Symptom Management over Time Among Homebound Patients Receiving Home-Based Primary and Palliative Care (SA527-A)

Abstract

1.Review changes in symptom burden over time among chronically ill homebound.2.Describe management of symptoms among homebound patients receiving home-based primary care services. Increasing numbers of patients, many of whom are frail and elderly, are living with multiple chronic medical conditions and functional impairments that leave them homebound. Home-based primary care (HBPC) programs provide access to healthcare services for this vulnerable population. The Mount Sinai Visiting Doctors Program (MSVD) is a primary and palliative care program that cares for over 1,000 homebound patients annually. Our previous study showed that homebound patients have high symptom burden upon program entry including pain (47%) presumably due to the conditions and/or treatments that contribute to their homebound state. Yet little is known as to how individual symptoms are treated at home and how they respond to intervention, especially over longer time periods. The purpose of this study was to see how symptoms change over time following HBPC enrollment. HBPC patients who reported any symptoms on the Edmonton Symptom Assessment Scale (ESAS) at program entry between 2008 and 2010 were eligible for telephone ESAS follow-up at 3 week and 12 week intervals. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow up care, interdisciplinary care management including social work, and urgent in home care as necessary. Paired t-tests assessed change between baseline and subsequent time points. 130 patients were followed. For each individual symptom, among those with baseline moderate or severe symptoms, mean symptom score decreased at 3 week follow up (p < .05). Patient pain, anxiety, depression, lack of well-being, loss of appetite, drowsiness, nausea, and tiredness remained significantly decreased at 12 week follow-up. In a non-hospice chronically ill population of urban homebound, patient symptoms can be successfully managed in the home.