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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 49-52

The surge of house calls: How COVID-19 pandemic is changing health care


1 Consultant Oral Pathologist, Kozhikkode, Kerala, India
2 Consultant Anesthesiologist and Intensivist, Kozhikkode, Kerala, India
3 Consultant Physician and Intensivist, Kozhikkode, Kerala, India

Date of Submission17-Nov-2021
Date of Acceptance02-Dec-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Dr. Vinit Shashikant Patil
Consultant Oral Pathologist, Kozhikkode, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmo.ijmo_18_21

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  Abstract 


Elderly, homebound individuals comprise a vulnerable segment of society who have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic through a myriad of unique challenges. Home-based primary care or house calls improve the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of house calls, and improved payments for house calls. There are 2 million to 4 million patients who could benefit from house calls, but only few are receiving it. The number of these patients is expected to double over the next two decades and there has been a surge during the COVID-19 pandemic. This requires a larger and better prepared workforce in India. Medical education curricula are necessary for undergraduate and postgraduate students studying medicine to sufficiently develop a future workforce capable of appropriately providing house calls to an increasing number of elderly patients.

Keywords: Frailty, health-care costs, home care, house calls, primary care, residency, workforce


How to cite this article:
Patil VS, Mubarak K A, Ebn Mohammed Abdulla P P, James JV, Ahmed JB, Rafeeque P A, Siraj M. The surge of house calls: How COVID-19 pandemic is changing health care. Int J Med Oral Res 2021;6:49-52

How to cite this URL:
Patil VS, Mubarak K A, Ebn Mohammed Abdulla P P, James JV, Ahmed JB, Rafeeque P A, Siraj M. The surge of house calls: How COVID-19 pandemic is changing health care. Int J Med Oral Res [serial online] 2021 [cited 2022 Jul 6];6:49-52. Available from: http://www.ijmorweb.com/text.asp?2021/6/2/49/333677




  Introduction Top


The COVID-19 pandemic has led to many paradigm changes within the health-care environment. One such change is the need to provide patient populations with high-quality health-care services at a safe distance. Elderly people and those with underlying medical problems such as hypertension, heart problems, and diabetes are more susceptible to develop the disease in its form of most intensive.[1],[2],[3],[4],[5] There are at least 1 million individuals aged 65 and older who are permanently homebound. Millions more are homebound with temporary illness or injury. Many of these older adults rely on home visits from physicians to provide for their health-care needs. From 1999 to 2004, the number of reimbursable home visits increased from approximately 1.5 million to 2.07 million. In 2005, the number of home visits reached a plateau, at least in part because of changes in reimbursement.[3]

Homebound patients tend to be the frailest of the frail, with high levels of functional impairment. These patients are typically nursing home eligible but are at higher risk for inadequate care because of continued residence in the community. Prior research has documented a high disease burden, including dementia, urinary incontinence, falls, diabetes mellitus, depression, stroke, coronary artery disease, cancer, palliative care, and congestive heart failure. Older adults with five or more chronic conditions account for two-thirds of medicare expenditures. Because homebound patients are similar to nursing home patients with regard to chronic disease burden, they require a similar number of provider visits (9–12 visits per year) to provide quality health care. Given that the current population of 1 million homebound elderly people receives only 2.1 million provider visits per year, the need for more providers performing house calls is clear. It is estimated that, by 2020, 2 million elderly people will be chronically homebound because of functional impairment.[1],[2],[3],[4],[5] This universal event has been announced a pandemic by the World Health Organization. A significant factor in slowing down the transmission of the virus is the “social gap” or social distancing that is made possible by the reduction of person-to-person contact. The implementation of various virtual care modalities has been forced to take place at a rapid pace, causing many health-care systems to either develop or restructure existing virtual care programs. Historically, health-care programs have been slow to develop telehealth programs despite telehealth being known to reduce cost and increase patient access.[1],[2],[3],[4],[5] Programs began the implementation of telehealth by seeking out various virtual care services such as Zoom and WhatsApp, Google Duo, Skype and by researching existing electronic medical record virtual health systems.[5],[6],[7],[8],[9],[10]


  What is Telehealth? Top


The use of telehealth technology is a 21st century approach that is both patient-centered and protects patients, physicians, as well as others. Telehealth is the delivery of health-care services by health-care professionals, where distance is a critical factor, through using information and communication technologies for the exchange of valid and correct information. Telehealth services are render using real-time or store-and-forward techniques. With the rapid evolution and downsizing of portable electronics, most families have at least one device of digital, such as smartphones and webcams that provide communication between patient and health-care provider.[11],[12],[13],[14],[15] Video conferencing and similar television systems are also used to provide health-care programs for people who are hospitalized or in quarantine to reduce the risk of exposure to others and employees. Physicians who are in quarantine can employ these services to take care of their patients remotely. In addition, covering multiple sites with a tele-physician can address some of the challenges of the workforce.[16],[17],[18],[19],[20] There are various benefits in using technology of telehealth, especially in nonemergency/routine care and in cases where services do not require direct patient-provider interaction, such as providing psychological services. Remote care reduces the use of resources in health centers, improves access to care while minimizing the risk of direct transmission of the infectious agent from person to person. In addition to being beneficial in keeping people safe, including the general public, patients, and health workers, another important advantage is providing widely access to caregivers. Therefore, this technology is an attractive, effectual, and affordable option. Patients are eager to use telehealth, but hindrances still exist. The barriers of implementing these programs also largely depend on accreditation, payments systems, and insurance. Furthermore, some physicians are concerned about technical and clinical quality, safety, privacy, and accountability. Telehealth can become a basic need for the general population, health-care providers, and patients with COVID-19, especially when people are in quarantine, enabling patients in real time through contact with health-care provider for advice on their health problems. Thus, the aim of this review was to identify and systematically review the role of telehealth services in preventing, diagnosing, treating, and controlling diseases during COVID-19 outbreak.


