How Often, Where, and by Which Specialty Do Long-Term Care Home Residents Receive Specialist Physician Care? A Retrospective Cohort Study

Shaver, Nicole; Lapenskie, Julie; Smith, Geoffrey C.; Hsu, Amy T; Liddy, Clare; Tanuseputro, Peter

doi:10.1177/0733464819901255

Cited by 6 publications

(11 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 The prevalence of these and other chronic conditions means that residents in LTC face an above-average need for specialty care; however, these same conditions make travel outside of the home to attend such appointments extremely challenging, a problem further exacerbated by Canada's excessive wait times for specialist care. 2,3 Several approaches exist to improving access to care in the LTC setting, such as visits to the homes by specialists themselves, use of nurse practitioners for acute issues, telemedicine, and video visits. 4 Video visits enable remote access to specialists through real-time appointments using video-enabled technology.…”

mentioning

confidence: 99%

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

Helmer-Smith

Fung

Afkham³

et al. 2020

Journal of the American Medical Directors Association

Self Cite

View full text Add to dashboard Cite

Patients in long-term care (LTC) homes face barriers to accessing specialist advice. Electronic consultation (eConsult) has the potential to improve access for these patients. We used a multi-method approach to evaluate adoption of the Champlain BASE eConsult service in LTC homes across Eastern Ontario, Canada. We conducted a cross-sectional study of all eConsults submitted by primary care providers (PCPs) working at LTC homes between January 1, 2018 and December 31, 2018. Service use data were collected and descriptive statistics were calculated. We completed a thematic analysis of 4 focus groups with PCPs, senior leadership, and a nurse champion working in LTC homes where eConsult is used. Sixty-four cases were submitted to 23 specialty and subspecialty groups by LTC PCPs, most frequently dermatology (19%), geriatric medicine (11%), and infectious disease (9%). Specialists responded in a median of 0.6 days, and 70% of cases were resolved without the resident needing a face-to-face specialist visit. In 60% of cases, PCPs received advice for a new or additional course of action. Participants described complexities in the LTC context, the value of eConsult in LTC, and considerations for implementation. PCPs with experience using the service described increased access to specialist advice, ease of use, and benefits to themselves, residents, and families. eConsult is feasible in LTC and should continue to be used in this region and beyond to improve equity of access to specialist advice. Resolving the identified limitations in LTC, which hinder access to specialists and adoption of eConsult and similar innovations, should be of high priority to researchers and policy makers.

show abstract

mentioning

confidence: 99%

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

Helmer-Smith

Fung

Afkham³

et al. 2020

Journal of the American Medical Directors Association

Self Cite

View full text Add to dashboard Cite

show abstract

“…Most NH residents received a recent medical care visit preceding their first-quarterly MDS 2.0 assessment, affirming the need for medical care visits and support during the transitionary NH admission period. NH medical care may be impacted by many resident-level factors, including resident demographics, medical complexity, and lability of clinical symptoms [ 10 , 23 , 24 ]. We identified six clinically important factors that increased the odds of a recent medical care visit in newly admitted NH residents, including wandering, pressure ulcers, UTIs, end-stage disease, new medication use, and analgesic use.…”

Section: Discussionmentioning

confidence: 99%

“…In our sample, one-fifth of NH residents did not receive any medical care visits by physicians within two weeks of their first-quarterly assessment. In NHs, older adults are typically frail with multimorbidity, complex health needs, and limited ability to seek medical services outside of NH facilities [ 6 , 23 ]. Consistent follow-up is crucial to ensure that NH residents are monitored and that their health concerns are managed proactively [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study

