Virtual Shared Care: Enhancing Healthcare Access for Frail Residents in the Community

Background:Mobility limitations, frailty and lack of caregiver support often hinder older adults from attending polyclinic (primary care clinic) visits. Those living alone or managing multiple chronic conditions may struggle with frequent medical appointments. Teleconsultations have shown promise in improving accessibility and convenience for older adults and caregivers, particularly when mobility or travel pose challenges.

Approach: The shared virtual care model between the polyclinic and community nursing teams was introduced to improve care access and coordination. To evaluate whether this model reached its intended population i) frail, ii) socially vulnerable and residents with iii) comorbidities, a retrospective review was conducted on 108 residents who received VC with shared care in the community. The VC sessions were conducted between the primary care clinic physician, pharmacist and resident, with community nurses and wellbeing coordinators (WBCs) coordinating and facilitating the sessions.

Community nurses and WBCs ensured the success of virtual consultations by providing on-site support and assisting in communication with the primary care physician and pharmacist. Data on demographics, frailty status (Clinical Frailty Scale), and comorbidities were collected. The total number of VC conducted was also analyzed as an indicator of the number of in-person trips to the primary care clinic that were avoided.

Results: All enrolled residents were classified as frail, with a Clinical Frailty Scale (CFS) score of 4-7 (N=108, 100%). The cohort had a mean age of 75 years (SD = 9.51) and consisted of 39.8% (n=43) males and 60.2% (n=65) females. More than a third of enrolled residents were single, widowed, separated or divorced (37.9%, n=41).

Comorbidities were prevalent, with hypertension affecting 91.7% (n=99), hyperlipidemia 79.6% (n=86) and diabetes mellitus 62.0% (n=67). A total of 139 video consultations were conducted, effectively preventing 139 in-person visits, reducing transport burden and waiting time at the primary care clinic.

Implications: The findings demonstrate that the VC shared care approach effectively reached frail, comorbid, and socially vulnerable residents, offering a viable alternative to in-person visits. By reducing in-person trips, it enhanced healthcare accessibility for those with mobility challenges, Further evaluation is needed to assess long term patient outcomes.