Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Sep 1;4(9):e2123453.
doi: 10.1001/jamanetworkopen.2021.23453.

Effect of a Telecare Case Management Program for Older Adults Who Are Homebound During the COVID-19 Pandemic: A Pilot Randomized Clinical Trial

Arkers Kwan Ching Wong  1 , Frances Kam Yuet Wong  1 , Karen Kit Sum Chow  2 , Siu Man Wong  2 , Paul Hong Lee  3
Affiliations
Randomized Controlled Trial

Effect of a Telecare Case Management Program for Older Adults Who Are Homebound During the COVID-19 Pandemic: A Pilot Randomized Clinical Trial

Arkers Kwan Ching Wong et al. JAMA Netw Open. .

Abstract

Importance: Older adults who are homebound can be difficult to reach owing to their functional limitations and social distancing during the COVID-19 pandemic, leaving their health needs unrecognized at an earlier stage.

Objective: To determine the effectiveness of a telecare case management program for older adults who are homebound during the COVID-19 pandemic.

Design, setting, and participants: This randomized clinical trial was conducted among 68 older adults in Hong Kong from May 21 to July 20, 2020, with a last follow-up date of October 20, 2020. Inclusion criteria were being 60 years or older, owning a smartphone, and going outside less than once a week in the previous 6 months.

Interventions: Participants in the telecare group received weekly case management from a nurse supported by a social service team via telephone call and weekly video messages covering self-care topics delivered via smartphone for 3 months. Participants in the control group received monthly social telephone calls.

Main outcomes and measures: The primary outcome was the change in general self-efficacy from before the intervention to after the intervention at 3 months. Self-efficacy was measured by the Chinese version of the 10-item, 4-point General Self-efficacy Scale, with higher scores representing higher self-efficacy levels. Analysis was performed on an intention-to-treat basis.

Results: A total of 68 participants who fulfilled the criteria were enrolled (34 in the control group and 34 in the intervention group; 56 [82.4%] were women; and mean [SD] age, 71.8 [6.1] years). At 3 months, there was no statistical difference in self-efficacy between the telecare group and the control group. Scores for self-efficacy improved in both groups (β = 1.68; 95% CI, -0.68 to 4.03; P = .16). No significant differences were found in basic and instrumental activities of daily living, depression, and use of health care services. However, the telecare group showed statistically significant interactions of group and time effects on medication adherence (β = -8.30; 95% CI, -13.14 to -3.47; P = .001) and quality of life (physical component score: β = 4.99; 95% CI, 0.29-9.69; P = .04).

Conclusions and relevance: In this randomized clinical trial, participants who received the telecare program were statistically no different from the control group with respect to changes in self-efficacy, although scores in both groups improved. After the intervention, the telecare group had better medication adherence and quality of life than the control group, although the small sample size may limit generalizability. A large-scale study is needed to confirm these results.

Trial registration: ClinicalTrials.gov Identifier: NCT04304989.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Drs A. K. C. Wong, F. K. Y. Wong, and S. M. Wong and Ms Chow reported receiving grants from the Nethersole Institute of Continuing Holistic Health Education (NICHE) during the conduct of the study. Dr A. K. C. Wong reported receiving grants from the NICHE outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. CONSORT Diagram
ITT indicates intention-to-treat.
See this image and copyright information in PMC

Comment in

References

    1. Xiang X, Chen J, Kim M. Trajectories of homebound status in Medicare beneficiaries aged 65 and older. Gerontologist. 2020;60(1):101-111. doi:10.1093/geront/gnz023 - DOI - PMC - PubMed
    1. Sterling-Fox C.Access to five nonprimary health care services by homebound older adults: an integrative review. Home Health Care Manag Pract. 2019;31(1):55-69. doi:10.1177/1084822318810384 - DOI
    1. Zhao YL, Alderden J, Lind B, Stibrany J. Risk factors for falls in homebound community-dwelling older adults. Public Health Nurs. 2019;36(6):772-778. doi:10.1111/phn.12651 - DOI - PubMed
    1. Xiang X, Brooks J. Correlates of depressive symptoms among homebound and semi-homebound older adults. J Gerontol Soc Work. 2017;60(3):201-214. doi:10.1080/01634372.2017.1286625 - DOI - PMC - PubMed
    1. Qiu WQ, Dean M, Liu T, et al. . Physical and mental health of homebound older adults: an overlooked population. J Am Geriatr Soc. 2010;58(12):2423-2428. doi:10.1111/j.1532-5415.2010.03161.x - DOI - PMC - PubMed

Publication types

Associated data