Abstract
BackgroundNovel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs.ObjectiveThe purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients.MethodsWe collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens.ResultsFour broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth.ConclusionsThese findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations.
Highlights
Estimates show that there are between 1 and 4 million homebound US adults aged 65 and older [1,2,3]
A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the home-based primary care (HBPC) program will hopefully facilitate the optimal integration of telehealth innovations. (JMIR Aging 2019;2(1):e12415) doi:10.2196/12415
Ornstein et al found that the homebound are much more likely to have been hospitalized in the past year than their nonhomebound counterparts (52% vs 16%), and very few (12%) receive home-based primary care (HBPC) [3]
Summary
Estimates show that there are between 1 and 4 million homebound US adults aged 65 and older [1,2,3]. 1 | e12415 | p.1 (page number not for citation purposes) disadvantaged due to experiencing difficulties in attending traditional primary care office visits, which results in significantly decreased access to care. Instead, they rely heavily on costly emergency department visits and hospitalizations, which lead to further deterioration of health, diminished functional status, institutionalization, and a hastened death [7]. Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs
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