Extended Primary Care at Home

Most patients with mild-moderate COVID-19 can be treated at home with good primary care monitoring. In the Extended Primary Care at Home project, DFM trialed an innovative model to support family physicians and teams in providing the best possible care and monitoring for primary care patients with COVID-19. The goal of this approach is to reduce the demand on the hospital and ER while facilitating early detection of those who need hospital care.

The team developed a free open access clinical pathway, which was made available with EMR templates thanks to DFM IT and the Hamilton Family Health Team. The process was rapidly piloted in practice by clinicians at the McMaster FHT (MFHT) in December and made available to the wider Hamilton family medicine community with pulse oximeter supply for high risk patients. The pathway is posted to the HFAM website, and has now been taken up and rolled out by Ontario Health as the standard of care for primary care, and supported by Ministry funded pulse oximeters.

The Foundation for Advancement in Family Medicine / Canadian Medical Association (Co-RIG Program) provided seed funding to evaluate the pilot phase in a cohort of consecutive patients cared for using the pathway by MFHT. As of March 31, 197 patients had been cared for in the pathway. Patients were overwhelmingly either “very satisfied” (61%) or “satisfied” (30%) or neutral about the care they received. Patients appreciated being able to receive care in their own home, and felt very reassured by the follow-up and management by their primary care team who know them. Most clinicians said they felt confident they know how to safely manage COVID-19 patients in the community, and that this work is very appropriate for family medicine.

Phase 2 is underway to design and pilot a care pathway for step down care from hospital for COVID patients still requiring oxygen but recovering from their illness.

This project was a collaboration across the Hamilton health care system, with so many contributors it is impossible to name them all individually, including but not limited to:

• Department of Family Medicine Research, IT, and Knowledge Translation teams
• Clinicians at MFHT (Physicians, PAs, nurses, and residents) piloted the clinical pathway
• Hamilton Health Team purchased pulse oximeters
• Volunteers delivered them to patients’ homes where they had no means of picking up
• Physicians from secondary care settings (Internal Medicine, Emergency Medicine) made themselves available to provide consultation on pathways and for clinical questions
• Hamilton Family Medicine (HFAM)
• Phase 2 involves representatives from primary care from primary care, hospital, home care, and oxygen providers

Contact for the project is Dee Mangin mangind@mcmaster.ca