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3.
J Cyst Fibros ; 20 Suppl 3: 57-63, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587342

ABSTRACT

BACKGROUND: Cystic fibrosis (CF) programs and people with CF (PwCF) employed various monitoring methods for virtual care during the COVID-19 pandemic. This paper characterizes experiences with remote monitoring across the U.S. CF community. METHODS: The CF Foundation (CFF) sponsored distribution of home spirometers (April 2020 to May 2021), surveys to PwCF and CF programs (July to September 2020), and a second program survey (April to May 2021). We used mixed methods to explore access, use, and perspectives regarding the use of remote monitoring in future care. RESULTS: By October 2020, 13,345 spirometers had been distributed, and 19,271 spirometers by May 2021. Programs (n=286) estimated proportions of PwCF with home devices increased over seven months: spirometers (30% to 70%), scales (50% to 70%), oximeters (5% to 10%) with higher estimates in adult programs for spirometers and oximeters. PwCF (n=378) had access to scales (89%), followed by oximeters (48%) and spirometers (47%), often using scales and oximeters weekly, and spirometers monthly. Over both surveys, some programs had no method to collect respiratory specimens for cultures associated with telehealth visits (47%, n=132; 41%, n=118). Most programs (81%) had a process for phlebotomy associated with a telehealth visit, primarily through off-site labs. Both PwCF and programs felt future care should advance remote monitoring and recommended improvements for access, training, and data collection systems. CONCLUSIONS: PwCF and programs experienced unprecedented access to remote monitoring and raised its importance for future care. Improvements to current systems may leverage these shared experiences to augment future care models.


Subject(s)
COVID-19 , Cystic Fibrosis , Equipment and Supplies/supply & distribution , Home Care Services , Monitoring, Physiologic/methods , Spirometry , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Child , Cystic Fibrosis/diagnosis , Cystic Fibrosis/epidemiology , Cystic Fibrosis/therapy , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Home Care Services/organization & administration , Home Care Services/standards , Humans , Models, Organizational , Needs Assessment , Oximetry/instrumentation , Oximetry/methods , Quality Improvement , SARS-CoV-2 , Spirometry/instrumentation , Spirometry/methods , Telemedicine/methods , Telemedicine/standards , United States/epidemiology
4.
Fam Pract ; 38(5): 549-555, 2021 09 25.
Article in English | MEDLINE | ID: covidwho-1575306

ABSTRACT

BACKGROUND: Virtual consults have replaced in-person visits for many home-isolated patients with COVID-19 disease. OBJECTIVES: To describe the natural history, clinical management and outcomes of community-dwelling patients with COVID-19, who received support from a family medicine-led, virtual CovidCare@Home program in Toronto, Ontario, Canada. METHODS: Observational, descriptive study conducted by retrospective chart review of 98 patients enrolled during the first 5 weeks of program implementation (8 April-11 May 2020); 73 patients with laboratory-confirmed COVID-19, with symptom onset ≤ 14 days before initial consult were included for analysis. Patients were classified as mild, moderate or severe based on WHO Criteria. RESULTS: All patients in the program experienced mild (88%) or moderate (12.3%) disease. No patients were hospitalized or died. Patients were mainly female (70%); with mean age of 43.3 years. Most patients (82.2%) worked in higher risk, healthcare settings. Almost 40% had no medical co-morbidities. Common symptoms were cough (65.8%), fatigue (60.3%), headache (42.5%) and myalgia (39.7%), followed by fever (32.9%), sore throat (21.9%), nasal congestion (21.9%) and rhinorrhea (20.5%). Headache (51%) and anosmia (45.1%) were common among females; fever and breathlessness among males (40.9%). Nine patients (12.3%) experienced worsening of symptoms (mainly respiratory) or exacerbation of co-morbidities, which required care outside the virtual service. CONCLUSION: Patients with mild to moderate COVID-19 disease can be managed safely and effectively in a family medicine-led virtual program. Some sex differences in symptoms were observed. Future work should focus on long-term follow up in view of the existence of so-called 'long-haulers'.


Subject(s)
COVID-19/therapy , Home Care Services/organization & administration , Primary Health Care/organization & administration , Symptom Assessment , Telemedicine , Adult , Female , Humans , Male , Retrospective Studies , Risk Factors , SARS-CoV-2
6.
J Cardiopulm Rehabil Prev ; 41(2): 88-92, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1406511

ABSTRACT

The unprecedented nature of the COVID-19 pandemic has challenged how and whether patients with heart disease are able to safely access center-based exercise training and cardiac rehabilitation (CR). This commentary provides an experience-based overview of how one health system quickly developed and applied inclusive policies to allow patients to have safe and effective access to exercise-based CR.


