66 Impact of COVID-19 on Home-Based Community Paramedicine and High-Risk Elder Patients

Abstract Objective: Evidence-based infection control strategies are needed for healthcare workers (HCWs) following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). In this study, we evaluated the negative predictive value (NPV) of a home-based 7-day infection control strategy. Methods: HCWs advised by their infection control or occupational health officer to self-isolate due to a high-risk SARS-CoV-2 exposure were enrolled between May and October 2020. The strategy consisted of symptom-triggered nasopharyngeal SARS-CoV-2 RNA testing from day 0 to day 7 after exposure and standardized home-based nasopharyngeal swab and saliva testing on day 7. The NPV of this strategy was calculated for (1) clinical coronavirus disease 2019 (COVID-19) diagnosis from day 8–14 after exposure, and for (2) asymptomatic SARS-CoV-2 detected by standardized nasopharyngeal swab and saliva specimens collected at days 9, 10, and 14 after exposure. Interim results are reported in the context of a second wave threatening this essential workforce. Results: Among 30 HCWs enrolled, the mean age was 31 years (SD, ±9), and 24 (80%) were female. Moreover, 3 were diagnosed with COVID-19 by day 14 after exposure (secondary attack rate, 10.0%), and all cases were detected using the 7-day infection control strategy: the NPV for subsequent clinical COVID-19 or asymptomatic SARS-CoV-2 detection by day 14 was 100.0% (95% CI, 93.1%–100.0%). Conclusions: Among HCWs with high-risk exposure to SARS-CoV-2, a home-based 7-day infection control strategy may have a high NPV for subsequent COVID-19 and asymptomatic SARS-CoV-2 detection. Ongoing data collection and data sharing are needed to improve the precision of the estimated NPV, and here we report interim results to inform infection control strategies in light of a second wave threatening this essential workforce.

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Decreasing Emergency Room Utilization in High Risk Geriatric Patients

Innovation in Aging ◽

10.1093/geroni/igaa057.443 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 135-135

Author(s):

Shamsi Fani ◽

Lizette Munoz ◽

Susana Lavayen ◽

Blair McKenzie ◽

Audrey Chun ◽

...

Keyword(s):

New York ◽

High Risk ◽

Emergency Room ◽

Geriatric Patients ◽

Social Issues ◽

The Elderly ◽

Mount Sinai Hospital ◽

Status Change ◽

Community Paramedicine ◽

Ed Visits

Abstract Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.

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How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR

BMJ Open ◽

10.1136/bmjopen-2020-046051 ◽

2021 ◽

Vol 11 (4) ◽

pp. e046051

Author(s):

Alasdair F O'Doherty ◽

Helen Humphreys ◽

Susan Dawkes ◽

Aynsley Cowie ◽

Sally Hinton ◽

...

Keyword(s):

High Risk ◽

Cardiac Rehabilitation ◽

Technology Use ◽

Healthcare Professionals ◽

Hospital Admissions ◽

Well Being ◽

Rehabilitation Service ◽

High Risk Patients ◽

Home Based ◽

Risk Patients

ObjectiveTo investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation.DesignA mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety.SettingInternational survey of exercise-based cardiac rehabilitation programmes.ParticipantsHealthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide.Main outcome measuresThe proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation.ResultsThree hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing.ConclusionsThe rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.

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Home-based medication review in a high risk elderly population in primary care--the POLYMED randomised controlled trial

Age and Ageing ◽

10.1093/ageing/afm036 ◽

2007 ◽

Vol 36 (3) ◽

pp. 292-297 ◽

Cited By ~ 88

Author(s):

E. Lenaghan ◽

R. Holland ◽

A. Brooks

Keyword(s):

Primary Care ◽

High Risk ◽

Randomised Controlled Trial ◽

Medication Review ◽

Elderly Population ◽

Controlled Trial ◽

Home Based ◽

Randomised Controlled

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A home-based longitudinal study of vocalization behaviors across infants at low and elevated risk of autism

Autism & Developmental Language Impairments ◽

10.1177/23969415211057658 ◽

2021 ◽

Vol 6 ◽

pp. 239694152110576

Author(s):

Shari L. DeVeney ◽

Anastasia Kyvelidou ◽

Paris Mather

Keyword(s):

