Older adults' perspectives on primary care telemedicine during the COVID-19 pandemic

Pandemic COVID-19 as a challenge for telemedicine in the Czech Republic

The COVID-19 Pandemic contributed to accelerating the process of using information and communication technologies and digital technologies in healthcare management and delivery within healthcare systems. At that time, the Czech healthcare system faced the same problems as other European systems and struggled with a temporary limitation of direct provision of healthcare services. It was solved by switching to telemedicine. The Czech healthcare system used telemedicine to a minimal extent until then. Despite adopting the law on healthcare digitisation, it is still one of the countries with a lower level of digitisation of healthcare processes. The article presents the results of an exploratory expert investigation focused on the implementation and development of telemedicine in the Czech Republic. The conducted research aimed to identify problems related to the implementation of telemedicine in practice, place them in the broader framework of the healthcare system and structure them, propose possible solutions, and identify the future challenges of telemedicine in the Czech Republic. We based our study on the results of a three-phase QUAL-QUAN-QUAL research. Data collection in the first phase took the form of individual semi-structured interviews with patients (25) with practical experience in the field of telemedicine, followed by the second quantitative phase of the questionnaire survey with patients (650). The third qualitative phase included semi-structured interviews with experts (17) with practical experience in telemedicine. The introduction and expansion of telemedicine require several fundamental changes. These include adjustments to the legislative environment and changes to the technological infrastructure, organisation of care and work. Several barriers have been identified at the healthcare system level, healthcare providers, healthcare professionals and patients.

Cost-Effectiveness Analysis of Telehealth and In-Person Primary Care Visits for People Living with Alzheimer's Disease-Related Disorders in the State of Nevada

To people living with Alzheimer's Disease-Related Disorders (ADRD), timely and coordinated communication is essential between their informal caregivers and healthcare providers. In provider shortage areas, for example, the state of Nevada, telehealth can be an effective primary care delivery alternative to in-person visits. To evaluate the cost-effectiveness of telehealth visits for people living with ADRD in the state of Nevada, a decision-analytic Markov model was developed from healthcare system perspectives with a 10-year horizon/1-year cycle. To estimate the effects of demographic and geographic parameters on the Markov model, race parameters were divided into non-Hispanic White individuals vs. others and location parameters were divided into urban vs. rural. A 12-item short-version Zarit Burden Interview (ZBI-12) was applied to measure the informal caregiver burdens of non-institutionalized people living with ADRD. The values of mortality rate and healthcare utilization were obtained from healthcare systems' publicly available payor administrative data and Nevada State Inpatient/Emergency Department datasets. Among urban-residing non-Hispanic White individuals, the Incremental Cost-Effectiveness Ratio (ICER) per modified ZBI-12 indicated a cost saving of USD 9.44 with telehealth visits; among urban-residing racial minorities, the ICER per modified ZBI-12 indicated a cost saving of USD 29.26 with in-person visits; and among rural residents, the ICER per modified ZBI-12 indicated a cost-saving of USD 320.93 with telehealth visits. Distributional differences in the cost-saving effects of telehealth primary care were noted in line with racial and geographic parameters. Workforce and caregiver training is necessary for reducing distributional differences, especially among urban-residing racial monitories living with ADRD in the provider shortage area of the state of Nevada.

The Experiences and Perceptions of Older Adults with Multimorbidity Toward E-Health Care: A Qualitative Evidence Synthesis

Background: Given the growing population of older adults globally, e-Health plays an indispensable role in the chronic disease management of multimorbidity. However, qualitative evidence that synthesizes the experiences of older adults with multimorbidity using e-Health service is currently lacking. The objective was to explore the experiences and perceptions of e-Health care in community-based settings among the older adults with multimorbidity. Methods: Seven electronic databases including PubMed, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, China National Knowledge Infrastructure, and Chinese BioMedical Literature were searched, and the search was limited to studies from inception to September 1, 2023. Screening, data extraction, and quality appraisal were conducted independently by two reviewers. Thomas and Harden's thematic synthesis methodology was applied to synthesize the original themes. The methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and the confidence of synthesized themes was evaluated by the Confidence in the Evidence from Reviews of Qualitative Research approaches. Results: Ten studies with moderate methodological quality met eligibility criteria and were included finally. Studies were conducted in four countries with 235 participants who were living with multiple chronic conditions. Among the 10 included studies, 37 credible findings were extracted and interpreted into 3 synthesized themes and 12 subthemes: (1) advantages and benefits perceived during e-Health service, (2) multidimensional challenges and negative experience posed by e-Health service, and (3) preferences, suggestions, and expectations for future e-Health improvement. The confidence in the majority of the three final synthesized themes was rated between "low" and "moderate" scales. Conclusions: The findings of this study provide new insights into implementing tailored e-Health care for older adults with multimorbidity. Further research should emphasize on realizing the potential value of e-Health service based on users' needs and perspectives to promote age-friendliness in geriatric practice.