Subject(s)
COVID-19/epidemiology , Cardiac Rehabilitation/methods , Exercise Therapy/methods , Heart Failure/rehabilitation , Home Care Services/organization & administration , Pandemics , Comorbidity , Heart Failure/epidemiology , Humans , SARS-CoV-2
9.
Diabetes Metab Syndr ; 15(5): 102228, 2021.
Article in English | MEDLINE | ID: covidwho-1333362

ABSTRACT

AIM: Amidst COVID-19 pandemic, the health care delivery in India faces major challenges owing to the overwhelming hospitals, exhausted healthcare workers, and shortage of crucial medical supplies such as ventilators and oxygen. The study aims to propose a novel successful interventional home care model, the Virtual COVID In-Patient (VCIP) care for effective COVID management. METHODS: The Covid-19 positive patients enrolled in VCIP were chosen for the study. A 24/7 active multidisciplinary WhatsApp group was created for each patient, for remote monitoring of temperature, blood pressure, blood glucose, respiratory and pulse rate along with the symptoms. Advice on sleep and exercises were given along with the medication via video-audio consultations. Lab facility was provided at the doorstep. Training on various devices, medications including steroids, delivering subcutaneous injections etc were given via video platforms. RESULTS: Among the 220 patients who availed the VCIP facility, only two were hospitalized, yielding a 99.5 % success rate in preventing hospitalizations and patients enrolled have been immensely satisfied with their experience. CONCLUSIONS: With similar pandemics anticipated in near future, VCIP model may be considered for successful domiciliary treatment and overcoming the challenges.


Subject(s)
COVID-19/therapy , Home Care Services/organization & administration , Models, Organizational , Algorithms , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Diabetes Complications/epidemiology , Diabetes Complications/therapy , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Female , Hospitalization/statistics & numerical data , Humans , India/epidemiology , Internationality , Male , Middle Aged , Models, Nursing , Monitoring, Physiologic/methods , Pandemics , Prognosis , Referral and Consultation/organization & administration , Telemedicine/organization & administration , Treatment Outcome
10.
J Am Geriatr Soc ; 69(10): 2963-2972, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1304114

ABSTRACT

BACKGROUND: Although more than seven million older adults struggle or are unable to leave their homes independently, only a small minority access home-based primary care (HBPC). Despite substantial growth of HBPC, fueled by growing evidence supporting positive patient outcomes and cost savings, the population remains dramatically underserved and many evidence gaps still exist around scope of practice and key issues in care delivery and quality. Understanding the current state of the field is critical to the delivery of high-quality home-based care. METHODS: We conducted a systematic search of the peer-reviewed literature on HBPC, published between January 2010 and January 2020, using Medline, CINAHL, Embase, Web of Science, and Scopus online libraries. All studies were evaluated by two members of the research team, and key findings were extracted. RESULTS: The initial search yielded 1730 unique studies for screening. Of these initial results, 1322 were deemed not relevant to this review. Of the 408 studies deemed potentially relevant, 79 were included in the study. Researchers identified five overarching themes: the provision of HBPC, the composition of care teams, HBPC outcomes, the role of telehealth, and emergency preparedness efforts. CONCLUSION: The need and desire for growth of HBPC has been highlighted by the recent COVID-19 pandemic. Current research on HBPC finds a diverse scope of practice, successful use of interdisciplinary teams, positive outcomes, and increasing interest in telehealth with many areas ripe for further research.


Subject(s)
COVID-19 , Civil Defense/standards , Delivery of Health Care/standards , Home Care Services , Primary Health Care , Telemedicine , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Health Services Needs and Demand , Home Care Services/organization & administration , Home Care Services/standards , Home Care Services/trends , Humans , Primary Health Care/methods , Primary Health Care/organization & administration , Professional Practice Gaps , SARS-CoV-2 , Telemedicine/methods , Telemedicine/trends , United States
11.
Br J Community Nurs ; 26(7): 328-333, 2021 Jul 02.
Article in English | MEDLINE | ID: covidwho-1299698

ABSTRACT

The COVID-19 pandemic has necessitated innovations in practice in almost all areas of healthcare, not least community nursing services. This article details how one organisation planned and executed a home vaccination programme for housebound members of the population in its remit. It discusses the challenges faced by the team, as well as the key learnings achieved from this programme, which will guide future home immunisation programmes. Implementation of this programme required excellent coordination between clinicians and administrative staff. Importantly, support from the procurement and IT teams and the medicines management committee went a long way in the ironing out of early hiccups and in ensuring smooth running of the programme.


