Post COVID-19 practices will also highlight new roles for collaborative efforts in primary care.  Through redefining of the primary care provider model to be inclusive of a system of providers and pathways, athletic trainers will establish a new and unique role in the larger healthcare system: the role of embedded, preventative first-responder. This is a system uniquely found in AT education in athletics and group management such as industrial and military medicine. Replicating this or a similar model will assist healthcare administrators and public policy makers in providing a more comprehensive approach to health management. Pandemic policy and strategy have reduced traditional barriers in scopes of practice and turf wars and support a primary care system where all providers are expected to work at the top of their scope and professional education and alongside other professionals. It is unfortunate that many types of providers, athletic trainers included, were put on pause because the system was unable to quickly and efficiently activate the strengths of professions. The amount of healthcare work needed to align outcomes with national expenditures is testament to the need for new roles for all providers.  The athletic trainer will find the opportunity to assist in screening and primary care.

Increasing Access, Improving Outcomes

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One of the main reasons for poor patient outcomes is a lack of focus on the social determinants of health. As providers, we inherently know that much of our impact is filtered through the lenses of society. Economics, distance, and access are but a few of the factors playing a greater role in outcomes than individual provider skill. Changes in national policy have realized the importance of increasing access and outcomes for the patient while at the same time reducing cost for both the patient and the provider. The federal government’s relaxation of telehealth policies and insurance providers’ modified options in cost-sharing for the subscriber has allowed the continuation of needed care and improved case management during stay-at-home orders.  Many of the initial telemedicine encounters were made to continue and finish existing plans of care.  Providers, businesses, and consumers are finding telemedicine as a viable and preferred option for many healthcare services moving forward.  Athletic trainers are finding the same situation.  As people return to work, life and sport, athletic trainers are being called upon to help guide re-entry, assist with risk reduction policies, and manage patient care concerns. Athletic trainers are embracing the unique skillsets required for digital care, tracking national policy, and understanding telehealth capacities. These innovations will most definitely redefine the profession. New practice settings that are entirely digital will develop in ways unique to the athletic trainer professional education. I look forward to seeing new models of embedded primary care services addressing critical aspects of population health.  These models will likely develop from a triangulation of educational foundations in group healthcare, new policy in digital care, and an expanded vision of primary care.

Digital care navigators, musculoskeletal triage specialists, and roles in population health management will be opportunities for athletic trainers in the post-COVID-19 world.

David Gallegos, MA, ATC, Cert. MDT, is Deputy Chief Executive Officer at Fzyical Therapy & Balance Centers in Las Cruces, New Mexico and El Paso, Texas. He also serves on the National Athletic Trainers’ Association Board of Directors, representing District 7. In addition, he has practiced in the Secondary School setting for more than 20 years. 

REFERENCES
  1. Breitbach AP, Muchow JA, Gallegos DF. Athletic Trainers unique clinical and teamwork skills contribute on the frontlines during the COVID-19 pandemic: a discussion paper. J Interprof Care. 2020; July 16;1-7. DOI: 10.1080/13561820.2020.1792426.
  2. Pecha F. Athletic Trainers’ value in physician practice. Clin Pract Athlet Training. 2020;3(1):1–3.
  3. Li T, Johnson ST, Koester MC, Hommel A, Norcross MF. The impact of high school athletic trainer services on medical payments and utilizations: a microsimulation analysis on medical claims. Injury Epidemiol. 2019;6:15.

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