Identifying Patterns of Primary Care In-Person and Telemedicine Use in the Veterans Health Administration: A Latent Class Analysis

BACKGROUND

The Veterans Health Administration increased synchronous telemedicine (video and telephone visits) in primary care in response to the COVID-19 pandemic.

OBJECTIVE

Our objective was to determine veteran use patterns of in-person and telemedicine primary care when all modalities were available.

DESIGN

A retrospective cohort analysis. We performed a latent class analysis of primary care visits over a 1-year period to identify veteran subgroup (i.e., class) membership based on amount of primary care use and modality used. Then, we used multinomial logistic regression with a categorical outcome to identify patient characteristics associated with class identification.

PARTICIPANTS

A random national sample consisting of 564,580 primary care empaneled veterans in June 2021.

MAIN MEASURES

Latent class membership.

KEY RESULTS

We identified three latent classes: those with few primary care visits that were predominantly telephone-based (45%), intermediate number of visits of all modalities (50%), and many visits of all modalities (5%). In an adjusted model, characteristics associated with the "few" visits class, compared to the intermediate class, were older age, male sex, White race, further driving distance to primary care, higher Gagne, optimal internet speed, and unmarried status (OR 1.002, 1.52, 1.13, 1.004, 1.04, 1.05, 1.06, respectively; p < .05). Characteristics associated with membership in the "many" visits class, compared to the intermediate class, were Hispanic race, higher JEN Frailty Index and Gagne (OR 1.12, 1.11, 1.02, respectively; p < .05), and higher comorbidity by Care Assessment Need score quartile (Q2 1.73, Q3 2.80, Q4 4.12; p < 0.05).

CONCLUSIONS

Veterans accessing primary care in-person or via telemedicine do so primarily in three ways: (1) few visits, predominantly telephone; (2) intermediate visits, all modalities, (3) many visits, all modalities. We found no groups of veterans receiving a majority of primary care through video.

Telemedicine-medical "snack community"-PHS ecosystem: Insights into the double-edged sword role of telemedicine in clinical practice and medical education during the COVID-19 pandemic and beyond

Telemedicine has gained tremendous development during the COVID-19 pandemic. With deblocking and opening, telemedicine accelerates the evolvution of the medical "snack community" and undermines the perception of medical students and staff, which promotes the incidence of psychosocial-related disorders. Moreover, the inconsistent telemedicine adaptability between medical workers and patients aggravates the doctor-patient conflict due to the aging population and COVID-19 squeal. Telemedicine is colliding with the national healthcare system, whose synchronization with conventional medical service is crucial to coordinate the relationship among medical payment, patient privacy and qualifications of clinicians. This study puts more emphasis on the double-edged sword role of telemedicine in clinical practice and medical education during the COVID-19 pandemic and beyond. Overall, while telemedicine has demonstrated its utility in health care throughout the COVID pandemic, it is pretty critical to continue evaluating the efficacy and limitations of telemedicine in order to maintain equal access to medical service and high-quality medical education. A new concept as telemedicine-medical "snack community"-PHS ecosystem, where the psychological health education system and partners healthcare system with enough bandwidth, especially 5G technology, could optimize the effect of telemedicine on medical practice and education, is proposed.

Clinical and cost-effectiveness of telemedicine among patients with type 2 diabetes in primary care: A systematic review and meta-analysis

AIMS

Telemedicine has been promoted as an effective way of managing type-2 diabetes (T2DM) in primary care. However, the effectiveness of telemedicine is unclear. We investigated the clinical and cost-effectiveness of different telemedicine interventions for people with T2DM, compared to usual care.

METHODS

We searched Medline, Embase, Cochrane, CINHAL, ProQuest and EconLit for randomized controlled trials (RCTs) that examined the effectiveness of telemedicine interventions on clinical outcomes (HbA1c, body mass index [BMI], weight, diastolic blood pressure [DBP], systolic blood pressure [SBP], fasting blood glucose, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, total cholesterol and triglyceride) in adults with T2DM, published in English from inception until 31 December 2022. Meta-analyses were conducted using random-effects models pooling mean differences, heterogeneity was quantified using the I2 statistic. Publication bias was assessed using funnel plots, Egger tests and trim and fill. Subgroup analyses included type of telemedicine intervention, telemedicine mode of delivery and type of healthcare professionals. This study was registered with PROSPERO, CRD 42022375128.

