Potential of Telemedicine to Provide Acute Medical Care for Adults in Senior Living Communities

Abstract

Objectives: Older adults dwelling in senior living communities (SLCs) often experience barriers to medical care when they experience acute illness. The potential of telemedicine as a substitute for standard routes of evaluating and caring for individuals with acute illness (e.g., in-person or telephonebased interactions with primary care providers and emergency department [ED] visits) was explored in this study. Methods:In this cross-sectional, observational study, the authors conducted a 6-month retrospective review of the medical records of adults enrolled in a university-affiliated geriatrics practice that offers onsite primary medical care in SLCs. For each episode of acute care, patient demographics, medical history, and chief complaint were collected and presented to an expert panel of physicians, who determined whether telemedicine could have been used to provide acute evaluation and care. The care actually provided, including outcomes, was also noted. Descriptive statistics were used to characterize the population and potential for telemedicine care.Results: The medical records of 646 patients were reviewed, accounting for 1,535 unique episodes of acute care. The expert panel identified 576 visits (38%) as potentially appropriate for telemedicinebased acute care, with 38, 47, and 27% of phone, in-home, and ED visits being eligible, respectively. Chief complaints most likely to be deemed potentially appropriate were falls and dermatologic, respiratory, and gastrointestinal illnesses, representing 58% of visits identified for telemedicine-based acute care.Conclusions: Telemedicine has a potentially significant role in the provision of acute care for older adults residing in SLCs. Studies are needed to evaluate the feasibility, acceptability, effectiveness, and efficiency of acute care telemedicine for this population.ACADEMIC EMERGENCY MEDICINE 2013; 20:162-168

Use of a voice and video internet technology as an alternative to in-person urgent care clinic visits

“…Previous studies of online care or telemedicine have involved either established patients; or providers seeking consultative advice from specialists at a distant location 15,20 ; or the use of an onsite professional intermediary who is present with the patient, to interpret symptoms and signs, or assist with hands-on physical examination, 14,21,22 or the use of highly structured, asynchronous e-visits through a patient portal. 16,17,18 This study evaluated the feasibility and scope of de novo real-time primary care and urgent care-type visits delivered via a voice-and-video-over-Internet protocol.…”

ATA Practice Guidelines for Live, On-Demand Primary and Urgent Care

“…26,41 The evidence indicates frequent monitoring for chronic diseases tends to reduce the need for office visits and transportation, as well as reduce stress and increase access to care for homebound patients. 39,[42][43][44] Providers also report benefits from the ability to observe the patient in his or her home environment.…”

“…The literature contains examples of clinical effectiveness of successful telemedicine programs in a variety of settings, including patient homes, childcare centers, schools, chronic care facilities, the workplace, and prisons. 6,26,27,33,36,37,41 All legal and regulatory requirements and ethical considerations shall be used in these settings.…”

Emergency Care and Health Systems: Consensus‐based Recommendations and Future Research Priorities

“…As technology continues to improve and new methods of data collection and information sharing are introduced, there are significant overlaps between the domains of “medical products” and “information research.” The field of telehealth has been advancing rapidly as a result of technology development. For example, telehealth has emerged as an option for providing acute care to older adults residing in senior living communities and may obviate a portion of ED visits . Other applications include outsourcing specialist consults, such as dermatology and radiology, for patients being seen in an ED .…”