scholarly journals Providers’ Perceptions of Telehealth Barriers Among Homebound Adults in in a Home-Based Primary Care Practice

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 537-537
Author(s):  
Alex Kalicki ◽  
Peter Gliatto ◽  
Emily Franzosa ◽  
Katherine Ornstein ◽  
Kate Moody
Keyword(s):  
Primary Care ◽  
New York ◽  
Care Practice ◽  
Provider Perceptions ◽  
Targeted Interventions ◽  
Home Based Primary Care ◽  
Home Based ◽  
Dramatic Shift ◽  
Patients Experience ◽  
First Time

Abstract The COVID-19 pandemic resulted in a dramatic shift to video-based telehealth use in home-based primary care. We conducted an online 11-item survey exploring provider perceptions of patients’ experience with and barriers to telehealth in a large HBPC program in New York City. More than one-third (35%) of patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020. The majority (82%) required assistance from a family member and/or paid caregiver. Among patients who had not used telehealth, providers deemed 27% (n=153) “unable to interact over video” for reasons including cognitive or sensory ability. Fourteen percent lacked caregivers. Physicians were not knowledgeable about patients’ internet connectivity, ability to pay for cellular plans, and video-capable device access. These findings highlight the need for novel approaches to facilitating telehealth and systematic data collection before targeted interventions to increase video-based telehealth use.

scholarly journals “There Is Something Very Personal About Seeing Someone’s Face”: Provider Perceptions of Video Visits in Home-Based Primary Care During COVID-19

2021 ◽  
pp. 073346482110283
Author(s):  
Emily Franzosa ◽  
Ksenia Gorbenko ◽  
Abraham A. Brody ◽  
Bruce Leff ◽  
Christine S. Ritchie ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioners ◽  
Nurse Managers ◽  
Adult Population ◽  
Provider Perceptions ◽  
Home Based Primary Care ◽  
Home Based ◽  
Rapid Deployment ◽  
Older Adult Population

The rapid deployment of video visits during COVID-19 may have posed unique challenges for home-based primary care (HBPC) practices due to their hands-on model of care and older adult population. This qualitative study examined provider perceptions of video visits during the first wave of the COVID-19 crisis in New York City (NYC) through interviews with HBPC clinical/medical directors, program managers, nurse practitioners/nurse managers, and social work managers ( n = 13) at six NYC-area practices. Providers reported a combination of commercial (health system-supported) and consumer (e.g., FaceTime) technological platforms was essential. Video visit benefits included triaging patient needs, collecting patient information, and increasing scheduling capacity. Barriers included cognitive and sensory abilities, technology access, reliance on caregivers and aides, addressing sensitive topics, and incomplete exams. Effectively integrating video visits requires considering how technology can be proactively integrated into practice. A policy that promotes platform flexibility will be crucial in fostering video integration.

“I felt useless”: a qualitative examination of COVID-19’s impact on home-based primary care providers in New York

2021 ◽  
pp. 1-15
Author(s):  
Ksenia Gorbenko ◽  
Emily Franzosa ◽  
Sybil Masse ◽  
Abraham A Brody ◽  
Orla Sheehan ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Primary Care Providers ◽  
Care Providers ◽  
Home Based Primary Care ◽  
Home Based

scholarly journals “At Home, with Care”: Lessons from New York City Home‐based Primary Care Practices Managing COVID ‐19

2020 ◽  
Author(s):  
Emily Franzosa ◽  
Ksenia Gorbenko ◽  
Abraham A. Brody ◽  
Bruce Leff ◽  
Christine S. Ritchie ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
New York City ◽  
York City ◽  
Home Based Primary Care ◽  
Home Based ◽  
Care Practices ◽  
Primary Care Practices ◽  
At Home

A QUALITATIVE INVESTIGATION OF THE IMPACT OF HOME-BASED PRIMARY CARE ON FAMILY CAREGIVERS

2019 ◽  
pp. 1-4
Author(s):  
E. Wool ◽  
J.L. Shotwell ◽  
J. Slaboda ◽  
A. Kozikowski ◽  
K.L. Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Family Caregivers ◽  
Emotional Support ◽  
Positive Impact ◽  
Clinical Care ◽  
Family Members ◽  
Home Based Primary Care ◽  
Home Based ◽  
The Impact

Background: Home-based primary care (HBPC) provides team-based clinical care for homebound patients who have difficulty accessing typical outpatient care. Interdisciplinary team members also provide social and emotional support and serve as a resource for family caregivers, who often experience significant emotional stress. Objectives: This qualitative study explores the impact of HBPC on family caregivers to identify aspects of the program that caregivers find most helpful and meaningful as well as areas for improvement. Design: Semi structured recorded interviews were conducted with family caregivers of frail, elderly homebound patients. Interviews included the following topics: overall program satisfaction and suggestions for improvement. Setting: A HBPC program serving patients in Queens, Nassau and Suffolk counties in New York. Participants: Nineteen family caregivers: 13 women, 6 men; 10 were adult children; 6 were spouses, and 3 were other family members of patients in a HBPC program. Measurements: Thematic coding of all recorded transcribed interviews was prepared by 3 qualitative coders. Interrater reliability was conducted to ensure reliability across coders before themes were disseminated and discussed until consensus was achieved with the larger group of investigators. Results: Three main themes were identified: the importance of staff emotional support; the burden of caring for homebound patients; and the need for a broader range of home-based services. Multiple family members noted that the program not only had saved their loved one’s life, but had also metaphorically saved their own. Conclusions: Family caregivers value the communication and accessibility of HBPC and report that the program has a positive impact on their stress and mental health. Results can inform key aspects that need to be retained or enhanced with the expansion in HBPC programs.

