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The benefits have worked so well – both economically as well as for the patients - that hospitals in the UAE are pursuing the model beyond the pandemic

Health care has forever changed — the value creation opportunities in home health care have never been greater. The rise in demand sparked new waves of innovation, and “anywhere care” became a reality during the Covid-19 pandemic.

“Home-care services increase accessibility to healthcare allowing the patient to receive premium services anytime, anywhere,” explains Marwa Saffi, Head of teleMEDCARE and Homecare Services, Medcare. “We understand the time and cost associated with obtaining healthcare the traditional way. The home continuum of care was created and implemented to provide patients with a range of services including teleconsultations, GP home consultations, and laboratory sample collection, as well as the introduction of the new specialised service lines such as post-operatives, post-delivery and elderly homecare.”

Pavan Sharma, Managing Director and CEO, First Response, succinctly points out the advantages of home care for patients.

“It brings licensed and experienced teams of doctors and nurses at the doorstep of a patient to take medical history, offer investigations and treatment along with all required follow-ups till the patient recovers. The vehicle of this team is well equipped with required point-of-care devices and equipment to capture vital signs and manage any emergency.”

Home care can enable safety, security, and increased independence; ease management of an ongoing medical condition; help avoid unnecessary hospitalisation; aid with recovery after an illness, injury, or hospital stay — all through care given in the comfort of the home, reiterates Dr Aajam Khan, General Physician – Homecare, Prime Healthcare Group. “Home care can include help with daily activities such as dressing and bathing; assistance with safely managing tasks around the house, companionship, therapy and rehabilitative services, short-or long-term nursing care for an illness, disease, or disability — including tracheostomy and ventilator care,” says Dr Khan.

Hospitals spring into action

The Covid-19 epidemic has had a massive effect on the way the healthcare industry in the UAE provides care, with many hospitals introducing home healthcare services. To meet the rising deamnd for home-based care in the UAE during the pandemic, Aster@ Home came up with a whole new set of home healthcare services, which are provided by quality healthcare professionals. “Leveraging the use of technology during the outbreak, remote monitoring devices have played a vital role in treating patients and ensuring healthcare providers’ well-being too,” says Nitin Navish Gupta, COO – Aster and Access Clinics, UAE and Bahrain.

“We developed many tutorial videos to educate patients on self-nebulisation, self-monitoring of hemodynamics, and room orientation. This helped us to limit the exposure to nurses and gain better involvement of patients in their care plans.”

Dr Khan says home care services could improve the quality and standard of care for patients by preventing the exposure of patients to multiple illnesses in the health care facilities. The doctor, physiotherapists and nurses at Prime Healthcare have observed infection control precautions as per DHA/MOH guidelines whenever they visited clients at home. “We have assigned staff with geriatric patients and managed staff for “live -in-care” for months to avoid chances of infection to our immunocompromised clients,” says Dr Khan. “Nursing staff who were continuously with patients for eight to 12 hours wear complete PPE during the shift. Transportations changed from big buses/multi-seater vans to saloon cars with very minimum staff at a time following the RTA guidelines with regular and frequent sanitisation of the car.”

Prime also received huge number of enquiries for doctor-at-home or nurse-at-home services as people were concerned about visiting health facilities. “We set up a dedicated group of nurses to collect PCR samples from homes, offices, companies, and hotels,” says Dr Khan. “We started remote monitoring program for the Covid positive patients to treat the mild to moderate conditions, and offered teleconsultation, health coordinator and a registered nurse will assist them to get the vital signs and SPO2 checks regularly.”

Dr Sharmila Banu, In-charge and Chair of the Department at Thumbay Physical Therapy and Rehabilitation Hospital, says during the pandemic, elderly people and people of determination could not visit the hospital as the working hours were reduced. “Decrease in functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behaviour, which affected their day-to-day functionality,” says Dr Banu. “To address this concern, Thumbay Physical Therapy and Rehabilitation Hospital started home services where patients were monitored and received therapy at the comfort of their homes.”

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Is home care better?

In a post-covid world, healthcare-at-home services have the ability to efficiently manage majority of primary (non-emergency) healthcare needs in home settings, giving hospitals and clinics enough time and space to manage secondary and tertiary care effectively. “The rapidly growing concept of healthcare at home enables patients to use internationally accredited healthcare standards in the comfort and privacy of their home without exposing themselves and others to infections and risks,” says Sharma.

To regain independence and quality of life, after a stroke, or spinal cord, brain or orthopaedic injury, research proves that individuals treated in inpatient rehabilitation facilities (IRFs) have better long-term clinical outcomes than those treated in home care services. The pandemic, however, had a negative impact on in-patient services. “Due to their advanced age and numerous underlying diseases, the patients in long-term care facilities represented a vulnerable population that should benefit from additional protective measures against contamination, says Dr Banu. “Hence long stay in the hospital is not advisable as the pandemic continues to hold ground. Home service is the best option.”

Digital innovations

Aster@Home has implemented a full-fledged paper less administrative and clinical record management whereby everything from patient registration, EHR entry, patient notes, record management and billing is done through hand-held smart devices. “In the next phase of digitisation, Aster@Home will be incorporated in the already existing mobile application called 1Aster,” says Gupta. “This would ensure easier patient accessibility of home health services.

Digital innovations have also helped Aster@Home to introduce a mental or psychological support group called COSMOS (Circle of Strength Master of Self) for Covid affected people. “This was done virtually with the use of technology and turned out to be so successful that it is continuing to cater to other disease groups such as oncology,” says Gupta.

As physical therapy is the basic pillar of Parkinson’s disease and stroke patients, its interruption during the pandemic led to the development of unconventional methods such as tele-rehabilitation, virtual reality, and tools for motivation physical activity for patients. “In Thumbay Physical Therapy and Rehabilitation Hospital, we started the use of tele-medicine device for the rehabilitation of Parkinson’s disease, stroke and Covid-19 patients,” says Dr Banu. “The technology assisted the therapist in providing comprehensive care for neuro, orthopaedic and paediatric, post-surgical and post-Covid rehabilitation.”

Managing chronic conditions

Chronic condition management has a long history of care in the home setting, but effective chronic care management requires a multidisciplinary, holistic approach.

“Medcare offers a comprehensive Chronic Care Management Program, providing clinical goals set by the treating physician, a dedicated case manager to provide lifestyle coaching and education as well as a dietician to provide custom-made meal plans to suit the needs of every enrolled individual,” says Saffi. “We have also collaborated with leading providers to offer discounted rates to our enrolled patients on gym memberships, healthy meal plans, personal training sessions and yoga classes to ensure our patients are managing their chronic conditions successfully.”

Teleconsultations with treating physicians and homecare services for routine laboratory sample collection enables Medcare patients to stay on top of their condition by ensuring that they are complying with clinical guidelines, their health status is continuously monitored, and medications accordingly adjusted. Case manager coaching and dietician consultations are also carried out virtually. “Medcare’s three departments: Homecare, teleMEDCARE and Chronic Care Management go hand in hand to provide the patient the freedom to manage their chronic condition with a touch of a button,” concludes Saffi.