RESULTS

Of the 4093 records identified, 21 RCTs, 10,732 participants from seven regions, were included. Reported interventions included telephone (k = 16 studies), internet-based (k = 2), videoconference (k = 2) and telephone and emails (k = 1). We observed no statistically significant differences between synchronous or asynchronous telemedicine interventions compared to usual care for HbA1c (-0.08% (-0.88 mmol/mol); 95% CI: -0.18, 0.02), BMI (0.51 kg/m2; 95% CI: -0.21, 1.22), SBP (-1.48 mmHg; 95% CI: -3.22, 0.26), DBP (3.23 mmHg; 95% CI: -0.89, 7.34), HDL-cholesterol (0.01 mmol/L; 95% CI: -0.03, 0.05), LDL-cholesterol (0.08 mmol/L; 95% CI: -0.22, 0.37), triglycerides (-0.08 mmol/L, 95% CI: -0.31, -0.15), total cholesterol (-0.10 mmol/L; 95% CI: -0.25, 0.04) and weight (-0.50 kg; 95% CI: -1.21, 0.21).

CONCLUSIONS

Telemedicine was as effective as usual care in improving health outcomes of people with T2DM. They can provide a safe solution in times of rising demands for primary healthcare services, or in extreme events, like a global pandemic. More high-quality RCTs are needed on the cost evaluation of telemedicine.

Telemedicine impact on patient disparities and physician practice patterns in cancer rehabilitation: A multicenter retrospective study

OBJECTIVE

To examine the impact of telemedicine on demographic and practice patterns between outpatients receiving virtual versus in-person cancer rehabilitation physiatry care.

DESIGN

Multicenter retrospective study.

SETTING

Outpatient cancer rehabilitation physiatry clinics at four academic medical centers in the United States.

PATIENTS

Patients with cancer diagnoses or history of cancer diagnosis.

INTERVENTIONS

Cancer rehabilitation physiatry encounters.

MAIN OUTCOME MEASURES

Visit mode (in-person, telemedicine); disparities variables (age, race, and gender) by visit mode, and practice interventions (imaging, medications, procedures, other orders, and orders of any type) by visit mode.

RESULTS

Among a total of 7004 encounters, 2687 unique patients were found. In-person participants were significantly older than the average telemedicine participant (mean 62.9 vs. 60.7 years; p < .001). A race effect was seen (p = .037) with individuals reporting as Asian or other being more likely to have telemedicine encounters. No gender disparities were seen. Using a random visit analysis model to compare populations receiving in-person versus telemedicine care, a slight majority (53%) of follow-up visits were via telemedicine, versus 40% of new patient visits (p < .001). No significant differences were seen in medication prescribing frequency (38.9% telemedicine vs. 36.7% in-person, adjusted relative risk [RR]: 0.988, confidence interval [CI]: 0.73-1.34; p = .988) or imaging frequency (2.4% telemedicine vs. 7.6%; adjusted RR: 0.784, CI: 0.44-1.39; p = .408) between telemedicine versus in-person visit types. Other orders were significantly less likely to be placed during telemedicine than in-person visits (19.9% telemedicine vs. 28.6% in-person; adjusted RR: 0.623, CI: 0.45-0.86, p = .004). Order(s) of any type were placed in 54% of visits (52% telemedicine vs. 56% in-person; adjusted RR: 0.92 for telemedicine, CI: 0.83-1.01, p = .082).

CONCLUSIONS

Telemedicine has been integrated into cancer rehabilitation physiatry practices and appears to be conducive for placing many types of orders, especially medications. Age was found to be the only major demographic difference between in-person and telehealth patients.