Longitudinal Study ◽

High Risk ◽

Risk Group ◽

Developmental Change ◽

Empirical Support ◽

Autism Spectrum ◽

Elevated Risk ◽

Low Risk ◽

Home Based ◽

Early Developmental

Background and Aims: The purpose of this exploratory study was to expand existing literature on prelinguistic vocalizations by reporting results of the first home-based longitudinal study examining a wide variety of behaviors and characteristics, including early vocalizations, across infants at low and elevated risk of autism spectrum disorder (ASD). The study of vocalizations and vocalization changes across early developmental periods shows promise in reflecting early clinically significant differences across infants at low and elevated risk of ASD. Observations of early vocalizations and their differences during infancy could provide a reliable and essential component of an early developmental profile that would lower the average diagnostic age for ASD. However, studies employing observation of vocalization behaviors have been limited and often conducted in laboratory settings, reducing the external generalization of the findings. Methods: The present study was conducted to determine the consistency of previous findings with longitudinal data collected in home environments. Infants in the present study represented elevated risk from two etiological backgrounds, (a) infants born prematurely and with low birth weight and (b) infants who had an older sibling diagnosed with ASD. All data were collected in the infants’ homes and compared with data collected from infants with low likelihood of ASD. The study included 44 participants (31 in the low-risk sample, 13 in the high-risk sample) with vocalization behaviors observed at 6- and 12-months through 20-min semi-structured play interactions with caregivers. Observations were video-recorded and later coded for speech and non-speech vocalizations. Results: Differences in the 6-month vocalization behaviors were not statistically significant across risk levels of ASD. By 12 months; however, risk group differences were evident in the total number of vocalizations overall with specific differences across groups representing moderate to large, clinically relevant effects. Infants at low risk of ASD demonstrated significantly greater developmental change between 6- and 12-months than did the infants at high risk. Data were also reviewed for differences across high-risk group etiologies. Conclusions: The present study was unique and innovative in a number of ways as the first home-based longitudinal study examining infant vocal behaviors across low and high risk of ASD. Many of the present study findings were consistent with previous cross-sectional investigations of infants at elevated risk for ASD, indicating support for further home-based longitudinal study in this area. Findings also indicated some preliminary subgroup differences between high-risk etiologies of ASD. Vocalization differences across high risk groups had not been previously addressed in the literature. Implications: Vocalization differences are notable by 12-months of age between infants at low and elevated risk of ASD and infants at high risk demonstrated reduced developmental changes between 6- and 12-months compared to the infants at low risk. Observation of early infant vocalization behaviors may reasonably occur in the home, providing early childhood professionals and researchers with empirical support for data collection of child-caregiver interactions in this setting. Potential differences across high-risk etiologies warrant further investigation.

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The Effectiveness of a Home-Based Delivery of Triple P in High-Risk Families in Rural Areas

Journal of Child and Family Studies ◽

10.1007/s10826-019-01684-2 ◽

2019 ◽

Vol 29 (4) ◽

pp. 997-1007

Author(s):

Anna Abate ◽

Ryan J. Marek ◽

Amanda Venta ◽

Leslie Taylor ◽

Luis Velez

Keyword(s):

High Risk ◽

Rural Areas ◽

Triple P ◽

Home Based ◽

High Risk Families

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P112: Strengthening inter-professional collaboration in home-based community paramedic programs

CJEM ◽

10.1017/cem.2020.318 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S105-S105

Author(s):

K. Jagos ◽

I. Drennan ◽

M. McNamara ◽

J. Limoges

Keyword(s):

Home Care ◽

Professional Education ◽

Professional Collaboration ◽

Snowball Sampling ◽

Patient Centered ◽

Collaborative Relationships ◽

Community Paramedicine ◽

Home Based ◽

Effective Collaboration ◽

Effective Integration

Introduction: Community paramedic programs are being implemented to leverage existing resources and contribute to a sustainable patient-centered healthcare system. Expanding the role of paramedics into home care requires new collaborative relationships with healthcare providers such as nurses and physicians. Developing effective and productive collaborative relationships will enhance and support the integration of community paramedic programs. Our objective was to describe the barriers and facilitators to effective collaboration between nurses, physicians, and paramedics within home-based community paramedicine. Methods: We conducted semi-structured interviews with nurses, physicians, paramedics, and faculty who teach in paramedic programs. We explored the attitudes, perceptions, barriers, and enablers to collaboration in home-based community paramedic programs. Participants were recruited utilizing the professional networks of the researchers as well as snowball sampling. Recruitment in each group stopped when saturation was achieved. We conducted a thematic analysis of the interviews to generate findings related to our objectives. Results: We interviewed 33 participants with a typical cross-section of age, years of experience, and education. Overall, participants felt that collaboration was important for effective integration of community paramedics into home care and for ensuring a patient-centered approach to care. Currently, collaboration mostly occurs between physicians and paramedics and community paramedicine appears to be a siloed rather than integrated service. Few collaborative relationships exist between paramedics and nurses, despite the fact that nurses are highly involved in home care. We identified several barriers to effective collaboration including lack of understanding of the contributions of the different health providers, and regulatory and funding constraints. Inter-professional education that supports collaboration and facilitates dismantling of professional and service silos can support the effective integration of paramedics into home care. Conclusion: Strengthening networks of collaboration between nurses, physicians, and paramedics can help dismantle silos and enhance inter-professional collaboration to support appropriate integration of paramedics into home care. The willingness and positive attitudes for collaboration are assets that provide an excellent foundation upon which to move forward. Continuing education to support inter-professional collaboration is needed.

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