Subject(s)
COVID-19 Vaccines , Home Care Services/organization & administration , Homebound Persons , Mass Vaccination/organization & administration , State Medicine , Humans , United Kingdom
12.
Home Healthc Now ; 39(4): 211-214, 2021.
Article in English | MEDLINE | ID: covidwho-1288200

ABSTRACT

Homebound older adults are a highly vulnerable population, yet little is known about their experiences with healthcare during the COVID-19 pandemic. We interviewed patients in home-based primary care (HBPC) in New York City by telephone in May and June of 2020. Interviews covered social supports, household activities, self-care, and medical care, and asked participants to compare current with prepandemic experiences. Among 70 participants, 37% were Black and 32% were Hispanic. Disruptions in the home included greater difficulty accessing paid caregivers (13.9%) and food (35.3%) than before the pandemic, and unaddressed household chores (laundry, 81.4%; food preparation, 11.4%). Black study participants were more likely than White and Hispanic participants to report disruptions in accessing medical care (13 [50.0%] vs. 3 [14.3%] vs. 6 [27.3%], respectively, p = 0.02), as well as food preparation and medication taking. Black patients in HBPC are at risk of disparities in healthcare and social support during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility/statistics & numerical data , Home Care Services/organization & administration , Homebound Persons , Primary Health Care/organization & administration , Activities of Daily Living , Aged , Aged, 80 and over , Ethnicity/statistics & numerical data , Female , Food Insecurity , Humans , Male , New York City/epidemiology , Pandemics , SARS-CoV-2 , Social Support
14.
J Korean Med Sci ; 36(19): e134, 2021 May 17.
Article in English | MEDLINE | ID: covidwho-1232535

ABSTRACT

During the three the coronavirus disease 2019 (COVID-19) surges in South Korea, there was a shortage of hospital beds for COVID-19 patients, and as a result, there were cases of death while waiting for hospitalization. To minimize the risk of death and to allow those confirmed with COVID-19 to safely wait for hospitalization at home, the local government of Gyeonggi-do in South Korea developed a novel home management system (HMS). The HMS team, comprised of doctors and nurses, was organized to operate HMS. HMS provided a two-way channel for the taskforce and patients to monitor the severity of patient's condition and to provide healthcare counseling as needed. In addition, the HMS team cooperated with a triage/bed assignment team to expedite the response in case of an emergency, and managed a database of severity for real-time monitoring of patients. The HMS became operational for the first time in August 2020, initially managing only 181 patients; it currently manages a total of 3,707 patients. The HMS supplemented the government's COVID-19 confirmed case management framework by managing patients waiting at home for hospitalization due to lack of hospital and residential treatment center beds. HMS also could contribute a sense of psychological stability in patients and prevented the situation from worsening by efficient management of hospital beds and reduction of workloads on public healthcare centers. To stabilize and improve the management of COVID-19 confirmed cases, governments should organically develop self-treatment and HMS, and implement a decisive division of roles within the local governments.


Subject(s)
COVID-19/therapy , Home Care Services/organization & administration , Home Nursing/organization & administration , Local Government , Pandemics , SARS-CoV-2 , COVID-19/epidemiology , Counseling , Database Management Systems , Databases, Factual , Health Services Needs and Demand , Home Care Services/statistics & numerical data , Home Nursing/statistics & numerical data , Hospital Bed Capacity , Humans , Patient Care Team , Republic of Korea/epidemiology , Self Care , Waiting Lists
16.
Pan Afr Med J ; 38: 196, 2021.
Article in English | MEDLINE | ID: covidwho-1209602

ABSTRACT

The onslaught of COVID-19 pandemic has greatly overwhelmed some of the best healthcare systems in the world. Medical practitioners working in hospitals at the epicenters of COVID-19 pandemic have emphasized on the need to manage mildly ill and convalescent COVID-19 patients at home or community facilities rather than at hospitals during a pandemic. In this article, we highlight that a standardized home- and community-based (HCBC) approach for management of COVID-19 patients will be a key component for preparing hospitals in sub-Saharan Africa (SSA) for a potential surge in COVID-19 cases. So far, based on the trajectory of infection, we think that SSA seems to have a window of opportunity, albeit narrowing, for implementing HCBC. However, there are challenges that will need to be addressed in order to implement and maintain HCBC. Successful implementation and maintenance of HCBC in SSA will require international agencies and key donors to work closely with the national governments; providing them with policy, technical, and financial assistance. Home- and community-based care (HCBC) is also important because it can play a role in advocacy, education, training, and health promotion during COVID-19 pandemic. We further underscore the need for a delicate balance between HCBC and hospital-based care (HBC) approach as well as with COVID-19 mitigation and suppression measures in order to reduce the risk of SARS-CoV-2 community transmission and allow optimal continuity of the HBC. We conclude by emphasizing once again that, for countries in SSA to adequately prepare for the worst-case scenario of COVID-19 pandemic in the absence of a cure, policy makers of member states need to act collectively and fast.


