The Nuts and Bolts of Utilizing Telemedicine in Nursing Homes – The GeriCare@North Experience

Abstract

ObjectivesWe examined the demographics and the clinical profile of teleconsultations conducted between an acute geriatric medicine department and 8 nursing homes over a period of 6.5 years. DesignThis is a prospective, descriptive study. Setting and ParticipantsThis study was conducted in 8 nursing homes of Singapore. All nursing home patients referred to the program for teleconsultation between December 2010 and May 2017 were enrolled in the study. MeasuresThe unit observed and studied was the individual telemedicine consultation. Each unique patient contributed 1 or more observation points. The data collected included consultation dates, patient demographics, background medical comorbidities, reasons for referral, physical examination findings, primary diagnoses, and general management plans recommended by the doctors. ResultsThere were 1673 teleconsultations conducted with 850 unique patients. Most of these patients were categorized as having moderate to severe disability. Ninety-five percent of the consultations were scheduled. The main reasons for referral were for medication review (47.6%) and behavioral problems (22.1%). The 4 commonest comorbidities were hypertension (57.0%), dementia (40.0%), diabetes (39.0%), and hyperlipidemia (38%). The most common primary diagnosis was dementia (21.6%), of which 227 of those diagnosed (62.8%) were referred for behavioral and psychological symptoms of dementia. Conclusions and ImplicationsA telemedicine service for older patients is feasible and could be of a high quality, especially if made available in places where a high density of the latter reside, such as in the care homes and other nursing and rehabilitation facilities.