scholarly journals Use of Video-Enabled Tablet for Virtual Care Among Older Veterans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 197-197
Author(s):  
Maria Yefimova ◽  
Jiaqi Hu ◽  
Cindie Slightam ◽  
Liberty Greene ◽  
Camila Chaudhary ◽  
...  
Keyword(s):  
Primary Care ◽  
Older Patients ◽  
Oldest Old ◽  
Age Groups ◽  
Old Patients ◽  
Younger Patients ◽  
Care Services ◽  
Virtual Care ◽  
Primary Care Services ◽  
Home Based

Abstract With the proliferation of virtual care, healthcare systems are exploring ways to bridge the digital divide among vulnerable patients. Department of Veterans Affairs (VA) is distributing devices for qualifying Veterans to enable video visits with medical providers at home, yet their use among older patients is unknown. This retrospective cohort study used administrative data to characterize the use of VA-loaned iPads among older Veterans compared to younger Veterans and identify demographic predictors of utilization. Among 16,385 patients who were shipped a VA-loaned iPad in 2014-2019, 33.66% (n=5,516) were over 65 years old, and 3.1% (n=503) were over the age of 85. Two thirds (n=6799) of younger patients had a video visit (mean=3 visits) with provider using iPad in the 6 months since shipment, compared to 50% (n=253) of 85+ year-olds (mean=1.8 visits). Most common types of virtual visits for the oldest old patients were for geriatrics or home-based primary care, compared to mental health visits among younger patients. Logistic regression identified characteristics of older patients who were more likely to use iPads, such a marital status, urban location, and lower disease burden, which is similar to their younger counterparts. While older age groups used VA-loaned tablets less frequently, those who engaged with the devices were similar in demographics as their younger counterparts. Older patients used iPads differently, with higher engagement in geriatric and primary care services. Providing devices for virtual care may allow health systems to more easily reach older patients in the comfort of their home.

Virtual Primary Care Implementation during COVID-19 in High-Income Countries: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Kristina De Vera ◽  
Priyanka Challa ◽  
Rebecca H Liu ◽  
Kaitlin Fuller ◽  
Anam Shahil Feroz ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Primary Care Physicians ◽  
Underserved Populations ◽  
High Income ◽  
Lessons Learned ◽  
Regulatory Policies ◽  
Care Services ◽  
Virtual Care ◽  
Primary Care Services

BACKGROUND Primary care physicians across the world are grappling with adopting virtual services to provide appropriate patient care during the COVID-19 pandemic. As the crisis continues, it is imperative to recognize the wide-scale barriers and seek strategies to mitigate the challenges of rapid adoption to virtual care felt by patients and physicians alike. OBJECTIVE The purpose of this scoping review was to map the challenges, strategies, and lessons learned from high-income countries that can be mobilized to inform decision-makers on how to best implement virtual primary care services during and after the COVID-19 pandemic. Moreover, the findings of our scoping review identified the barriers and strategies within the Quadruple Aim components, which may prove to be an effective implementation strategy for virtual care adoption in primary care settings. METHODS The two concepts of virtual care and COVID-19 were searched in MEDLINE, EMBASE, and CINAHL on Aug 10, 2020, and Scopus was searched on Aug 15, 2020. The database searches returned 10,549 citations and an additional 766 citations were retrieved from searching the citations from the reference lists of articles that met all inclusion criteria. After deduplication, 6,580 unique citations remained. Following title and abstract screening, 1,260 full-text articles were reviewed, of which 49 articles were included for data extraction, and 38 articles met the eligibility criteria for inclusion in the review. RESULTS Seven factors were identified as major barriers to the implementation of virtual primary care. Of the 38 articles included in this scoping review, 20 (53%) articles focused on challenges to equitable access to care, specifically regarding the lack of access to internet, smartphones, and Internet bandwidth for rural, seniors, and underserved populations. The second most common factor discussed in the articles was the lack of funding for virtual care (n= 14; 37%), such as inadequate reimbursement policies for virtual care. Other factors included negative patient and clinician perceptions of virtual care (n=11; 29%), lack of appropriate regulatory policies (n= 10, 26%), inappropriate clinical workflows (n= 9, 24%), lack of virtual care infrastructure (n= 8; 21%), and lastly, a need for appropriate virtual care training and education for clinicians (n=5;13%). CONCLUSIONS This review identified several barriers and strategies to mitigate those barriers that address the challenges of virtual primary care implementation related to equity, regulatory policies, technology and infrastructure, education, clinician and patient experience, clinical workflows, and funding for virtual care. These strategies included providing equitable alternatives to access care for patients with limited technical literacy and English proficiency and altering clinical workflows to integrate virtual care services. As many countries enter potential subsequent waves of the COVID-19 pandemic, applying early lessons learned to mitigate implementation barriers can help with the transition to equitable and appropriate virtual primary care services.

