Impact of a Novel Multi-Specialist Telemedicine Consultation Program Model of Care for Homebound Older Adults

Abstract

Introduction: In 2015, a centralized Multi-Specialist Telemedicine (TM) Consultation Program was established to improve access to specialist care and enhance continuity of care for homebound older adults in Toronto, Canada. Community-dwelling patients were referred to the program by their primary care providers (PCP), treating specialists, and inpatient physicians for specialist-led post-hospital discharge follow-up care. A clinical nurse specialist (CNS) thereafter collaborated with hospital-based consulting specialists, utilizing videoconferencing technology to facilitate consultations and follow-up visits for homebound patients. Methods: We conducted a retrospective observational study of the overall intervention including patient characteristics and the number/type of consultations provided by analyzing the clinical charts of each enrolled patient. Satisfaction surveys were conducted after five years of program implementation with patients, family caregivers and healthcare providers utilizing paper-based questionnaires administered by members of our research team. Data were analyzed using summary statistics. Results: From April 2015 to March 2020, this program supported a total of 216 homebound patients, with an average age of 84 years, and an average Charlson Comorbidity Index (CCI) of 3.36. Patients received a total of 1,003 consultation and follow-up visits from 42 specialist care providers representing 22 unique clinical specialties. 59 (27%) patients and family caregivers and 22 specialist and primary care providers voluntarily completed satisfaction surveys. 100% of surveyed patients and caregivers reported being very satisfied with the program and 86% of physicians reported that the program enhanced their delivery of patient care. Conclusion: Our TM program had a high participation rate and showed promising results in improving the delivery of patient care by centrally facilitating multi-specialist consultations and maintaining continuity of care for homebound older adults in an urban setting, which may have potentially reduced future ED visits. The program also received high satisfaction rates among providers, patients, and caregivers, indicating a positive response to its implementation.