Variation in Value-Based Outcome Measures Among Assisted Living Communities Served by a Home-Based Primary Care Practice During COVID-19

2020 ◽  
Vol 33 (1) ◽  
pp. 45-48
Author(s):  
William R. Mills ◽  
Janet M. Buccola ◽  
Jamie Roosa ◽  
Lisa Lemin ◽  
Lynn Cappelli ◽  
...  
Keyword(s):  
Primary Care ◽  
Assisted Living ◽  
Primary Care Practice ◽  
Hospitalization Rate ◽  
Care Practice ◽  
Community Settings ◽  
Home Based Primary Care ◽  
Home Based ◽  
The Mean ◽  
At Home

We aimed to determine the hospitalization rate and average days spent at home in a population of assisted living (AL) residents served by a home-based primary care (HBPC) practice during the COVID-19 pandemic. We provided on-site HBPC to 1,699 AL residents and calculated hospitalization rate and days spent at home. The AL population had a mean age of 84 ± 10 years and 73% were female. The mean hospitalization rate was 449 admissions per 1,000 per year, and there was wide variation among AL communities. AL residents spent a mean of 358 days at home per year, and the average days spent at home varied during the COVID-19 pandemic. Use of these measures may help AL articulate its value proposition by enabling seniors with complex health needs to live in community settings for as many days as possible.

scholarly journals Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study

JMIR Aging ◽  
10.2196/12415 ◽  
2019 ◽  
Vol 2 (1) ◽  
pp. e12415 ◽  
Author(s):  
Andrzej Kozikowski ◽  
Jillian Shotwell ◽  
Eve Wool ◽  
Jill C Slaboda ◽  
Karen A Abrashkin ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Qualitative Study ◽  
Nurse Practitioners ◽  
Care Program ◽  
The United States ◽  
Care Team ◽  
Medical Needs ◽  
Home Based Primary Care ◽  
Home Based

Background Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Objective The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients. Methods We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results Four broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations.

scholarly journals Provider Perceptions of Video Telehealth in Home-Based Primary Care During COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 537-537
Author(s):  
Emily Franzosa ◽  
Abraham Brody ◽  
Bruce Leff ◽  
Christine Ritchie ◽  
Bruce Kinosian ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Nurse Managers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Provider Perceptions ◽  
Home Based Primary Care ◽  
Sensitive Topics ◽  
Home Based

Abstract The COVID-19 pandemic accelerated the adoption of virtual care. In this qualitative study, we sought to determine provider perceptions of video telehealth during the first wave of COVID-19 in NYC to inform practice for home-based primary care providers nationwide. We conducted semi-structured interviews with clinical directors, program managers, nurse practitioners, nurse managers, and social workers at 6 NYC practices (N=13) in spring 2020. We used combined open and focused coding to identify themes. Participants employed both hospital-supported and commercial technological platforms to maintain care during COVID-19. Benefits of video telehealth included improved efficiency, capacity and collaboration between providers. Barriers included patients’ physical, cognitive or technological abilities, dependence on caregivers and aides to facilitate video visits, challenges establishing trust with new patients and addressing sensitive topics over video, and concerns over missing important patient information. Considering patient, clinical, and technological conditions can help optimize telehealth implementation among older homebound adults.

scholarly journals Disruptions in Care and Support for Homebound Adults in Home-Based Primary Care in New York City During the COVID-19 Pandemic

2021 ◽  
Vol 39 (4) ◽  
pp. 211-214
Author(s):  
Alex D. Federman ◽  
Bruce Leff ◽  
Abraham A. Brody ◽  
Sara Lubetsky ◽  
Albert L. Siu ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
New York City ◽  
York City ◽  
Home Based Primary Care ◽  
Home Based ◽  
Care And Support

scholarly journals The Psychological Impact of COVID-19 on Home Based Primary Care Providers in New York: A Qualitative Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 383-383
Author(s):  
Emily Franzosa ◽  
Sybil Masse ◽  
Abraham Brody ◽  
Jonathan Ripp ◽  
Katherine Ornstein ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioners ◽  
Psychological Impact ◽  
Well Being ◽  
Primary Care Providers ◽  
Personal Accomplishment ◽  
Care Providers ◽  
Home Based Primary Care ◽  
Home Based

Abstract Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.

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