Does telehealth delivery of an occupational therapy home visiting service provide a non-inferior alternative to in-person delivery of the same service? A matched cohort study

Introduction

Health services are encouraging the adoption of telehealth to improve efficiencies and health-care access for patients. Research is needed to explore clinical outcomes in telehealth occupational therapy home visiting services. The aim of this study was to determine if telehealth delivery of occupational therapy home visiting services reduces total therapy time while maintaining clinical outcomes.

Methods

A retrospective matched cohort study to examine the impact of telehealth occupational therapy home visiting services on therapy time and clinical outcomes, compared to standard in-person therapy.

Results

A total of 544 patients were included (telehealth services [case] = 216, in-person services [control] = 272, received both resulting in a hybrid service = 56). Differences in total therapy time between groups were significant: median therapy time in the telehealth (case) group was 40 minutes (IQR: 63.8) versus 160 minutes (IQR: 90) in the in-person (control) group (P < 0.001). Patients in the hybrid group were excluded from this comparison as received mixed care. There were no significant differences between groups regarding the incidence of adverse events such as falls, delirium, and pressure injuries (P = 0.32). Fifty-six patients (20.6%) in the case group escalated to require in-person services receiving hybrid care. Factors associated with switching from telehealth to in-person services included the need for carer education and equipment assessment and provision, which resulted in greater therapy time and more occasions of service.

Conclusion

Telehealth delivery of occupational therapy home visiting services reduced therapy time and did not increase incidences of adverse events. However, telehealth delivery of services is not appropriate for all patients, and hybrid models of care must be considered.

Plain Language Summary:

Occupational therapists help patients leave the hospital and live safely at home. They visit homes to see if patients can manage on their own. Therapists may suggest changes like adding grab bars or bathing aids to make the home safer. These visits take a lot of time, so telehealth is being tested as a way to reduce the need for in-person services. This study looked at whether telehealth could save time and reduce workloads. This study found telehealth visits were shorter than in-person visits. It also found there were no differences between groups for events like falls, delirium, and pressure injuries. However, some patients still needed in-person visits, especially for equipment setup or caregiver training. Telehealth is a helpful tool, but it is important to know when in-person visits are still needed.