54 From the COVID-19 Epicenter: Using Telemedicine to Serve the Needs of the Geriatric Population

Abstract

intervention characteristics from the Consolidated Framework for Implementation Research (CFIR): intervention source, evidence strength and quality, relative advantage, adaptability, trialability, complexity, design quality and packaging, and cost.Results: We identified 18 clinicians who documented ePPE use. On review, 2 never used ePPE and 5 only supervised other clinicians who used ePPE. Of the remaining 11, we interviewed 7 attending physicians and 1 physician assistant between 5/15/20 and 6/5/20. Providers gave ePPE a mean effectiveness score of 4.2 (SD 0.53). Identified advantages included improved patient and provider safety, PPE conservation, and improved patient-provider communication. The primary perceived limitation was inability to auscultate the lungs. While noting the risk of missed alternate diagnoses (eg, heart failure), providers asserted that video-based history-taking and respiratory exam sufficed for low-acuity patients and that auscultation's absence was unlikely to change management. Beyond MSEs, providers used ePPE for patient reassessment and counseling, as well as to facilitate supervision. Many emphasized ePPE's flexibility: "If I do pick up on a few things...I can always, sort of, abandon [ePPE] and go in and do my exam." Barriers to use included potential for negative patient perceptions, poor audio quality, difficulty incorporating an interpreter, and workflow challenges related to staff coordination. Clinicians revealed that many ePPE encounters were not fully documented, suggesting ePPE use may be underrepresented in this study.Conclusion: In this trial implementation of ePPE, we found that ED clinicians perceived ePPE as an effective and useful technique for MSEs of COVID-19-suspected patients. The benefits largely outweighed the disadvantages, particularly in the lowacuity population. Our study may have been limited by early adoption from clinicians favorable to such technology, and future work should examine perceptions among clinicians with varying degrees of technology comfort.

Application and implementation of telehealth services designed for the elderly population during the COVID-19 pandemic: A systematic review

“…One study described the remote evaluation of patients by an ED (emergency department) provider on a telemedicine platform on a desktop or mobile phone during the local pandemic surge, in northern Manhattan/NYC. 73 …”

“…11 studies were finally included after reviewing the full texts. [65][66][67][68][69][70][71][72][73][74][75] No additional suitable studies were found after reference screening.…”

“…One study described the remote evaluation of patients by an ED (emergency department) provider on a telemedicine platform on a desktop or mobile phone during the local pandemic surge, in northern Manhattan/NYC. 73 Most services were mainly related for the treatment and surveillance of chronic conditions such as Parkinson's disease, 68,71 diabetes, 67 chronic affective disorder, 72 psychiatric mental care, 74 cognitively impaired old adults, 75 lympho-venous disease, 69 and consultations for the geriatric population given at nursery homes or home hospitalization by nurses and physicians. [65][66] The evaluation tools for each service described in the selected studies were examined and described in Table 2.…”