Potential of telemedicine to provide acute medical care for adults in senior living communities.

Objectives Older adults dwelling in senior living communities (SLCs) often experience barriers to medical care when they experience acute illness. The potential of telemedicine as a substitute for standard routes of evaluating and caring for individuals with acute illness (e.g., in-person or telephone-based interactions with primary care providers and emergency department [ED] visits) was explored in this study. Methods In this cross-sectional, observational study, the authors conducted a 6-month retrospective review of the medical records of adults enrolled in a university-affiliated geriatrics practice that offers on-site primary medical care in SLCs. For each episode of acute care, patient demographics, medical history, and chief complaint were collected and presented to an expert panel of physicians, who determined whether telemedicine could have been used to provide acute evaluation and care. The care actually provided, including outcomes, was also noted. Descriptive statistics were used to characterize the population and potential for telemedicine care. Results The medical records of 646 patients were reviewed, accounting for 1,535 unique episodes of acute care. The expert panel identified 576 visits (38%) as potentially appropriate for telemedicine-based acute care, with 38, 47, and 27% of phone, in-home, and ED visits being eligible, respectively. Chief complaints most likely to be deemed potentially appropriate were falls and dermatologic, respiratory, and gastrointestinal illnesses, representing 58% of visits identified for telemedicine-based acute care. Conclusions Telemedicine has a potentially significant role in the provision of acute care for older adults residing in SLCs. Studies are needed to evaluate the feasibility, acceptability, effectiveness, and efficiency of acute care telemedicine for this population. Resumen El Potencial de la Telemedicina para Proporcionar Atencion Medica Aguda a Adultos en Comunidades Residenciales para Mayores Objetivos Los ancianos en comunidades residenciales para mayores (CRM) a menudo experimentan barreras a la atencion medica cuando ellos sufren una enfermedad aguda. Se exploro en este estudio el potencial de la telemedicina como un sustituto de los mecanismos estandar de evaluacion y atencion a los individuos con enfermedad aguda (ej: interacciones personales o telefonicas con los medicos de atencion primaria (MAP) y visitas a los servicios de urgencias (SU)). Metodologia En este estudio observacional transversal, se llevo a cabo una revision retrospectiva de 6 meses de las historias medicas de los adultos en un centro geriatrico afiliado a la universidad que ofrece atencion primaria en CRM. Para cada episodio de atencion aguda, se recogieron las caracteristicas demograficas, la historia medica y la queja principal y se presentaron a un panel de medicos expertos, que determinaron si la telemedicina podia haberse usado para proporcionar la evaluacion y la atencion aguda. La asistencia proporcionada, incluyendo los resultados, tambien se anoto. La estadistica descriptiva se utilizo para caracterizar la poblacion y la atencion potencial para la telemedicina. Resultados Se revisaron las historias medicas de 646 pacientes, y se contabilizaron 1.535 episodios unicos de atencion aguda. El panel de expertos identifico 576 visitas (38%) como potencialmente apropiadas para la atencion aguda mediante telemedicina, y fueron elegibles un 38%, 47% y 27% de llamadas, y visitas al domicilio y a urgencias, respectivamente. Las quejas principales mas probablemente consideradas apropiadas fueron las caidas y las enfermedades dermatologicas, respiratorias y gastrointestinales, que representaron el 58% de las visitas identificadas para atencion aguda mediante telemedicina. Conclusiones La telemedicina tiene un papel potencialmente significativo en la provision de atencion aguda a los ancianos que residen en una CRM. Se necesitan estudios para evaluar la viabilidad, la aceptabilidad, la efectividad y la eficiencia de la atencion aguda mediante telemedicina para esta poblacion.