Adaptations to In-Home Health Care Due to COVID-19: The VA’s Home-Based Primary Care Program

The COVID-19 pandemic disrupted traditional Home Based Primary Care (HBPC) care processes, including changes to provision of face-to-face care in-home for older adults. Our study describes and explains care delivery changes Department of Veterans Affairs (VA) HBPC programs made in response to the pandemic. We fielded a national survey to all 140 VA HBPC programs, targeting interdisciplinary care teams and HBPC leadership. We structured survey questions using a mixed method approach with both closed and open-ended questions, applying a qualitative content analysis approach to open-ended responses complemented by analysis of descriptive quantitative data. Preliminary findings highlight the value and consideration of different telehealth modalities when caring for an older, homebound population, as well as creative adaptations HBPC teams made to deliver care during the pandemic. Implications include nascent development of decision-making paradigms beyond the pandemic particularly for appropriate use of telehealth modalities for older homebound adults.

Bridging Age-Friendly Health Systems Into the Community

As the Age-Friendly Health Systems initiative is implemented across the country, building bridges into the community assures that older adults live safely, enjoy good health and stay involved in their communities. In this symposium, we present innovative approaches that bridge the Age-Friendly Health Systems initiative into the community. Each presentation explores how the 4Ms concepts are integrated into their programs and enhance community with older adults. CATCH-ON Connect provides free cellular-enabled tablets and individual training to older adults to help them do What Matters to them by using their tablets. Rush@Home is a home-based primary care program that addresses the 4Ms in the comfort of an older adult’s home. Social Connections was co-designed with older adults to decrease loneliness by connecting older adults to each other. The Caregiver Initiative identifies and supports caregivers of older adults by meeting the 4Ms health needs of both caregiver and care recipient. Dementia Friendly Communities engage community stakeholders in a process to become educated, creating safe and respectful environments for individuals with dementia. By exploring these approaches, we can bridge the Age-Friendly Health Systems initiative into the community to support older adults outside the four walls of the health system.

Rush@Home: Home-Based Primary Care Focused on Underserved Communities and Health Equity

Homebound patients are often medically complex and are among those in greatest need of care and services. This is especially true for those that reside in underserved communities, where they face the added risk stemming from scarce community resources. Often these patients are only able to access health care for emergencies, which is ineffective and high cost. Rush@Home is a home-based primary care program that exemplifies the Age-Friendly Health System mission with a focus on the 4Ms, incorporating navigation and social work. Patients reflect the West Side of Chicago, with 80% of patients identifying as Black and/or Latino. During the first two years, Rush@Home demonstrated better care at a lower cost with readmission rates decreased by 11.8%, hospitalizations by 17.5%, length of stay by 8.7%, ED visits by 17.9%, and missed appointments by 72%. This presentation will highlight outcomes and discuss key issues in home-based primary care.

Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study

Background The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0. Methods A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used. Results A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03). Conclusion Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community.

Waste Disposal Practices in Low-Income Settlements of South Africa

Domestic solid waste is rapidly increasing due to accelerated population growth and urbanization. Improper waste disposal poses potential health risks and environmental concerns. Here, we investigated waste disposal practices in relation to household/dwelling characteristics in South African low-income communities. Data for 2014 to 2019 from a community-orientated primary care program were analyzed using logistic regression. Families who reported living in a shack were more likely to dump waste in the street. Households who reported using non-electric sources of fuel for heating/cooking, those who lacked proper sanitation, and those who did not have access to piped water inside the dwelling were more likely to dispose of waste by dumping it in the street/in the yard or burying it. Families living in low-income settlements are at risk of solid waste exposure and this situation is exacerbated by poor access to piped water, proper sanitation, and electricity.

