<scp>Home‐Based</scp> Medical Care: High‐Value Health Care During Coronavirus Disease 2019 and Beyond

Fessler, Emily; Soriano, Theresa; Whitehouse, Christina R.; Miller, Rachel

doi:10.1111/jgs.16967

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…Indeed, recent literature advocates for a more integrated role for home-based medical care. 13 , 14 The expansion of telemedicine may allow some HBPC clinicians to increase patient panels by reducing travel time to and between visits. Collaborations with health systems and health departments increased, fostering better access to supplies and workforce and targeted outreach to at-risk groups.…”

Section: Discussionmentioning

confidence: 99%

COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey

Ritchie

Gallopyn

Sheehan

et al. 2021

Journal of the American Medical Directors Association

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Objectives Approximately 7.5 million US adults are homebound or have difficulty accessing office-based primary care. Home-based primary care (HBPC) provides such patients access to longitudinal medical care at home. The purpose of this study was to describe the challenges and adaptations by HBPC practices made during the first surge of the COVID-19 pandemic. Design Mixed-methods national survey. Setting and Participants HBPC practices identified as members of the American Academy of Homecare Medicine (AAHCM) or participants of Home-Centered Care Institute (HCCI) training programs. Methods Online survey regarding practice responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Descriptive statistics and t tests described frequency distributions of nominal and categorical data; qualitative content analysis was used to summarize responses to the open-ended questions. Results Seventy-nine practices across 29 states were included in the final analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices pivoted to new use of video visits (76.3%). The most common challenges were as follows: patient lack of familiarity with telemedicine (81.9%), patient anxiety (77.8%), clinician anxiety (69.4%), technical difficulties reaching patients (66.7%), and supply shortages including masks, gown, and disinfecting materials (55.6%). Top adaptive strategies included using telemedicine (95.8%), reducing in-person visits (81.9%), providing resources for patients (52.8%), and staff training in PPE use and COVID testing (52.8%). Conclusions and Implications HBPC practices experienced a wide array of COVID-19–related challenges. Most continued to see patients in the home, augmented visits with telemedicine and creatively adapted to the challenges. An increased recognition of the need for in-home care by health systems who observed its critical role in caring for fragile older adults may serve as a silver lining to the otherwise dark sky of the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey

Ritchie

Gallopyn

Sheehan

et al. 2021

Journal of the American Medical Directors Association

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“…Video‐based telehealth has emerged as an important care‐delivery innovation within HBPC, especially during the COVID‐19 pandemic. Not only does telehealth reduce costs, transportation, and time on the part of the patient, but the pandemic also has highlighted additional benefits such as reduced infection exposures 6,7 . The federal government has recognized these benefits and implemented regulatory waivers and rule changes aimed at increasing telehealth accessibility, facilitating its rapid uptake since early 2020 8‐11 …”

Section: Introductionmentioning

confidence: 99%

Barriers to telehealth access among homebound older adults

Kalicki

Moody

Franzosa

et al. 2021

J American Geriatrics Society

134

145

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Background/Objectives: To identify major barriers to video-based telehealth use among homebound older adults.Design: Cross-sectional survey. Setting: A large home-based primary care (HBPC) program in New York City (NYC) serving 873 homebound patients living in the community. Participants: Sixteen primary care physicians.Measurements: An 11-item assessment of provider perceptions of patients' experience with and barriers to telehealth. Results: According to physicians in the HBPC program, more than one-third (35%) of homebound patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020 during the first COVID-19 surge in NYC. The majority (82%) required assistance from a family member and/or paid caregiver to complete the visit. Among patients who had not used telehealth, providers deemed 27% (n = 153) "unable to interact over video" for reasons including cognitive or sensory impairment and 14% lacked access to a caregiver to assist them with technology. Physicians were not knowledgeable of their patients' internet connectivity, ability to pay for cellular plans, or video-capable device access. Conclusion:The COVID-19 pandemic resulted in a large and dramatic shift to video-based telehealth use in home-based primary care. However, 4 months into the pandemic a majority of patients had not participated in a video-based telehealth encounter due to a number of barriers. Patients lacking caregiver support to assist with technology may benefit from novel approaches such as the deployment of community health workers to assist with device setup. Physicians may not be able to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video-based telehealth use.

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“…The COVID-19 pandemic led to the prioritization of hospitalization for severely ill patients both in Japan and overseas, whereas those with mild illnesses were increasingly treated at home; the home medical and nursing care system was strengthened to support this transition. [27][28][29] Therefore, it is now easier to provide acute treatment at home than when this study was carried out. Furthermore, it has been reported that 55% of older patients in Japan hospitalized with COVID-19 infection developed functional decline.…”

Section: Discussionmentioning

confidence: 99%

“…We consider the possibility that home care might currently have an equal or even better prognosis than before the pandemic. The COVID‐19 pandemic led to the prioritization of hospitalization for severely ill patients both in Japan and overseas, whereas those with mild illnesses were increasingly treated at home; the home medical and nursing care system was strengthened to support this transition 27–29 . Therefore, it is now easier to provide acute treatment at home than when this study was carried out.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of home‐cared or hospital‐treated acute fever in older adults: A prospective multicenter case‐control study

Arai

Suzuki

Jeong

et al. 2023

Geriatrics Gerontology Int

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Aims This study aimed to investigate the differences in the prognosis of older patients who received home care or hospitalized care to treat acute fever in Japan. Methods This prospective case–control study screened 192 registered acutely pyrexic older patients who received home care at 10 medical institutions in Japan, and enrolled 15 and 30 patients who were treated in the hospital (hospitalized group) and at home (home‐care group), respectively, matched for fever and the physical conditions before fever onset. Intergroup differences in the 90‐day mortality from fever onset and changes in patients' disability and dementia from the pre‐fever to 90 days post‐fever onset were determined. Results No significant intergroup difference in the 90‐day mortality rate was detected (26.7% vs 13.3% for hospitalized and home‐care groups, respectively, P = 0.41). Disability tended to worsen in the hospitalized group compared with the home‐care group (54.5% vs 23.1%, respectively, P = 0.06), whereas dementia significantly worsened in the hospitalized group compared with the home‐care group (45.5% vs 3.8%, respectively, P = 0.02). Conclusions Home care confers a better prognosis for treating acute fever in older people whose daily functions have deteriorated enough to necessitate regular home care. This study assists those people in making informed choices about where to receive treatment for acute fever. Geriatr Gerontol Int 2023; 23: 355–361.

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Home‐Based Medical Care: High‐Value Health Care During Coronavirus Disease 2019 and Beyond

Cited by 7 publications

References 22 publications

COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey

COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey

Barriers to telehealth access among homebound older adults

Prognosis of home‐cared or hospital‐treated acute fever in older adults: A prospective multicenter case‐control study

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