Subject(s)
COVID-19/therapy , Community Health Services/organization & administration , Delivery of Health Care/organization & administration , Home Care Services/organization & administration , Africa South of the Sahara , Community Health Services/standards , Delivery of Health Care/standards , Home Care Services/standards , Hospitalization , Humans
18.
J Gerontol Nurs ; 47(4): 7-12, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1175623

ABSTRACT

This process evaluation of the Rural Elder Awareness of Medication Safety (REAMS) program provided identification of successful and unsuccessful elements along with barriers to and facilitators of this home-based pilot program. The REAMS program was developed to assist rural older adults aged >65 years and community health care organizations with strategies to improve health literacy related to medications. Recruitment of older adults, rurality of the program's setting, time constraints, and the onset of the COVID-19 pandemic were the greatest barriers. The collaborative relationship developed with community health care partners was the greatest facilitator. This relationship promoted shared ideas and adjustments in program design to achieve the outcome goals. The lessons learned from process evaluation may benefit future researchers or community health promotion planners with designing community-based programs for older adults in rural areas. Future research should focus on expanding recruitment opportunities in acute care, primary care, and home health with the inclusion of all established health care providers in the community. [Journal of Gerontological Nursing, 47(4), 7-12.].


Subject(s)
Frail Elderly , Health Literacy , Home Care Services/organization & administration , Patient Education as Topic/methods , Patient Medication Knowledge , Patient Safety , Rural Health Services/organization & administration , Aged , Aged, 80 and over , Female , Humans , Male , Pilot Projects , Rural Population , United States
20.
Am J Health Syst Pharm ; 78(12): 1112-1117, 2021 06 07.
Article in English | MEDLINE | ID: covidwho-1093474

ABSTRACT

PURPOSE: Intravenous immune globulin (IVIG) therapy is used in patients with hypogammaglobulinemia to lower the risk of infections. IVIG and subcutaneous IVIG (SCIG) therapy have been to shown to be safe and effective when administered as clinic-based infusions. Concern from both patients and providers for increased transmission of the coronavirus disease 2019 (COVID-19) virus to immunosuppressed patients with scheduled medical visits and procedures made it necessary for us to reassess our process of how we manage patient care in general and chronic clinic infusions in particular. Here we describe our experience of transitioning patients from clinic-based to home based IVIG and/or SCIG infusions to decrease the risk of COVID-19 exposure. METHODS: Criteria were developed to identify high-risk immunosuppressed patients who would be appropriate candidates for potential conversion to home based IVIG infusions. Data were collected via chart review, and cost analysis was performed using Medicare Part B reimbursement data. A patient outcome questionnaire was developed for administration through follow-up phone calls. RESULTS: From March to May 2020, 45 patients met criteria for home-based infusion, with 27 patients (60%) agreeing to home-based infusion. Posttransition patient outcomes assessment, conducted in 26 patients (96%), demonstrated good patient understanding of the home-based infusion process. No infusion-related complications were reported, and 24 patients (92%) had no concerns about receiving future IVIG and/or SCIG doses at home. No patient tested positive for COVID-19 during the study period. Clinic infusion visits decreased by 26.6 visits per month, resulting in a total of 106 hours of additional available infusion chair time per month and associated cost savings of $12,877. CONCLUSION: Transition of clinic based to home based IVIG/SCIG infusion can be successfully done to decrease potential exposure during a pandemic in a high-risk immunosuppressed population, with no impact on patient satisfaction, adherence, or efficacy. The home-based infusion initiative was associated with a reduction in costs to patients and an increase in available chair time in the infusion clinic.


Subject(s)
COVID-19/prevention & control , Home Care Services/organization & administration , Immunocompromised Host , Immunoglobulins, Intravenous/administration & dosage , Adult , Aged , Aged, 80 and over , Ambulatory Care Facilities/organization & administration , Female , Humans , Immunoglobulins, Intravenous/adverse effects , Immunoglobulins, Intravenous/economics , Male , Middle Aged , Patient Care Team , Patient Satisfaction , SARS-CoV-2 , United States
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