Search

Accessing timely acute medical care is a challenge for older adults. This article describes an innovative healthcare model that uses high-intensity telemedicine services to provide rapid acute care for older adults without requiring them to leave their senior living community (SLC) residences. This program, based in a primary care geriatrics practice that cares for SLC residents, is designed to offer acute care through telemedicine for complaints that are felt to need attention before the next available outpatient visit but not to require emergency department (ED) resources. This option gives residents access to care in their residence. Measures used to evaluate the program include successful completion of telemedicine visits, satisfaction of residents and caregivers with telemedicine care, and site of care that would have been recommended had telemedicine been unavailable. During the first 2 years of the program's operation, 281 of 301 requested telemedicine visits were completed successfully. Twelve residents were sent to an ED for care after the telemedicine visit. Ninety-four percent of residents reported being satisfied or very satisfied with telemedicine care. Had telemedicine not been available, residents would have been sent to an ED (48.1%) or urgent care center (27.0%) or been scheduled for an outpatient visit (24.4%). The project demonstrated that high-intensity telemedicine services for acute illnesses are feasible and acceptable and can provide definitive care without requiring ED or urgent care use. Continuation of the program will require evaluation demonstrating equal or better resident-level outcomes and the development of sustainable business models.

The possibility that controllable environmental factors such as passive smoking and non-breast feeding contribute substantially to wheezing has implications for prevention. Effects of passive smoking and non-breast feeding on wheezing in children aged 6 to 10 years were explored in a historical cohort study of 223 children. Family history of respiratory allergy or asthma, male sex, maternal smoking, and non-breast feeding were significantly associated (p less than 0.05) with wheezing in bivariate analysis. In multivariate loglinear analyses, predictors of wheezing included non-breast feeding (p = 0.05, odds ration = 2.1), male sex (p less than 0.03, odds ratio = 3.1), and family history of respiratory allergy (p less than 0.03, odds ratio = 2.6). In a second model, predictors included an interaction of maternal smoking and family history (p less than 0.005, odds ratio = 4.6) in addition to male sex and family history of respiratory allergy. In further exploration based on tabular analysis, maternal smoking appeared to increase wheezing among children in whom the family history of respiratory allergy was positive (p less than 0.001). Among children in whom the family history of respiratory allergy was negative, non-breast feeding appeared to increase wheezing (p = 0.01). Promotion of breast feeding and reduction of maternal smoking might reduce childhood wheezing.