Alternatives for Homebound Patient Care

Telemedicine-Based Options

Telemental health has shown robust adoption because mental healthcare commonly does not rely on physical examination of patients, making it particularly suitable for homebound individuals 1

The American College of Physicians, as reported in Annals of Internal Medicine, suggests that the PCMH model provides continuous, "whole-person" care through all stages of a patient's life with improved access to healthcare services 2
The PCMH model aims to centralize care across the health system for all patient healthcare needs, including preventive, acute, and chronic care services 2

The American Heart Association, as reported in Circulation, demonstrates two useful models that could be adapted for homebound patients: combined clinic models (multiple specialties in one visit) or single specialty models 3
Multidisciplinary clinics that use a combination of physicians, advanced practice providers, nurses, and pharmacists can provide comprehensive care 3

Home visits are an option for homebound patients that may be more convenient, improve access, and reduce the need for emergency department visits 3
For patients who need mobility assistance but don't qualify for home health services, alternative funding sources like State Medicaid programs or Department of Veterans Affairs may provide support 4

When determining where care should take place, consider: patient's ability to tolerate treatment in different settings, required therapeutic interventions, and eligibility for various services 5
Some patients may be too frail or debilitated to tolerate traveling to an outpatient clinic setting, making home-based care necessary 5

Regular follow-up should be conducted to assess the effectiveness of any care arrangement and adjust as needed 1
Documentation should include patient consent to telehealth arrangements, method of monitoring and communication, and specific accommodations being provided 1

During video visits, it is not possible to perform a conventional physical examination, which is a significant limitation of telemedicine 6, 7
It is also not possible to obtain ancillary tests during the encounter; therefore, any important tests that are required have to be conducted separately 6

A self-examination directed by the physician is a reasonable option during video visits 6, 7
Physicians can document a limited physical examination by guiding the patient through it during video visits 8

During video visits, ensure a quiet and private environment for both provider and patient 6, 7
The patient should preferably be alone or with a relative who may help with technical issues 6
Laptops and desktop computers are preferable to cell phones for video visits 6
Ensure adequate lighting with good audio and place the camera at eye level 6
Wear professional "work" clothes and manage your body language while analyzing the patient's body language 6
Offer advice to perform a guided physical self-examination 6, 7

Patients at risk for melanoma and nonmelanoma skin cancer should be seen in person at a frequency consistent with standard of care for a full skin examination 9
New patients establishing care may benefit from in-person visits 9
Patients experiencing unstable disease/flares should be considered for in-person care 9
Patients requiring a thorough skin/joint examination and a full physical examination for rheumatology patients should be seen in person 9

It is essential to document all data in the clinical record as with face-to-face consultation 8, 10
The note should include a disclaimer, such as "teleconsultation is provided with the consent of the patient" 8, 10

The European Urology Association recommends documenting informed consent for telehealth encounters with a disclaimer, and notes that physical examination is limited by telehealth modality 11
The American Heart Association, as published in Circulation, suggests that patient-reported vital signs, such as temperature, heart rate, and blood pressure, can be requested if home equipment is available 12
The American Academy of Pediatrics recommends the use of home pulse oximeters to assess oxygen saturation 13
The American College of Physicians, as published in Annals of Internal Medicine, identifies examination components that cannot be performed remotely, including palpation for masses, organomegaly, or subtle tenderness, and suggests that patients with high-risk features, such as cardiovascular disease with respiratory symptoms, may require in-person visits 14, 15

The American Academy of Pediatrics suggests that electronic stethoscopes, video otoscopes, high-resolution cameras, and home pulse oximeters can significantly improve examination quality when available 13
The use of peripheral devices, such as electronic stethoscopes and video otoscopes, can enhance the accuracy of cardiac and pulmonary auscultation, as well as ear examination 13