Clinical learnings from a virtual primary care program monitoring mild to moderate COVID-19 patients at home

Background Virtual consults have replaced in-person visits for many home-isolated patients with COVID-19 disease. Objectives To describe the natural history, clinical management and outcomes of community-dwelling patients with COVID-19, who received support from a family medicine-led, virtual CovidCare@Home program in Toronto, Ontario, Canada. Methods Observational, descriptive study conducted by retrospective chart review of 98 patients enrolled during the first 5 weeks of program implementation (8 April–11 May 2020); 73 patients with laboratory-confirmed COVID-19, with symptom onset ≤ 14 days before initial consult were included for analysis. Patients were classified as mild, moderate or severe based on WHO Criteria. Results All patients in the program experienced mild (88%) or moderate (12.3%) disease. No patients were hospitalized or died. Patients were mainly female (70%); with mean age of 43.3 years. Most patients (82.2%) worked in higher risk, healthcare settings. Almost 40% had no medical co-morbidities. Common symptoms were cough (65.8%), fatigue (60.3%), headache (42.5%) and myalgia (39.7%), followed by fever (32.9%), sore throat (21.9%), nasal congestion (21.9%) and rhinorrhea (20.5%). Headache (51%) and anosmia (45.1%) were common among females; fever and breathlessness among males (40.9%). Nine patients (12.3%) experienced worsening of symptoms (mainly respiratory) or exacerbation of co-morbidities, which required care outside the virtual service. Conclusion Patients with mild to moderate COVID-19 disease can be managed safely and effectively in a family medicine-led virtual program. Some sex differences in symptoms were observed. Future work should focus on long-term follow up in view of the existence of so-called ‘long-haulers’.

Team-based primary care program for disabled people and changes in rate of unmet health care needs

Background Few studies have been conducted on the application of specific and practical methods, such as interventions, for reducing the unmet health care needs (UHCN) of disabled people. Objectives The study aims to evaluate the impact of the team-based primary care program (TPCP) for disabled people on UHCN. Method In 2017, we surveyed 696 disabled people who were enrolled in the TPCP at one of the 11 institutions belonging to the Korea Health Welfare Social Cooperative Federation from 2015 to 2017 to assess their unmet needs before and after enrolment. We conducted a logistic regression analysis before and after the program to evaluate the relationship between participation period and unmet needs after adjusting for physician type, gender, age, drinking, monthly income, disability type, personal assistance services and living alone. Result After using the service, the proportion of disabled people with unmet needs decreased from 42.9% to 20.4% for a medical doctor and 43.6% to 18.6% for a Korean medical (KM) doctor. After adjusting for related factors and stratifying with type of physician, the proportion of disabled people with unmet needs decreased significantly in response to the participation period for the medical doctor-involved program (P-trend &lt; 0.001); this was not observed in the KM counterpart (P-trend = 0.6). Conclusion The TPCP for disabled people provides disease prevention, health care and health promotion activities and is crucial for solving the unmet needs.

Conhecimento dos agentes comunitários de saúde da fronteira franco-brasileira sobre atenção básica

Resumo: O Agente Comunitário de Saúde (ACS) realiza um trabalho fundamental no envolvimento da população para o enfrentamento dos problemas de saúde, sobretudo para a modificação das condições de vida, buscando melhores conjunturas de saúde em seu território de abrangência profissional. O Ministério da Saúde salienta que a qualificação do ACS deve ser contínua e permanente, sendo fundamental para aprimorar as capacidades individuais e coletivas na prática profissional. O objetivo deste estudo foi relatar a percepção dos ACS a respeito de seu papel dentro da Atenção Básica em um município fronteiriço. O estudo teve caráter descritivo com análise qualitativa realizada através da análise de Bardin. Os dados foram coletados em 2018. Resultados demonstraram que os ACS estão desinformados quanto a situações de agravos a saúde, o programa da atenção básica não está sendo executado da forma como é preconizado, apesar de alguns discursos relatarem de forma concreta a importância desses profissionais.Palavras-chave: Saúde Pública; Agentes Comunitários de Saúde; Promoção á Saúde. Knowledge of community health agents of the french brazilian border on basic careAbstract: The Community Health Agent (CHA) performs a fundamental work in the involvement of the population to face health problems, especially for the modification of living conditions, seeking better health conditions in their professional territory. The Ministry of Health emphasizes that the qualification of the CHA must be continuous and permanent, being essential to improve individual and collective capacities in professional practice. The aim of this study was to report the perception of CHAs about their role within Primary Care in a border municipality. The study was descriptive with qualitative analysis performed through Bardin analysis. The data were collected in 2018. Results showed that the CHA are uninformed about health problems, the primary care program is not being implemented as recommended, although some speeches specifically report the importance of these professionals.Keywords: Public Health; Community Health Agents. Health Promotion.