et al. 2022

View full text Add to dashboard Cite

Objectives We examined which resident-level clinical factors influence the provision of a recent medical care visit in nursing homes (NHs). Design Multi-site cross-sectional. Setting and participants We extracted data on 3,556 NH residents from 18 NH facilities in Ontario, Canada, who received at minimum, an admission and first-quarterly assessment with the Resident Assessment Instrument Minimum Data Set (MDS) 2.0 between November 1, 2009, and October 31, 2017. Methods We conducted a secondary analysis of routinely collected MDS 2.0 data. The provision of a recent medical care visit by a physician (or authorized clinician) was assessed in the 14-day period preceding a resident’s first-quarterly MDS 2.0 assessment. We utilized best-subset multivariable logistic regression to model the adjusted associations between resident-level clinical factors and a recent medical care visit. Results Two thousand eight hundred fifty nine (80.4%) NH residents had one or more medical care visits prior to their first-quarterly MDS 2.0 assessment. Six clinically relevant factors were identified to be associated with recent medical care visits in the final model: exhibiting wandering behaviours (OR = 1.34, 95% CI 1.09 – 1.63), presence of a pressure ulcer (OR = 1.37, 95% CI 1.05 – 1.78), a urinary tract infection (UTI) (OR = 1.52, 95% CI 1.06 – 2.18), end-stage disease (OR = 9.70, 95% CI 1.32 – 71.02), new medication use (OR = 1.31, 95% CI 1.09 – 1.57), and analgesic use (OR = 1.24, 95% CI 1.03 – 1.49). Conclusions and implications Our findings suggest that resident-level clinical factors drive the provision of medical care visits following NH admission. Clinical factors associated with medical care visits align with the minimum competencies expected of physicians in NH practice, including managing safety risks, infections, medications, and death. Ensuring that NH physicians have opportunities to acquire and strengthen these competencies may be transformative to meet the ongoing needs of NH residents.

show abstract

“…Advice from colleagues and specialists can help to inform clinical decision-making by PCPs in LTC, but access to specialists within LTC homes is limited. In Ontario, the rate of specialist visits outside of the LTC home is much higher than within the home, as residents are most often required to attend external appointments to receive specialist advice ( Shaver et al, 2020 ). These appointments are challenging for most residents due to the barriers associated with mobility and transfers, transportation, and coordinating caregiver escorts.…”

Section: Introductionmentioning

confidence: 99%

Clinical Questions Asked by Long-Term Care Providers Through eConsult: A Retrospective Study

Fung

Shah

Helmer-Smith

et al. 2021

Gerontology and Geriatric Medicine

Self Cite

View full text Add to dashboard Cite

Introduction eConsult allows primary care providers (PCPs) to access timely specialist advice and informs patient care. To understand the use of eConsult in long-term care (LTC) settings, we examined the clinical content and types of questions asked by LTC PCPs. Methods A descriptive, retrospective study of eConsults submitted through the Champlain BASE™ eConsult Service between January 1, 2017, and December 31, 2018, by LTC PCPs was conducted. Cases were classified using validated taxonomies. Descriptive statistics were generated for content and question type classifications, service utilization data, and close-out survey responses. Results 22 LTC PCPs submitted 113 eConsults. They sought advice about drug treatment (58%), diagnosis (44%), and management (38%) in a breadth of clinical areas, often skin-related (39%). Long-term care PCPs frequently asked more than one question type (42%). They received advice within 1 week (91%) and rated eConsult as very helpful and educational. Three case examples are presented. Conclusion This study demonstrates the type of advice LTC PCPs are seeking through eConsult and its usefulness in this setting. Long-term care stakeholders are encouraged to consider implementing eConsult in other regions, as a means to improve access to timely specialist advice, support clinical decision-making, and improve residents’ quality of life.

show abstract

How Often, Where, and by Which Specialty Do Long-Term Care Home Residents Receive Specialist Physician Care? A Retrospective Cohort Study

Cited by 6 publications

References 31 publications

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

The Feasibility of Using Electronic Consultation in Long-Term Care Homes

Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study

Clinical Questions Asked by Long-Term Care Providers Through eConsult: A Retrospective Study

Contact Info

Product

Resources

About