Navigating the Landscape of Telemedicine Research: A Topic Modeling Approach for the Present and Future

Introduction: Telemedicine, which is the provision of remote clinical services via telecommunication technology, has undergone an upsurge since the COVID-19 pandemic. To capture this paradigm, this study surveyed telemedicine literature, including postpandemic publications, to identify dominant research themes and temporal trends and suggest directions for future research. Methods: A corpus of 56,445 telemedicine studies is sourced from PubMed. Latent Dirichlet allocation (LDA) topic modeling performed using the Konstanz Information Miner platform. The textual data for topic modeling were processed by following standard procedures for natural language processing. Moreover, the term frequency-inverse document frequency approach was used to capture the importance of words within the corpus. We assessed perplexity, coherence, and the elbow method to determine the optimal number of topics for modeling. Results: The findings confirm the surge in telemedicine research after 2020, signifying its prominence. LDA topic modeling reveals seven distinct research themes, with the most prominent topic being "patient satisfaction" (21.38%) followed by "perspectives and challenges" (17.95%), and "smartphone apps" (14.32%). Furthermore, the results demonstrate a noticeable shift in topics from screening to therapeutic applications of telemedicine. Conclusions: This study serves as a guide for a broad range of telemedicine research topics. This synthesis of themes reflects the commitment of scholars to address the changing dynamics and health care needs, such as the COVID-19 pandemic, aging in place, smartphone usage, and technological advancement. The analysis also reveals flexible research responses to policy and contextual shifts, highlighting the collective drive to broaden the application of telemedicine in community health care.

The Impact of Telehealth Expansion on Health Care Utilization, Access, and Outcomes During the Pandemic: A Systematic Review

Introduction: The COVID-19 pandemic brought unprecedented change to the health care industry, including a large and rapid shift to providing care through telehealth technologies. Although the expansion of telehealth services was successful in continuing to provide patients with care while preventing the spread of disease, it is less clear how patient sociodemographic characteristics influenced telehealth use during this time. This study aims to systematically review the published literature on demographic differences in telehealth access, utilization, and health outcomes among a variety of adult patient types in the United States. Methods: Litcovid, PubMed, Web of Science, and MEDLINE databases were searched, resulting in a final sample of n = 32 studies. Results: Results found that studies could be categorized as addressing at least one of eight different areas of inquiry: sociodemographic differences in telehealth use (1) during and (2) before the pandemic, telehealth use versus nonuse (3) during and (4) before the pandemic, (5) telehealth modality, (6) satisfaction with telehealth, (7) outcomes associated with telehealth use, and (8) perceived or actual access to telehealth services. Discussion: Findings are robust across included studies with respect to racial, age, and socioeconomic differences in telehealth utilization and health outcomes, reflecting sociodemographic differences in health care access, utilization, and outcomes more broadly that persist despite this expansion of telehealth services owing to COVID-19. Additional findings across studies are summarized and areas for future research are discussed.

Connecting the disconnected: Leveraging an in-home team member for video visits for older adults

BACKGROUND

Older adults are interested and able to complete video visits, but often require coaching and practice to succeed. Data show a widening digital divide between older and younger adults using video visits. We conducted a qualitative feasibility study to investigate these gaps via ethnographic methods, including a team member in older participants' homes.

METHODS

This ethnographic feasibility study included a virtual medication reconciliation visit with a clinical pharmacist for Veterans aged 65 and older taking 5 or more medications. An in-home study team member joined the participant and recorded observations in structured fieldnotes derived from the Updated Consolidated Framework for Implementation Research and Age-Friendly Health Systems. Fieldnotes included behind-the-scenes facilitators, barriers, and solutions to challenges before and during the visits. We conducted a thematic analysis of these observations and matched themes to implementation solutions from the Expert Recommendations for Implementing Change.

RESULTS

Twenty participants completed a video visit. Participants were 74 years old (range 68-80) taking 12 daily medications (range 7-24). Challenges occurred in half of the visits and took the in-home team member and/or pharmacist an average of 10 minutes to troubleshoot. Challenges included notable new findings, such as that half of the participants required technology assistance for challenges that would not have been able to be solved by the pharmacist virtually. Furthermore, although many participants had a device or had used video visits before, some did not have a single device with video, audio, Internet, and access to their email username and password.

CONCLUSIONS

Clinicians may apply these evidence-based implementation solutions to their approach to video visits with older adults, including having a team member join the visit before the clinician, involving tech-savvy family members, ensuring the device works with the visit platform ahead of time, and creating a troubleshooting guide from our common challenges.

Experience of Older Patients with COPD Using Disease Management Apps: A Qualitative Study

(1) Background: Digital medicine is developing in the management of chronic diseases in older people, but there is still a lack of information on the use of disease management apps in older patients with COPD. This study aims to explore the views and experience of older patients with COPD on disease management apps to provide a basis for the development and promotion of apps for geriatric diseases. (2) Methods: A descriptive qualitative research method was used. Older patients with COPD (N = 32) with experience using disease management apps participated in semi-structured interviews. Thematic analysis was used to analyze the data. (3) Results: Seven themes were defined: (a) feeling curious and worried when facing disease management apps for the first time; (b) actively overcoming barriers to use; (c) gradually becoming independent by continuous online learning; (d) feeling safe in the virtual environment; (e) gradually feeling new value in online interactions; (f) relying on disease management apps under long-term use; (g) expecting disease management apps to meet personalized needs. (4) Conclusions: The adoption and use of disease management apps by older people is a gradual process of acceptance, and they can obtain a wide range of benefits in health and life.

