Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine

Abstract

PURPOSE Most models for managing chronic disease focus on single diseases. Managing patients with multimorbidity is an increasing challenge in family medicine. We evaluated the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP-Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus-a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada. METHODSWe assessed feasibility of the TIP model from the number of referrals from PCPs and emergency departments in Toronto, Canada; the intervention cost; and the satisfaction of patients, PCPs, and team members with the new model. One patient and PCP story highlights the model's impact. We also performed thematic analysis of written feedback. RESULTSA total of 76 patients were referred from 53 PCPs and 4 emergency departments, and 65 PCPs participated in TIP. All 74 patient survey respondents indicated TIP improved their access to interdisciplinary resources, and 97% reported feeling hopeful their conditions would improve as a result. Of 21 PCP survey respondents, 100% reported they would use TIP again, and 90% reported improved confidence in managing their patient's care. Of 87 team member survey respondents, 97% rated TIP as effective. Qualitative findings indicated benefits to both patients and health professionals. The cost was about 22% less than that of a 1-day hospital admission through the emergency department (C$854 vs C$1,088).CONCLUSIONS TIP is a feasible intervention in multiple primary care settings that gives patients an active role in their health management, supported by their team. The model effectively addresses the needs of the most complex patients and their PCPs.To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/17/Suppl_1/S57.

Video Consultations for Older Adults With Multimorbidity During the COVID-19 Pandemic: Protocol for an Exploratory Qualitative Study

“…Video consultations have been found to support patients with chronic conditions and prevent unnecessary admissions to long-term institutional care [ 29 ]. In Canada, they have made possible an interprofessional model of practice involving hospital specialists, a social worker, a pharmacist, a home care community coordinator, and other allied health professionals who allow older patients with complex multimorbidity to be managed within the community [ 30 ]. Jiwa et al [ 31 ] reported that Australian general practitioners who were favorably inclined toward video consultations were more likely to work in larger practices and be more established professionally.…”

“Standing on common ground” - a qualitative study of self-management support for patients with multimorbidity in primary health care

“…By addressing the holistic needs of patients with multimorbidity, eHealth (i.e. information and communication technologies used to facilitate health promotion and care) has the potential to help promote patient-centered care, and thus, self-management [26,27]. However, both patients and professionals have been reluctant to adopt eHealth tools [28][29][30][31].…”

Twelve tips for the integration of medical students into telemedicine visits

“…Some institutions may also need to incorporate allied health providers or health educators at the start, middle or end of the visit. Yet other departments may have a multi-disciplinary team providing consultation simultaneously (Pariser et al 2019;O'Hara et al 2020). The location of team members and how they will communicate with each other also needs to be determined, for example, via video conferencing or phone call.…”

“…technology literacy, lack of internet) that may limit the effectiveness of telemedicine and reduce its adoption. Telemedicine offers a breadth of opportunity for rethinking how health care teams interact to facilitate patient care; therefore, they should receive instruction on potential opportunities for incorporating other healthcare professionals (Huang et al 2019;Pariser et al 2019;O'Hara et al 2020). Ultimately, this curriculum should be informed by the literature and align with already established professional training standards.…”