College of Nursing, Thomas Jefferson University, 130 S. 9th Street, Suite 867, Philadelphia, PA, USA.
College of Nursing, Thomas Jefferson University, 130 S. 9th Street, Suite 867, Philadelphia, PA, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, USA; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St, Suite 704, Philadelphia PA 19107.
Geriatr Nurs. 2021 Sep-Oct;42(5):1029-1034. doi: 10.1016/j.gerinurse.2021.06.009. Epub 2021 Jul 10.
BACKGROUND/OBJECTIVES: Home health care (HHC) agencies provide an important role in helping to transition patients from acute care to independent residential living. Telehealth has the potential to transform care delivery in HHC, however the majority of studies in HHC have focused on the use of telemonitoring for patients with specific chronic conditions. The objective of this study was to examine reasons HHC patients use acute care services and assess the acceptability of on-demand telehealth services among HHC patients, caregivers and personnel to help alleviate the need for seeking in-person acute care. Design/Setting/Participants/Measures: This study was a secondary analysis of qualitative data from in-depth interviews of 30 HHC personnel, patients and caregivers from a Medicare-certified HHC agency affiliated with a large healthcare system from January through May 2020. A conventional content analysis approach was used to identify themes.
Themes associated with reasons for seeking acute care included: sense of urgency, behavioral and psychosocial factors, and access to care. Participants described their perceptions of the benefits, usability and acceptability and barriers to using telehealth. Patients and HHC personnel agreed that on-demand telehealth should not replace in-person visits but all identified roles that on-demand telehealth services could play in improving communication and access to care. The biggest barriers to use of telehealth identified by HHC personnel were cost, access and ability to use technology by HHC patients.
This study identified reasons HHC patients seek unscheduled acute care and the usability and acceptability of on-demand telehealth services to increase access to care among HHC patients. These findings underscore the need to improve communication and coordination between patients, HHC personnel, and primary care providers and the role that on-demand telehealth services can have in transforming HHC.
背景/目的：家庭保健（HHC）机构在帮助患者从急性护理过渡到独立居住方面发挥着重要作用。远程医疗有可能改变 HHC 的护理服务方式，但 HHC 中的大多数研究都集中在使用远程监测特定慢性病患者。本研究的目的是探讨 HHC 患者使用急性护理服务的原因，并评估 HHC 患者、护理人员和人员对按需远程医疗服务的接受程度，以帮助减轻对寻求门诊急性护理的需求。设计/设置/参与者/措施：本研究是对与大型医疗保健系统相关的医疗保险认证 HHC 机构的 30 名 HHC 人员、患者和护理人员的深入访谈的定性数据的二次分析。采用常规内容分析方法确定主题。
与寻求急性护理原因相关的主题包括：紧迫性、行为和心理社会因素以及获得护理的机会。参与者描述了他们对远程医疗的益处、可用性和可接受性以及使用障碍的看法。患者和 HHC 人员都认为按需远程医疗不应替代面对面就诊，但都确定了按需远程医疗服务在改善沟通和获得护理方面可以发挥的作用。HHC 人员认为使用远程医疗的最大障碍是成本、获取和 HHC 患者使用技术的能力。
本研究确定了 HHC 患者寻求非计划性急性护理的原因，以及按需远程医疗服务的可用性和可接受性，以增加 HHC 患者获得护理的机会。这些发现强调了需要改善患者、HHC 人员和初级保健提供者之间的沟通和协调，以及按需远程医疗服务在改变 HHC 方面可以发挥的作用。