"You matter": patients perceptions and disparities about cancer care and telehealth during and after COVID-19 pandemic

PURPOSE

Disparities in cancer care have been exacerbated by the COVID-19 pandemic. The aim of this study is to establish how telehealth mitigated the effect of COVID-19 on the healthcare sector and to identify potential disparities in perception and experience with telehealth in cancer care during and after the pandemic.

METHODS

We identified individuals with an established cancer diagnosis who received treatment at a comprehensive academic cancer center with a diverse patient population between 2019 and 2021, during the COVID-19 pandemic. Participants were asked to complete a self-administrated survey intended to collect patient-reported outcomes on socioeconomic and mental health challenges incurred during the pandemic as well as participants' experience with telehealth. The assessment was adapted from a 21-question-based survey applied for mental health. Descriptive statistics were used to summarize participant characteristics and the response to the survey items. Multivariable logistic regression was performed to assess and analyze the contributing factors to the survey responses.

RESULTS

A total of N = 136 participants were included in this analysis. The majority of participants (60.6%) reported increased anxiety, stress, or experience of distress as a direct result of COVID-19. However, among 54.1% of survey responders participated in a telehealth appointment and 84.4% agreed it was an easy and effective experience.

CONCLUSION

Elderly, male, and black participants reported the worst impact related to the pandemic. The majority of patients had a positive experience with telehealth. The results of the study suggest that telehealth services can serve as a tool for patients with cancer during and beyond active treatment to access supportive services.

Designing Telemedicine for Older Adults With Multimorbidity: Content Analysis Study

BACKGROUND

Telemedicine is a potential option for caring for older adults with multimorbidity. There is a need to explore the perceptions about telemedicine among older adults with multimorbidity to tailor it to the needs of older adults with multiple chronic conditions.

OBJECTIVE

This study aims to explore the perceptions about telemedicine among older patients with multimorbidity.

METHODS

A qualitative study was conducted using semistructured interviews. The interview questions examined older adults' perspectives about telemedicine, including their expectations regarding telemedicine services and the factors that affect its use. Thematic analysis was performed using NVivo (version 12; Lumivero). The study was reported using the Standards for Reporting Qualitative Research guidelines.

RESULTS

In total, 29 patients with multimorbidity-21 (72%) female patients and 8 (28%) male patients with a mean age of 69 (SD 10.39) years-were included. Overall, 4 themes and 7 subthemes emerged: theme 1-perceived benefit of telemedicine among older adults with multimorbidities, theme 2-appropriate use of telemedicine for multimorbid care, theme 3-telemedicine system catering to the needs of older patients, and theme 4-respect patients' decision to decline to use telemedicine.

CONCLUSIONS

Telemedicine for older adults with multimorbidity should focus on those with stable conditions. This can help increase access to care for those requiring continuous condition monitoring. A structured telemedicine program and patient-centered services can help increase patient acceptance of telemedicine. However, health care providers must accept the limitations of older patients that may prevent them from receiving telemedicine services.

Affinity and Usage of Technology in General, and Telehealth in Particular amongst Michigan Older Adults during the COVID-19 Pandemic

The COVID-19 pandemic and the travel restrictions imposed by many states led people to resort to technology for many of their daily needs which put older adults (aged 65 years and over) at a particular disadvantage as it is known that they are slow to adopt technology on a wide scale. Increasing the adoption and usage of technology for all purposes, especially healthcare appointments, would particularly benefit this population segment. Primary data was collected through online surveys targeted at older adults, aged 65 and over, living in Michigan, through a Qualtrics panel. Results indicate that, since this survey was an online survey, there is a bias in the use of technology as more than half the respondents had used zoom/skype or a similar medium to connect with friends and family during the period of travel restrictions. However, a substantial portion had not used telehealth services. Barriers to using telehealth services and factors that would encourage them to use them more are discussed. The study points to an emerging need for older adults to take advantage of technology more in order to overcome some of the barriers to accessing telehealth for their healthcare needs. Although technology cannot replace having real contact with people and being able to move about in the community, it helps, to a certain degree, to elevate overall wellbeing.

