key: cord-1001554-24a59qig
authors: Cormi, Clément; Chrusciel, Jan; Laplanche, David; Dramé, Moustapha; Sanchez, Stéphane
title: Telemedicine in nursing homes during the COVID‐19 outbreak: A star is born (again)
date: 2020-05-27
journal: Geriatr Gerontol Int
DOI: 10.1111/ggi.13934
sha: bc468e0125d295efdfb668c60e007e5dd71bc0d9
doc_id: 1001554
cord_uid: 24a59qig

nan

Since December 2019, the global COVID-19 outbreak has been raging. Emerging infectious disease threats such as this require a prompt and decisive response. 1 When implementing nonpharmaceutical interventions to slow the spread of disease, such as forms of partial or total lockdown, special attention must be paid to frail people. Emerging epidemiological and clinical data indicate that older people are more likely to develop severe forms of COVID-19, and the presence of comorbid conditions worsens prognosis and leads to increased mortality. 2 Therefore, it follows that nursing home residents represent a particularly vulnerable group. In this regard, information and communication technologies should be an indispensable part of the public health armamentarium. Remote consultations have the potential to protect healthcare workers from unnecessary exposure to disease, while ensuring continuity in the delivery of care to the most vulnerable.

Because it is highly contagious, any resident with suspected COVID-19 in a nursing home must be quarantined. An initial medical teleconsultation can be performed for screening purposes, and further examinations can be prescribed as required. If the resident is in good general health, they may stay in the nursing home, and a physician can perform a daily follow-up teleconsultation. In the event of a clustering of cases within a nursing home, teleconsultation and tele-expertise can prevent healthcare providers from additional exposure. Telemedicine can thus contribute to managing the crisis from a remote location, 3 without exposing additional staff to the virus and risking increased absenteeism among healthcare staff during this critical time.

During an outbreak, usual care needs are decreased, but continue to exist nevertheless. For example, during the 2014 Ebola outbreak in Guinea, people were afraid of going to the hospital, and therefore malaria mortality dramatically increased. 4 Even with the COVID-19 epidemic, frail elderly residents in nursing homes still need their treatment, and regular follow-up of chronic diseases. To address demand, our hospital is currently successfully mobilizing a range of disciplines (endocrinologists, geriatricians, general surgery, cardiologists, neurologists and geronto-psychiatrists) to provide tele-expertise to nursing homes.

An important point for the nursing home staff is to focus on sanitization of telemedicine equipment. In an epidemic context, the use of telemedicine equipment requires rigorous asepsis and disinfection methods, the absence of which may give rise to clusters of infection in the nursing home.

Our hospital has been rolling out a telemedicine program since 2018 with 36 participating nursing homes to date. In early March 2020, based on our experience over the last 18 months, we drew up protocols to be ready to implement telemedicine solutions during a COVID-19 outbreak. About 1 month later, the epidemic is in full swing, but we have observed no significant increase in the hospital teleconsultation rate.

To anticipate the massive influx of patients, French health authorities positioned general practitioners (GPs) at the center of outbreak management for COVID-19. At the same time, two legal decrees 5, 6 have relaxed the rules, and now allow GPs to perform teleconsultations, while prescriptions for chronic diseases have had their duration of validity automatically extended to April 15, 2020. 7 While the national health insurance announced in the press that more than 600 000 teleconsultations were performed between March 1 and 28, 2020 8 which is 15 times more than in February, we believe that it is the GPs who are carrying out these teleconsultations to prevent hospitals from reaching saturation.

Telemedicine has great potential to deliver efficient, appropriate and safe care in the context of highly transmissible disease epidemics, both for screening and management, and for regular follow-up of chronic disease among nursing-home residents. The lessons from the COVID-19 epidemic about the advantages (and possible disadvantages) of this technology must be taken to heart, to inform future telemedicine policy, and ensure that the actual end-users are included in the planning and implementation of telemedicine in any future crisis scenarios.

The authors declare no conflict of interest.

This research did not receive any funding from agencies in the public, commercial or not-for-profit sectors. 

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Telemedicine in nursing homes during the COVID-19 outbreak: A star is born (again)

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