A Hybrid Model of Outpatient Memory Care in the COVID Era

Abstract

Introduction The coronavirus pandemic has drastically affected day-to-day life, including the way healthcare is provided. An emphasis is placed on the need to transition to telemedicine to reduce exposure rates. The effects of the pandemic have been especially significant in the geriatric population, which is at increased risk of hospital mortality with infection: 35% mortality for patients aged 70 to 79 years and greater than 60% mortality for patients aged 80 to 89 years (Gómez-Belda et all., 2020, Wiersinga et al., 2020). Physicians, as well as patients, have had to quickly adapt to telemedicine for outpatient services to reduce rates of transmission and infection. However, the barriers to telemedicine are also higher in the geriatric population. The lack of smart devices with cameras, microphones, internet, and the lack of ability and comfort in using these are some of the barriers in which the older population face (Hawley, et al. 2020). With confounding factors of dementia limiting instrumental activities of daily living, learning new technology can also be an additional burden to this population. This can lead to unwillingness or hesitation in participation of telehealth visits by both the patient and the caretaker. An increase in caregiver burden has also been shown secondary to the coronavirus pandemic and the increased isolation (Alexopoulos et al., 2020). Methods At the Banner Alzheimer's Institute, the needs of this population led to the development of the Hybrid model of care, which allows some patients to be present in person at the office but distanced in a separate room from the providers. In a separate room, a screen with a camera is set up so the appointment can occur as a “remote” visit. When indicated, short direct contact is made to complete a physical exam. This reduced time of close contact is important for infection control, especially when as testing prior to visits is not widespread for outpatient services. Prolonged exposure is defined as within 6 feet of contact with infected persons for at least 15 minutes (Wiersinga et al., 2020). This hybrid model allows for decreased time of contact, and therefore decreases exposure risk while removing the initial barrier of access to and difficulty navigating technology in this population. With more hybrid visits, patients may even develop more comfort and confidence in technology use for fully remote visits. We analyzed data routinely collected by the department regarding patient and provider satisfaction. We analyzed ratings on front desk interactions, provider interactions, ease of care, office net promoter score (NPS), and provider NPS. We compared the ratings from June to October of 2020, when the hybrid model was in use, to the ratings from June to October of 2019 using a paired t-test. Results None of the measures analyzed showed any statistically significant difference between the scores. Conclusions To provide care to the ...

Telehealth use and Models for Geriatric Patients Since the COVID-19 Pandemic: A Systematic Review

“…The key characteristics of the studies included in the review are summarized in Table 1. Overall, seven studies were included in this review; two focused on the effectiveness of telehealth [21,22], three focused on the experiences of patients and providers [23][24][25], and two focused on the use of telehealth [26,27]. Wong et al [21] conducted a pilot randomized controlled trial whereby they randomized 68 patients to the control arm (n=34) and the intervention arm (n=34).…”

“…The outcome was to assess patients' self-efficacy in either arm three months after initiation of the program. Kaur et al [23] conducted a comparative analysis of patient and provider satisfaction in an Alzheimer's clinic. The patients were partially remote-monitored, whereby they were placed in a separate room for their appointment, and only when indicated, direct short contact made for a complete physical examination.…”

“…The secondary outcome measures were significantly better in the telecare group for medication adherence and quality of life. Kaur et al [23] found that patient and provider satisfaction levels were comparable when comparing partially remote monitoring to conventional monitoring of geriatric patients with Alzheimer's. The authors suggested the application of full remote monitoring through normalizing remote monitoring in this hybrid model of telemedicine.…”