Patient Satisfaction with Telehealth at an Academic Medical Center Primary Care Clinic

Objective: To determine whether the quality of the patient experience differs between video visits and in-person visits for primary care. Methods: Using patient satisfaction survey results from patients who had visits with the internal medicine faculty primary care practice at a large urban academic hospital in New York City from 2018 to 2022, we compared results regarding satisfaction with the clinic, physician, and ease of access to care between patients who attended a video visit and those who attended an in-person appointment. Logistic regression analyses were performed to determine if there was a statistically significant difference in patient experience. Results: In total, 9,862 participants were included in analysis. Mean age of respondents attending in-person visits was 59.0; mean age of respondents attending telemedicine visits was 56.0. There was no statistically significant difference in scores between the in-person and telemedicine groups for likelihood of recommending the practice to others, quality of time spent with the doctor, and how well the clinical team explained care. Patient satisfaction was significantly higher in the telemedicine group compared with the in-person group for ability to get an appointment when needed (4.48 ± 1.00 vs. 4.34 ± 1.04, p < 0.001), how helpful and courteous the person who assisted them was (4.64 ± 0.83 vs. 4.61 ± 0.79, p = 0.009), and ease of reaching the office through phone (4.55 ± 0.97 vs. 4.46 ± 0.96, p < 0.001). Conclusions: This analysis demonstrated parity in patient satisfaction for traditional in-person visits and telemedicine visits in primary care.

Telehealth Utilization and Good Care among Informal Caregivers: Health Information National Trends Survey, 2022

BACKGROUND

The COVID-19 pandemic accelerated the adoption of telehealth services. Informal caregivers provide vital support to family and friends. Studying telehealth among informal caregivers is crucial to understanding how technology can support and enhance their caregiving responsibilities, potentially enhancing telehealth services for them as well as their patients. The present study aims to nationally investigate telehealth utilization and quality among informal caregivers.

METHODS

This cross-sectional investigation employed the 2022 Health Information National Trends Survey (HINTS) dataset. Informal caregivers, telehealth variables (utilization, good care, technical problems, convenience, and concerns about infection exposure), and sociodemographic factors (age, gender, race/ethnicity, income, education, health insurance, and census regions) were identified based on questions in the survey. Weighted multivariable logistic regression models were employed to calculate odds ratios (ORs), 95% confidence intervals (CIs), and p-values.

RESULTS

Significant disparities in telehealth utilization were detected among informal caregivers (N = 831), when telehealth users were compared to non-users. Those aged 50-64 (OR = 0.36, 95% CI = 0.20-0.65) and 65+ (OR = 0.40, 95% CI = 0.21-0.74) had significantly lower odds of using telehealth than those aged 35-49. Men had significantly lower odds of telehealth utilization (OR = 0.47, 95% CI = 0.25-0.87). Black caregivers compared to Whites had significantly lower odds (OR = 0.49, 95% CI = 0.24-0.99), while health insurance increased odds (OR = 5.31, 95% CI = 1.67-16.86) of telehealth utilization. Informal caregivers who used telehealth were more likely to be perceived as good telehealth caregivers if they had no telehealth technical issues compared to caregivers who had (OR = 4.61, CI = 1.61-13.16; p-value = 0.0051) and if they were from the South compared to the West (OR = 2.95, CI = 1.18-7.37, p-value = 0.0213).

CONCLUSIONS

For the first time, to the best of our knowledge, we have nationally investigated telehealth utilization and quality among informal caregivers. Disparities in telehealth utilization among informal caregivers are evident, with age, gender, race, and health insurance being significant determinants. Telehealth quality is significantly influenced by technical problems and census regions, emphasizing the importance of addressing these aspects in telehealth service development for informal caregivers.

Improving older adults' telehealth through a novel community-academic partnership: Preliminary data

BACKGROUND

The COVID-19 pandemic increased the use of telehealth, which posed unique challenges for the provision of care to older adults who face numerous barriers to accessing and using technology. To improve older adults' online health-related abilities, the UCSF Geriatrics Workforce Enhancement Program (UCSF-GWEP) partnered with Little Brothers Friends of the Elderly-San Francisco (LBFE-SF) to develop a model telehealth training intervention.

METHODS

LBFE-SF recruited older adults from their members with wi-fi and paired each one with a new device and volunteer trainer to cover seven lessons and four key tasks (emailing providers, video visits, accessing health information, and using patient portals). Older adults completed surveys to self-assess their skill level after training, and their confidence before, immediately after, and 3 months post training. A subset of trainees were also interviewed about their program goals and experiences. UCSF-GWEP conducted statistical analyses of survey data, and coded interview transcripts to identify aspects of the model supportive to learning and success.

