For years, Dr. Andrea Somers has seen patients come to the hospital emergency department because they weren’t capable of attend followup appointments.
She remembers one man who got here to the ER along with his wrist in a forged “that was not supportive or doing anything” and in numerous pain.
When she asked why he didn’t follow up with a physician, he said his housing situation modified, he moved and he did not have a cellphone. So he got here to the ER for help.
“In the event you haven’t got a phone and also you haven’t got stable housing where someone can contact you or leave a message, you are stuck. So what do you do? You return to the social safety net, which is the emergency department, and also you seek help there,” said Somers, who’s an emergency physician at Toronto’s University Health Network (UHN).
Patients who return to the closest emergency department because they’re unable to get the followup care they need shouldn’t be a latest phenomenon.
But with the broader use of virtual care implemented through the COVID-19 pandemic, Somers said she was motivated to assist.
She created a project that gives donated prepaid cellphones to those that are homeless, fighting mental health or substance use, or socially isolated, in hopes of getting people followup care as an alternative of going to the ER.
For the reason that project launched almost three years ago, early data shows the cellphones have helped some individuals avoid ER visits and receive the care they need.
“Providing a phone to those people [is a] very practical device for improving the continuity of their care, which reduces their ER visits,” Dr. Howard Ovens, a staff emergency physician at Toronto’s Mount Sinai Hospital and a member of the Canadian Association of Emergency Physicians (CAEP) public affairs committee, said of the project.
Phone costs a fraction of ER visit
The necessity to connect vulnerable patients with followup care outside of the ER existed long before the pandemic, Somers said.
Those that are experiencing homelessness “often live in conditions that adversely affect their overall short- and long-term health,” in line with the non-profit and non-partisan Canadian Observatory on Homelessness.
The organization also said that “being unhoused makes it difficult, and in some cases not possible, to access general health-care services” for several reasons, including not having a health card or access to a phone.
Of those visiting the emergency departments on the UHN, an average of 1 in 20 patients lacks an lively phone number, in line with the UHN Foundation.
“There’s so some ways now that not having a phone disadvantages an individual,” Somers said.
She launched Phone Connect in July 2020, after she and colleagues struggled to share COVID-19 test results or get ahold of patients as a part of contact tracing.
Greater than 450 people have now received a phone through the grassroots project, which primarily runs out of St. Michael’s Hospital in downtown Toronto.
The donated phones have helped people connect with addiction counsellors, family doctors and other specialists, said Somers, who manages the project on top of her role as an emergency physician.
Money for the project comes from private donors and research funding, she said, noting that monthly bills are only $5.49 — well below the fee of a single visit to the ER.
“We have been capable of notify folks that they’ve lung cancer and connect them to an outpatient clinic. In the event that they did not have a phone, they would not get that message,” she said, adding that the project continues to be accepting phone donations.
But Somers said where she also sees success is within the reduction of emergency visits.
The preliminary data has not been peer-reviewed and has been submitted to CAEP for review.
It shows that 68 patients seen at St. Michael’s Hospital who received a cellphone were capable of avoid on average one emergency room visit over a three-month period, in line with data compiled by Somers and colleagues.
They consider that is because for a few of those patients, the phone was also paired with access to an outreach employee.
Somers said the phones are also helping people access followup care and that they are seeing “higher attendance at scheduled followup appointments.”
“We have now plenty of wonderful programs arrange. It is a matter of having the ability to access them without coming through the ER,” she added.
‘I believe it is a improbable first step’
Brian Cleary, a formerly homeless activist working on homelessness in Toronto, says having a cellphone is important.
“In my very own experience anecdotally and universally, I believe those are two really big things: cellphone access and access to a primary care physician. I believe it doesn’t get more basic or necessary than that,” he said.
“It’s sadly lacking within the support and shelter system.”
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Cleary said that way more needs to be done to assist those in need of adequate housing or other social support.
“The best way we treat our poorest in society is horrendous at once. It’s absolutely horrendous, and we’ve to begin asking some hard questions on what we wish to be as a city, a province and as a rustic,” he said.
Dr. Louis Francescutti, an emergency physician at Edmonton’s Royal Alexandra Hospital and a professor within the University of Alberta’s public health department, said Somers’s project is an “modern idea to attach” individuals to followup care.
“I believe it is a improbable first step, but we want to take it much further than that,” he said, referring to housing and other supports, equivalent to helping vulnerable individuals acquire identification.
Francescutti said helping people beyond the ER was the motivation behind a pilot project in Edmonton that he helped get off the bottom.
The Bridge Healing Transitional Accommodation Program will provide people with no home a secure place to recuperate from illness or injury following their hospital visit. The 36-bed project is about to open this month with 12 beds, followed by one other 24 beds in May.
“Hopefully down the road at some point, the patient doesn’t even need to go to the emergency. They will just walk right as much as one in every of these buildings, knock on the door … after which bypass an ambulance ride and bypass an emergency visit as well,” he said. “That is the last word dream that we’ve.”
Somers said she hopes the Ontario government takes on the cellphone project and adopts it more widely, because from what she’s heard from those that have received a phone, it has been a life-changer.
“It isn’t a panacea by way of how we’re going to unravel emergency department crowding. It is so multifactorial, obviously,” she said.
“But when we are able to eliminate the occasional unnecessary visit or enable people to be self-efficacious and make direct connections, that might be great.”