EMT examining little girl's leg injury for telemedicine in-home visit

A New Normal? Telemedicine In-Home Visits May Include Primary Care

Integrating telemedicine into emergency medical services is nothing new, but the focus thus far has revolved around acute cases and specialties such as telestroke. However, in a recently released proof of concept, researchers questioned this trend and applied the model of telemedicine in-home visits to primary care services. This preliminary observatory study suggests that using telemedicine to bring primary care services into the patient’s home may be feasible, effective, and satisfactory for homebound seniors with chronic medical conditions.

Considering the nation’s growing elder population, many of whom suffer multiple chronic medical conditions and/or experience significant impairment in activities of daily living (ADL), the demand for home-based medical care will only increase in the coming years. Traditionally, both routine follow-ups and appointments for acute care issues are held at the physician’s office, necessitating awkward and time-consuming travel requirements for patients and their caregivers. Unfortunately, in the absence of telemedicine in-home care, many seniors, dissuaded by the time and inconvenience of office visits, delay seeking care or skip it altogether, ultimately leading to over-reliance on emergency services and increased hospitalization as compared to non-homebound older adults.

A medical clinic in downstate New York challenged this paradigm by expanding its existing home-based primary care (HBPC) program to bring health care to the patient through its mobile telemedicine technician (MTT) program. The goal of this initiative was to double the number of patient evaluations that could be performed in one day while maintaining high levels of satisfaction for the patient/caregiver, EMT, and primary care provider (PCP). For this study, the authors followed emergency medical technicians (EMTs) and PCPs who have been specially-trained in the use of the technology as they brought telemedicine in-home care to elderly patients’ comfort zones.

Upon arrival at the patient’s home, the EMT assessed the patient’s situation and, if needed, evaluated the home environment for safety, medication review, and social influences. Next, the EMT connected with the patient’s own PCP through real-time video conferencing; this allowed the PCP to remain at the clinic while utilizing the telemedicine in-home setup to examine the patient remotely and oversee the EMT’s actions, as well as giving the EMT instant access to the patient’s medical records. The availability of the patient’s own doctor, as opposed to an unfamiliar PCP, provides continuity of care, trust, and peace of mind for the patient.

As noted by the researchers, keeping the PCPs at the office and staggering appointment times allowed the providers to double the number of patient evaluations conducted each day compared to the number of patient assessments that typically occur in one day. Follow-up surveys revealed high levels of satisfaction for the patient/caregiver, EMT, and PCP.

Most of the home visits were prompted by acute symptoms, such as rashes or coughs, that appeared between regularly scheduled check-ups. In 6% of the cases, the EMT found a worse situation than anticipated; these patients were transported to the hospital. Overall, however, the authors believe that by deploying the telemedicine in-home care, the MTT program for primary care-related visits prevented unnecessary visits to the emergency department (ED). This conclusion is supported by data from the Department of Veterans Affairs, which includes mental health services in their telemedicine programs.

The next step, according to the researchers, is to further expand the MTT initiative to determine whether this approach can consistently allow an increase in patient census while maintaining clinical outcomes without having to increase the demand on physicians. For more thorough data, randomized trials also need to be performed in the future. In the meantime, reimbursement needs to be secured in order for the MTT and similar programs to be successful; having been temporarily permitted due to the COVID-19 pandemic, support from the future continuation of such reimbursement and payment parity remains uncertain.

To view the study, visit Telehealth and Medicine Today.

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