Experiences of patients and their caregivers in a Virtual Ward in Singapore: A descriptive qualitative study.

BACKGROUND: The experiences of COVID-19 patients admitted to Virtual Wards and their caregivers are underexplored in Asian communities. A COVID-19 Virtual Ward (CVW) was recently established in Singapore. AIM: This study aims to describe the experiences of high-risk COVID-19 patients admitted to a Virtual Ward and their caregivers in a multi-racial Asian community. METHODS: A descriptive qualitative study was conducted from November 2021 to March 22 among high-risk COVID-19 patients and their caregivers who had been admitted to a CVW. The CVW involved teleconsultation whereby patients submitted their vital signs via a chatbot on their mobile phone and were supported remotely by a team of allied health professionals. In-depth interviews were conducted with patients and their caregivers and analyzed thematically. Findings The findings were supported by three themes. First, CVW admissions were perceived to be safe and effective. The second emerging theme related to the benefits and burdens of receiving care at home. The benefits of CVW were perceived comfort and familiarity with the home environment, while burdens included ensuring discipline in submitting health data and self-isolating from other household members. Last, the role of external factors such as informal support, paid domestic workers, and work arrangements was highlighted by the participants. Overall, key enablers for a successful CVW experience were the availability of social support, timely care from the care team, and 24/7 access to the team. CONCLUSION: In conclusion, CVW was perceived as a safe and effective strategy to manage high-risk patients at home. We recommend that Virtual Wards should be further developed to expand bed capacity in both pandemic and non-pandemic settings.

Experiences of Patients and Their Caregivers Admitted to a Hospital-at-Home Program in Singapore: a Descriptive Qualitative Study.

BACKGROUND: Hospital at Home (HaH) programs have been shown to improve clinical outcomes, quality of care, and patient satisfaction. However, how Asian patients experience HaH remained underexplored. OBJECTIVE: To explore the perceptions and experiences of patients and caregivers admitted to a hospital-at-home program in Singapore. DESIGN: Descriptive qualitative study design. PARTICIPANTS: Purposive sampling was used to conduct 36 interviews with 13 patients, nine Legally Acceptable Representatives (LARs), and 14 caregivers until data saturation was achieved. INTERVENTIONS: NUHS@Home is a HaH program providing care through a multi-disciplinary team, enabled by remote vital signs monitoring through a tablet and wireless blood pressure and oxygen meters. APPROACH: This study used in-depth semi-structured individual interviews. Interviews were transcribed and thematically analyzed using Braun and Clark's six-step inductive approach. KEY RESULTS: The overarching theme identified was "Enablers, difficulties, and improvements to the HaH experiences" which was supported by three key themes: (1) Perceived better care at home, (2) Importance of social support, and (3) Organizational structures required to support HaH. Participants described overall HaH experiences around factors contributing to their impeding engagement, overall satisfaction, and quality of care. CONCLUSIONS: Although HaH is unfamiliar to the Singapore population, most of the participants in this study had an overall positive experience. The key challenges found in this paper were the stress and inconvenience caused to caregivers. The enablers for positive HaH experiences were (1) consideration of patient's family members as key participants in the patients' therapeutic alliance; (2) the HaH care team must be accessible, approachable, and reassuring, and communicate frequently and timely with patients and their families; and (3) financing strategies to ensure HaH out-of-pockets costs remain affordable which are critical to keeping HaH as an option for patients and families.