scholarly journals Type 2 diabetes in older patients: an analysis of the DPV and DIVE databases

2020 ◽  
Vol 11 ◽  
pp. 204201882095829
Author(s):  
Gesine van Mark ◽  
Sascha R. Tittel ◽  
Stefan Sziegoleit ◽  
Franz Josef Putz ◽  
Mesut Durmaz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Older Patients ◽  
Microvascular Complications ◽  
Oldest Old ◽  
Age Groups ◽  
Young Patients ◽  
Severe Hypoglycemia ◽  
Old Patients

Background: The clinical profile differs between old and young patients with type 2 diabetes mellitus (T2DM). We explored, based on a large real-world database, patient and disease characteristics and actual treatment patterns by age. Methods: The analysis was based on the DIVE and DPV registries of patients with T2DM. Patients were analyzed by age groups 50–59 (middle-young), 60–69 (young-old), 70–79 (middle-old), 80–89 (old), and 90 years or more (oldest-old). Results: A total of 396,719 patients were analyzed, of which 17.7% were 50–59 years, 27.7% 60–69 years, 34.3% 70–79 years, 18.3% 80–89 years and 2.0% at least 90 years. We found that (a) T2DM in old and oldest-old patients was characterized much less by the presence of metabolic risk factors such as hypertension, obesity, dyslipidemia and smoking than in younger patients; (b) the HbA1c was much lower in oldest-old than in middle-young patients (7.2 ± 1.6% versus 8.0 ± 2.2%; p < 0.001), but it was associated with higher proportions of patients with severe hypoglycemia (7.0 versus 1.6%; p < 0.001); (c) this was potentially associated with the higher and increasing rates of insulin use in older patients (from 17.6% to 37.6%, p < 0.001) and the particular comorbidity profile of these patients, for example, chronic kidney disease (CKD); (d) patients with late diabetes onset had lower HbA1c values, lower bodyweight and less cardiovascular risk factors; (e) patients with a longer diabetes duration had a considerable increase in macrovascular and even more microvascular complications. Conclusion: In very old patients there is a need for frequent careful routine assessment and a tailored pharmacotherapy in which patient safety is much more important than blood-glucose-lowering efficacy.

scholarly journals General Practice Services in England During the COVID-19 Pandemic and Beyond: Patient Access and Barriers

2021 ◽  
pp. 70-77
Author(s):  
Pablo Millares Martin
Keyword(s):  
Primary Care ◽  
Age Groups ◽  
Careful Consideration ◽  
Care Physician ◽  
Readiness For Change ◽  
Health Needs ◽  
Online Information ◽  
Care Services ◽  
Primary Care Services ◽  
Number Of Patients

Background: During the coronavirus disease (COVID-19) pandemic, primary care services have been forced to operate differently, limiting face-to-face consultations and relying on telemedicine. This has impacted the care received by patients in need of primary care. The aim of this article was to assess the patient needs during the pandemic, their perspectives on current interactions with primary care, and the readiness for change in operating general practices in the future. Method: A survey was conducted among patients in Leeds, UK, that explored whether patients had health needs during the pandemic, the decisions that were then taken if so, their use of online information and resources, and their satisfaction with primary care website portals and consultations. Results: Over 75% of patients gathered information online before deciding to consult. The main effect of the pandemic was that among those whose health needs remained, 37% did not consult, preferring to wait to see if their symptoms resolved by themselves. There was a significant statistical difference depending on age groups: among those patients aged <30 years, 48% did not consult a primary care physician. Conclusion: The primary care response during the pandemic led to a large number of patients to withhold their concerns, and careful consideration is needed to access how to improve accessibility in future crises.

scholarly journals Pandemic trends in health care use: From the hospital bed to the general practitioner with COVID-19