RESULTS

Of 43 participants, 31 completed training. Their median age was 75; 48% were non-white; 45% had no more than a high school education; and 63% reported yearly income below U.S. $20,000. Three months after completing the program, more than 50% of trainees reported that they needed little or no help performing all four key tasks, and confidence with video visits, online searches, and patient portals showed significant improvement. Additionally, in interviews participants reported improved health, social benefits, and explained that learning was facilitated by self-pacing, repetition, and longitudinal support from volunteer trainers.

CONCLUSIONS

Older adults with various barriers to learning technology showed online independence and increased confidence with some telehealth tasks after a novel training intervention. Key characteristics of the model included a tablet device, one-on-one longitudinal support from volunteers, comprehensive learning materials, and community-academic partnership.

Insights into the use of telemedicine in primary care in times of the SARS-CoV-2 pandemic - a cross-sectional analysis based on the international PRICOV-19 study in Austria

BACKGROUND

The SARS-CoV2 pandemic as well as the implementation of public health measures to decrease the spread of the virus re-sparked the call for "virtual" health or "distance" treatments. This paper aimed to assess the use of video consultations, the up-to-dateness of practice websites, and the views of GPs on whether eHealth is a positive aspect for the future of their practices in publicly -funded primary healthcare facilities in Austria.

METHODS

The cross-sectional online questionnaire, part of the PRICOV-19 study, was conducted from December 2020 until July 2021. We randomly recruited 176 GP practices across Austria. Descriptive statistics as well as binary logistic regression models were applied to examine the associations between telemedicine use and practice factors.

RESULTS

Compared with before the pandemic (3.8%), 7.6% of publicly funded GP practices have been using video consultations since the pandemic. In line with this, 93.9% of the practices had no increase in video consultation use. Fewer than half (44.3%) had an up-to-date webpage, and 27.8% assumed that the pandemic might have been a positive driver for eHealth in their practices. Positive associations with video consultation use could be found in practices with fewer patients aged 70 years and over than the average and more patients with chronic diseases than the average.

CONCLUSION

The use of video consultations in general practice and the readiness for other telemedicine approaches are both very low in Austria. Austria has to urgently follow the example of countries with a transparent and comprehensive national digital health strategy that includes video consultation. Without a proper payment system, patient inclusion, and support with regard to administrative and organizational aspects, no substantial change will occur in spite of an increase in need due to the pandemic and changes in the patient population.

Telehealth Use Among Older Adults With Sensory, Cognitive, and Physical Impairments: A Substitute or Supplement to Traditional Care?

OBJECTIVES

Telehealth use flourished during the COVID-19 pandemic, as older patients faced obstacles to seeking in-person care. Heavy reliance on telehealth may continue postpandemic, due to increased Medicare investments in its use. However, it is unclear if older adults with disabilities face obstacles to effective telehealth use. We evaluate (a) how sensory, physical, and cognitive impairments affect older adults' use of telehealth only, traditional in-person care only, neither, or both (i.e., combined care); and (b) whether these patterns differ on the basis of socioeconomic and social resources that may facilitate telehealth use.

METHOD

Data are from the Self-Administered Questionnaire in the 2020 wave of the Health and Retirement Study (n = 4,453). We estimated multinomial logistic regression models to evaluate associations between impairments and health care service use and tested 2-way interaction terms to evaluate moderation effects.

RESULTS

Persons without impairments were most likely to use combined care, considered the optimal form of care. Persons with vision or cognitive impairment were more likely to use telehealth or traditional care only, whereas persons with 3 or more physical limitations were least likely to use telehealth alone, relative to combined care. Patterns did not differ significantly on the basis of any of the potential moderators.

DISCUSSION

We discuss implications for health care policy and practice, in light of reimbursement changes proposed by the Centers for Medicare and Medicaid Services for telehealth services. These proposals include the elimination of voice-only services which may be particularly beneficial to vision-impaired older adults.

General practitioner residents' experiences and perceptions of outpatient training in primary care settings in China: a qualitative study

OBJECTIVES

The implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited research exists on their experiences and perceptions of this training. This study aimed to explore the experiences and perceptions of GP residents regarding outpatient training in primary care settings in China and provide insights and recommendations to enhance training quality.

DESIGN

A qualitative descriptive study employing in-depth interviews.

