School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
Belmont Hospital, Hunter New England Local Health District, Belmont, Australia.
BMC Geriatr. 2022 Jan 10;22(1):40. doi: 10.1186/s12877-021-02703-y.
Older people living in Residential Aged Care (RAC) are at high risk of clinical deterioration. Telehealth has the potential to provide timely, patient-centred care where transfer to hospital can be a burden and avoided. The extent to which video telehealth is superior to other forms of telecommunication and its impact on management of acutely unwell residents in aged care facilities has not been explored previously.
In this study, video-telehealth consultation was added to an existing program, the Aged Care Emergency (ACE) program, aiming at further reducing Emergency Department (ED) visits and hospital admissions. This controlled pre-post study introduced video-telehealth consultation as an additional component to the ACE program for acutely unwell residents in RACs. Usual practice is for RACs and ACE to liaise via telephone. During the study, when the intervention RACs called the ED advanced practice nurse, video-telehealth supported clinical assessment and management. Five intervention RACs were compared with eight control RACs, all of whom refer to one community hospital in regional New South Wales, Australia. Fourteen months pre-video-telehealth was compared with 14 months post-video-telehealth using generalized linear mixed models for hospital admissions after an ED visit and ED visits. One thousand two hundred seventy-one ED visits occurred over the 28-month study period with 739 subsequent hospital admissions.
There were no significant differences in hospital admission or ED visits after the introduction of video-telehealth; adjusted incident rate ratios (IRR) were 0.98 (confidence interval (CI) 0.55 to 1.77) and 0.89 (95% CI 0.53 to 1.47) respectively.
Video-telehealth did not show any incremental benefit when added to a structured hospital avoidance program with nursing telephone support.
The larger Aged Care Emergency evaluation is registered with ANZ Clinical Trials Registry, ACTRN12616000588493.
居住在养老院的老年人有发生临床恶化的高风险。远程医疗有可能提供及时、以患者为中心的护理，在这种情况下，将患者转移到医院可能会带来负担，并可以避免这种情况。视频远程医疗相对于其他形式的远程通信的优越性，以及它对养老院中病情急性恶化的居民的管理的影响，以前尚未得到探索。
在这项研究中，视频远程医疗咨询被添加到现有的老年急症（ACE）计划中，旨在进一步减少急诊科（ED）就诊和住院。这项对照前后研究将视频远程医疗咨询作为 ACE 计划的一个附加组件，用于养老院中病情急性恶化的患者。养老院和 ACE 通常通过电话进行联系。在研究期间，当干预的养老院打电话给 ED 的高级执业护士时，视频远程医疗支持临床评估和管理。五个干预养老院与八个对照养老院进行比较，所有对照养老院都向澳大利亚新南威尔士州一个社区医院转诊。在引入视频远程医疗之前的 14 个月和之后的 14 个月，使用广义线性混合模型比较 ED 就诊后和 ED 就诊的住院情况。在 28 个月的研究期间共发生了 1271 次 ED 就诊，随后有 739 次住院。
引入视频远程医疗后，住院或 ED 就诊没有显著差异；调整后的发病风险比（IRR）分别为 0.98（95%CI 0.55 至 1.77）和 0.89（95%CI 0.53 至 1.47）。
在具有护理电话支持的结构化医院回避计划中添加视频远程医疗并没有显示出任何额外的益处。
更大规模的老年急症评估在澳大利亚临床试验注册中心注册，注册号为 ACTRN12616000588493。