2021 ◽  
Author(s):  
Fredrik Methi ◽  
Kjersti Helene Hernaes ◽  
Katrine Damgaard Skyrud ◽  
Karin Magnusson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Age Groups ◽  
Health Care Use ◽  
Specialist Care ◽  
Care Services ◽  
Primary Care Services ◽  
Hospital Bed ◽  
Bed Days ◽  
The Mean

Aim: To explore whether the acute 30-day burden of COVID-19 on health care use has changed from the beginning to the end of the pandemic. Methods: In all Norwegians (N=122 699) who tested positive for SARS-CoV-2 in three pandemic waves (March 1st-July 31st 2020 (1st wave), August 1st-December 31st 2020 (2nd wave), and January 1st-May 31st 2021 (3rd wave)), we studied the age- and sex-specific share of patients (by age groups 1-19, 20-67, and 68 or more) who had: 1) Relied on self-care, 2) used primary care, and 3) used specialist care. Results: We find that a remarkably high and stable share (70-80%) of patients with COVID-19 exclusively had contact with primary care in the acute phase, both in the 1st, 2nd and 3rd wave. The mean number of primary care visits ranged between 2 and 4. We also show that the use of specialist care in the acute 30-day phase of COVID-19 has decreased, from 14% being hospitalized at least once during spring 2020, to 4% during spring 2021. The mean number of hospital bed-days decreased significantly for men from the 1st to the 2nd wave (from 13 days, 95% CI=11.5-14.5 to 10 days (9-11) for men aged ≥68 years, and from 11 days (10-12) to 9 days (8-10) for men aged 20-67 years), but not for women. Conclusion: COVID-19 places a continued high demand on the primary care services, and a decreasing demand on the specialist care services.

scholarly journals Division of Primary Care Services Between Physicians, Physician Assistants, and Nurse Practitioners for Older Patients With Diabetes

2013 ◽  
Vol 70 (5) ◽  
pp. 531-541 ◽  
Author(s):  
Christine M. Everett ◽  
Carolyn T. Thorpe ◽  
Mari Palta ◽  
Pascale Carayon ◽  
Valerie J. Gilchrist ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Older Patients ◽  
Physician Assistants ◽  
Care Services ◽  
Primary Care Services ◽  
Patients With Diabetes

Evaluation of quality indicators near death in older adult cancer decedents in Japan: A nationwide retrospective cohort study

2021 ◽  
Author(s):  
Sachie Shirane ◽  
Nobuaki Michihata ◽  
Kazuhiro Yoshiuchi ◽  
Keisuke Ariyoshi ◽  
Satoru Iwase ◽  
...  
Keyword(s):  
Length Of Stay ◽  
End Of Life ◽  
Older Adult ◽  
Quality Indicators ◽  
Older Patients ◽  
Oldest Old ◽  
Age Groups ◽  
National Database ◽  
Old Patients ◽  
Hospitalization Costs

Abstract Objectives End-of-life cancer care is important; however, data on hospitalization and costs for older patients have been lacking. We aimed to examine quality indicators and costs for older patients in Japan. Methods Using the Diagnosis Procedure Combination database, a national database of acute-care hospitals in Japan, we retrospectively collected data on cancer decedents aged ≥65 years. We evaluated the quality indicators (hospitalizations, length of stay in the hospital, emergency hospitalizations, emergency hospitalizations using an ambulance, intensive care unit [ICU] admissions, length of stay in the ICU, interval between last chemotherapy use and death, and chemotherapy within 14 days before death) and hospitalization costs at 30, 90 and 180 days before death. We compared the outcomes across age groups (65–74, 75–84 and ≥ 85 years). Results Between January 2011 and March 2015, we identified 369 616 cancer decedents. From 180 to 30 days before death, there were increases in emergency hospitalizations, emergency hospitalizations using an ambulance, and the mean costs per hospital day. Overall, 16.7% of patients receiving chemotherapy last received this treatment on the day before death or the day of death. Costs decreased with increasing age. The group aged ≥85 years had the shortest hospital and ICU stays and the lowest multiple hospitalizations, ICU admissions, chemotherapy within 14 days before death, and costs. Conclusions Many older adult patients had emergency hospitalizations and received chemotherapy just prior to death, and there is room for improvement in appropriate end-of-life care. Oldest old patients consumed relatively few medical resources.

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