Résumé
We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were "very" or "extremely" satisfied with the ease of completing the screening via telephone and value for time spent;for 79% the protocol was "very" or "extremely" feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care.
Résumé
Background: At the beginning of the COVID-19 pandemic, there was uncertainty if individuals with spinal cord injury (SCI) were at greater risk for adverse health events. Certainly, there was great concern over direct effects (e.g. physical illness, hospitalization) but also fear of indirect effects (e.g. mental health, isolation, caregiver disruption) due to COVID-19 and the public health measures to contain it. Since individuals with SCI often have limited or tenuous access to healthcare and resources, they are at greater risk than the general population of destabilization. Objective: To proactively identify risks that may be exacerbated by the pandemic and mitigate them where possible, a primary care outreach program was developed. Methods: A screening algorithm was developed by our interdisciplinary Mobility Clinic team, and focuses on 5 domains: health destabilization, mental health, access to services and supports, social isolation, and caregiver stress. The algorithm was administered by phone to a total of 107 individuals, who were identified as past and current Mobility Clinic patients. Any risks identified received further investigation by the team. We used the opportunity to educate patients about the risks of COVID-19 and protective measures. Follow-up with patients continued every 6-8 weeks throughout the duration of the pandemic. An evaluation of this outreach program involved a description of the patient population contacted, the identification of common risks for patients, and patient satisfaction with the program. Results: The contacted patient population consisted of 76 males and 31 females. 74 patients were identified as having a spinal cord injury. Some of the most common questionnaire responses by patients with SCI included feelings of stress and/or anxiety and a reduction in Personal Support Worker services leading to increased caregiver stress. A patient satisfaction survey demonstrated that 83% of patients (n=12) were very satisfied with the phone call and the care received. Conclusion: The outreach program helps us to proactively identify risks for individuals with SCI and address any healthcare needs they have. Risk assessment and care at the primary care level can mitigate adverse events and hospitalizations, which is especially important during a pandemic situation when healthcare and hospital resources are limited.