Out of Hospital and Remote Care

Consultant Home Automation & Practitioner in nursing homes and Community care

As a technical physician, you can play a valuable role in the medical treatment team of a VVT organisation, with wonderful diverse opportunities for contributions, from clinical integration through walking visits to utilising your technical background.

The deployment of healthcare technology can be divided into several areas, such as the use of glucometers and automatic blood pressure readings for vital signs, social robots to combat loneliness, or GPS trackers and smart doors to monitor living circles. These elements are all being integrated into both care and treatment plans.

A growing trend is the transfer of medical care to the home situation, allowing (outpatient) clinical equipment to go home with the client for long-term follow-up. With such applications, besides technical aspects, the scalability of the solution is also a challenge, given the tight labour market and the requirements of national care agreements such as the IZA. In addition to regular treatment packages, (healthcare) technology consultations can also be offered.

Using healthcare technology from a treatment perspective offers a complementary approach to the biopsychosocial model, which can significantly broaden treatment options. With the rapidly growing healthcare technology market, complexity and implementation can vary, ranging from plug-and-play solutions to large-scale projects that require careful planning.

Technical Medicine in substance abuse treatment

Substance Use Disorders (SUDs) are one of the considerable contributors to the global burden of disease, and do result in great health and societal costs. According to the (Diagnostic and Statistical Manual of Mental Disorders (edition 5), an SUD involves patterns of symptoms caused by using a substance that an individual continues taking despite its negative effects. The impact of SUDs is often neglected, because they are commonly not a direct cause of death. During the last two decades, they have become more important as health goals shift from only increasing life expectancy to increasing disability-free years.

Despite the relevance for both individuals and society, there is a lack of access to treatment because of limited capacity, which is typically reserved and accessible only for the most severe cases. The first step of treatment is detoxification: a set of interventions leading to a safe discontinuation of a substance of dependence, intended to manage the acute intoxication and withdrawal symptoms to reduce physical harm and adverse effects. Traditionally, this treatment process is performed in an in-patient setting, because it is associated with potentially serious complications (including seizures, as well as physiological, psychological and behavioural dysregulation), requiring intensive monitoring and timely interventions if needed.

For patients with a low risk of complications during detoxification, outpatient alternatives are available. These are preferred when in-patient detoxification is not feasible or acceptable, due to the associated stigma, physiological burden, removal from a trusted and supportive environment, and/or practical issues like responsibilities for work or care for others. However, their applicability is limited as they require optimal patient compliance, a strong social support system and frequent home visits to monitor and treat the patient.

Digital health could help to lower these barriers and allow an increase in capacity. However, in the current clinical practice, an integral system to support remote detoxification is still missing. The COVID-19 pandemic has accelerated the implementation of individual telemedicine technologies, but there has been no aggregate implementation in the field of addiction care. Interoperability and interusability are mostly missing, scattering the care process across separate applications and platforms.

Technology can help to make detoxification in the home environment more widely accessible, more effective and less labour-intensive. To fully exploit its potential, the use of technology in addiction care should support the practitioner and client in all aspects of detoxification. Technical Physicians are able to implement technology for remote monitoring and intervention that can be integrated into the detoxification process. While currently the number of technical physicians in substance abuse treatment is limited, their role is thus important.

Best use of available capacity in emergency care for the frail elderly

People are living longer, the number of medical treatments has increased, and advances in medical science have transformed diseases that were once fatal into chronic conditions. An increasing number of individuals are dealing with multiple chronic conditions simultaneously. This, combined with an aging population, leads to a rise in healthcare demand and more complex challenges, especially in elderly care.

Providing more complex care to an increased number of people by fewer healthcare professionals does not necessarily mean working harder or compromising on quality. In emergency care for the frail elderly, it has always been customary for doctors who work during the day to be on call for emergency care in their nursing homes during nights and weekends. This working method is vulnerable to peak loads, and the doctors are not selected based on their affinity for emergency care. In addition, emergency care requires specific knowledge and skills. Specialization, collaboration, and the easy and rapid availability of specific information contribute to an unprecedented increase in efficiency and quality improvement.

Not long ago, it was common for a doctor to be available in the evening and night for medical emergencies in his nursing home. Institutions started working together and doctors were no longer obligated to participate in emergency services but were instead selected and trained for this purpose. By working together with almost all nursing homes in a region, we are now able to predict at what times more-or fewer doctors are needed. Peak workloads are distributed among different doctors in the region, whereby telephone consultations can also be handled by a doctor outside the region. However, this approach does require doctors to be able to work in many different healthcare institutions per shift. Healthcare institutions have their own ICT systems, patient records, and contact numbers, and procedures can vary significantly between institutions.

It is precisely those professionals who understand the patient’s healthcare needs, feel comfortable in the clinical setting, and simultaneously have a good understanding of the technical possibilities and limitations who can make a difference in this context.

The technical physician plays a key role in developing healthcare outside the hospital to address the increased demand for care, ensure sustainable healthcare, and improve quality.

Advice and project management on implementing/scaling up technology

For non-hospital care, many technologies are already available to keep the elderly independent, live safely at home for longer and provide care at a distance. Examples include sensors that map out lifestyle patterns, automatic medicine dispensers and remote monitoring. Healthcare organisations increasingly realise that making optimal use of technology is one of the solutions to the exploding demand for care. Innovating, implementing, securing and scaling up technology in the care process is a challenge. This requires change of organizational structures, behavioural change of care staff and clients, cooperation with technology suppliers and collaboration with (regional) partners. A technical physician can advise on this, help bring about change and maintain cooperation between all domains.

Conclusion and discussion

Care outside the hospital is extensive in terms of size, impact and variety. The technical physician is a new professional in this care sector which has the potential to make an incredible impact. In this chapter, several examples from a tremendous amount of opportunities and needs for technical physicians outside the hospital are given. In contrast to other places, there are not a lot of specific vacancies yet. Not only does care outside the hospital need intelligent and savvy professionals. As a field of work, it is a rapidly developing, varied landscape with major social interests and solutions that affect people in their daily lives. It can therefore be expected that the amount of technical physicians working in out of hospital and elderly care will increase in only a matter of time.