  Effects of COVID-19 on the Elderly Population Top


Although it is currently unclear what the full extent of the effects of this pandemic will be, its negative impact on psychological well-being has become very evident. Early studies have already reported an increase in anxiety, and depression in the general population, especially those facing extended lockdowns. These effects are magnified in the elderly population due largely to stricter lockdowns, higher threat of illness, and loss of social support. Prior studies have also reported that even outside of crisis times, the elderly population have relatively high rates of depressive symptoms, which is troubling in the face of evidence that those suffering from preexisting mental health conditions have been most affected by the negative psychological consequences of lockdowns. While increased mental health problems in the general population may already be a cause for concern, these concerns go beyond psychological well-being in the elderly. Studies have shown that depression in the elderly is linked the subsequent cognitive decline and risk of Alzheimer's disease. This means that while many societies now face the immediate threat of increasing mental health concerns, the long-term effects could be devastating, as depression and stress result in the older generation facing hastened cognitive decline and increased rates of Alzheimer's disease. This problem will likely be even further worsened by the physical limitations put on the movement of individuals outside their homes, resulting in less exercise opportunities for many individuals. Several studies have shown that exercise, even in light to moderate doses and intensities, can have a significant positive effect on cognitive function in the elderly, especially in those with cognitive impairments or neuropsychiatric disorders.[1],[2],[3],[4],[5] Looking at this prior research, loss of socialization, increased mental strain and general mental health problems, and decreased exercise could have substantial negative effects on the elderly population. Although the lockdowns may be temporary, these effects are likely to be long lasting and could pose significant risks to the quality of life of the elderly population in the coming years. However, the changes many countries have seen come into place since the start of the COVID-19 pandemic extend far beyond loss of socialization and increased depression. Lockdowns have resulted in a significant shift in the functioning of day-to-day life: the world has gone digital. As hospitals have filled with COVID-19 patients, access to regular health care for non-COVID-related disorders has been interrupted. Those who do not seek care for non-COVID-related disorders may be at higher risk of illness and fatality during this period. This risk is likely to disproportionately affect the elderly, who have higher rates of health problems than younger populations and are more likely to be encouraged to avoid areas where they could contract the disease. In response to this problem, there has been a significant shift in health care into the digital world.[21],[22],[23],[24]


  Implementation of Telehealth for Home Bound Patients Throughout COVID-19 Top


The rapid implementation of telehealth services has also provided patient populations with a safe and effective treatment modality during the COVID-19 pandemic. Patient safety is a factor in the implementation of virtual visits. By having a virtual visit at a distance, patients feel that they are being cared for while in the safety of their own home. While this service may not be a full alternative to an in-person visit, it does provide the patient with a feeling of convenience. Virtual visits also are convenient for provider scheduling purposes. This convenience acted as a factor in patient and provider acceptance of usage of telehealth services. The implementation of telehealth services also provided virtual visit opportunities in the inpatient realm of health-care services. During the implementation of telehealth throughout COVID-19, health-care systems encountered barriers to rapid implementation. Barriers such as low internet connectivity, lack of device access, elderly patient populations, and general technology difficulties slowed virtual visit implementation. However, many of these barriers were able to be corrected by varying application usage, patient education practices, and provider/patient flexibility. Telehealth implementation also faced the barrier of lack of provider buy-in. Although older physician may face challenges with technology, they can be educated and trained to use devices and applications. Competency with the use of technology and embracement of such contributions to the delivery of care continues to be an observed barrier in selected studies. As the pandemic continues, many of these barriers should be addressed as health-care systems gain more experience with telehealth. More older adults in India and globally become homebound (never or rarely leave home) each year than enter nursing homes. As such, home-based primary care or house calls is an increasingly adopted approach to delivering health care to older patients in the home, particularly those of whom experience disability, multimorbidity, cognitive impairment, and high rates of hospitalization. Home-based primary care or house calls improve the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of house calls, and improved payments for house calls. There are 2 million to 4 million patients who could benefit from house calls, but only few are receiving it. The number of these patients is expected to double over the next two decades and there has been a surge during the COVID-19 pandemic. This requires a larger and better prepared workforce in India. Medical education curricula are necessary for undergraduate and postgraduate students studying medicine to sufficiently develop a future workforce capable of appropriately providing house calls to an increasing number of elderly patients.


  Conclusion Top


Changes are occurring in health care due to the COVID-19 global pandemic. Telehealth and house calls are continuing to adapt to environmental and industry needs to provide the highest quality of care for a variety of patients while also assisting with physical distancing mandates and other public health measures. The patient experience of care and the specific health outcomes of care delivered through telehealth during the COVID-19 pandemic would also be opportune areas for future research. Health-care organizations are encouraged to continue to infuse telehealth initiatives to support patient care and related outcomes during the COVID-19 pandemic with ongoing attention and efforts directed toward implementation/process improvement of best practices, controlling organizational liability by maintaining standards of care, and the maintenance of altered privacy standards during this challenging pandemic time period at the safety of their homes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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