Authors (including presenting author) :
Chan MY, Kwok WY, Choi CY, Kwok SK, Yu HL, Wu YT, Wong MF, Hui N
Affiliation :
Occupational Therapy Department, United Christian Hospital
Introduction :
Patients with orthopedic conditions often encounter difficulties in activities of daily living limited by functional capacity decline and home environmental barriers. Conventionally, occupational therapists conduct on-site home visits (COT) or review home environment photos to assess any potential home barriers and recommend on modifications and assistive devices. Yet, the efficiency of on-site COT was limited by transportation time, and information collected from only photos was restricted. Telehealth was a new modality to conduct home assessment in recent decade. In United Christian Hospital, OTs started to conduct telehealth home assessment (tele-COT) via HA-Go Application since March 2024.
Objectives :
(1) To investigate the cost-effectiveness and efficiency of tele-COT when compared to on-site COT
(2) To identify suitable case types and possible limitations for tele-COT service.
Methodology :
Participants with home assessment and modification needs and caregivers who were able to operate the HA-Go mobile application were recruited from UCH orthopedics ward. Therapists would conduct home assessment via tele-consultation, with caregivers showing real-time home environment and taking measurements. Phone follow-up and satisfaction survey was conducted to collect feedback upon service completion.
Time spent in on-site COT and tele-COT session, and the average waiting time for on-site COT service before and after commencement of tele-COT service were analyzed. Qualitative outcomes include patients’ satisfaction and therapists’ comment.
Result & Outcome :
12 patients were recruited into the study from March to November 2024, with diagnosis including hip and lower limb fracture (4), spine conditions (4) and other miscellaneous orthopedic conditions (4). 3 cases returned the satisfaction survey, and 5 therapists involved in the project were interviewed.
From patient’s perspective, patients were able to receive more timely service since tele-COT was introduced. The average waiting time for on-site COT service has reduced from 23.33 days to 14.08 days. Service users agreed that suitable advice on home modification and aids prescription were made within the tele-consultation session and showed positive attitude with an overall score of 4.6 out of 5 in the satisfaction survey.
For therapists, tele-COT improves efficiency by reducing time costs for COT. The average time spent on tele-COT was 25-30 minutes, while that for on-site COT, including transportation time, was 64 minutes. OTs generally agreed that similar service quality was achieved by tele-COT in cases for handrail installation and aids prescription, and was more comprehensive than only reviewing photos. However, caregiver input is considered crucial as they are responsible for handling smartphones and taking measurements in tele-health sessions. Conventional on-site COT is still preferred in cases involving complex modifications and require detailed measurements, for example doorframe resizing, or demolishing and rebuilding shower area.
Conducting home assessment via telehealth means is considered a cost effective and efficient alternative in reducing therapist intervention time and shortening patient waiting time. Although the service quality of tele-COT is comparable to conventional on-site COT in simple cases, its application on cases involving complex home modification still require further exploration.