SETTING

Two community healthcare centres (CHCs) that implement outpatient training programmes for GP residents in Zhejiang Province, China.

PARTICIPANTS

In total, 20 GP residents affiliated with 14 CHCs and two hospitals across Zhejiang Province and Guizhou Province who had completed outpatient training in either CHC for over 1 month.

RESULTS

Of the 20 participants in this study, 11 (55%) were women, and the mean age was 28 years. GP residents completed the process of consultation, physical examination and therapy independently; subsequently, the community preceptors provided feedback based on their clinical performance and modelled their clinical skills. The benefits perceived by GP residents included improved clinical skills and confidence in practice, and they learned approaches to maintaining good relationships with patients. They preferred dealing with complex cases, discussions with peers and the indirect supervision of community preceptors in the training session. Residents recommended that measures be taken to improve the training quality regarding patient selection and recruitment, clinical skills in the training session, and assessment of clinical performance.

CONCLUSIONS

The outpatient training in primary care settings provides constructive opportunities for GP residents to improve their professional competencies. Although the current training sessions and the abilities of community preceptors largely satisfy the needs of GP residents, further research is needed to evaluate the effectiveness of training and explore approaches to improve its quality.

Teaching medical students in general practice when conducting remote consults: a qualitative study

BACKGROUND

Telehealth involves real-time communication (telephone or video-call) between patients and health providers. The COVID-19 pandemic propelled general practitioners to conduct most consultations remotely, seeing patients face-to-face only when required. Placement opportunities and experience for medical students were reduced. Initially online learning programmes replaced clinical attachments. Subsequently, clinical teachers supervised students to engage in remote consultations, either in clinics or from their homes. This study aimed to explore the experience of New Zealand general practitioners undertaking clinical teaching with medical students when telehealth consulting.

METHODS

Semi-structured interviews with general practitioners who had taught medical students whilst consulting remotely. General inductive thematic analysis of transcribed interviews.

RESULTS

Six female and four male participants aged 40 to over 65 years. Participants often focused on general practicalities of telehealth consultations and effects on the patient-doctor relationship, and needed direction to consider remote consultations with students, which added to the interactions. Four themes were identified: changes needed in teaching delivery format; direct comparison with face-to-face; challenges and advantages to remote teaching, each with subthemes.

DISCUSSION

Clinicians needed to determine practical logistics and develop skills for both remote consulting and teaching. New format and structures of consultations needed planning. Differences from face-to-face teaching included scene-setting for the consultation and supervision factors. Telehealth teaching conferred new opportunities for learning but also challenges (e.g. consent, cues, uncertainty). Remote consultations are likely to remain a significant mode for doctor-patient interactions. Preliminary guidelines for teaching and learning using telehealth need to be developed and embedded into medical programmes and then evaluated.

Joining telehealth in rheumatology: a survey on the role played by personalized experience from patients' perspective

BACKGROUND

The beginning of the Covid-19 pandemic has forced many hospital departments worldwide to implement telehealth strategies for the first time. Telehealth represents the opportunity to increase value for all stakeholders, including patients and healthcare staff, but its success constitutes a challenge for all of them and particularly patients play a crucial role for their needed adherence. This study focuses on the experience of the Rheumatology Unit of Niguarda Hospital in Milan (Italy), where telehealth projects have been implemented for more than a decade with structured design and organized processes. The case study is paradigmatic because patients have experimented personalized mixes of telehealth channels, including e-mails and phone calls, Patient Reported Outcomes questionnaires, and home delivery of drugs. Given all these peculiarities, we decided to deepen patients' perspective through three main aspects related to the adoption of telehealth: (i) the benefits perceived, (ii) the willingness to enrol in future projects, (iii) the preference on the service-mix between remote contacts and in-person visits. Most importantly, we investigated differences in the three areas among all patients based on the mix of telehealth channels experienced.

METHODS

We conducted a survey from November 2021 to January 2022, enrolling consecutively patients attending the Rheumatology Unit of Niguarda Hospital in Milan (Italy). Our survey comprised an introductory set of questions related to personal, social, clinical and ICT skills information, followed by the central part on telehealth. All the answers were analysed with descriptive statistics and regression models.

RESULTS

A complete response was given by 400 patients: 283 (71%) were female, 237 (59%) were 40-64 years old, 213 (53%) of them declared to work, and the disease most represented was Rheumatoid Arthritis (144 patients, 36%). Descriptive statistics and regression results revealed that (i) non-users imagined wide-ranging benefits compared to users; (ii) other things being equal, having had a more intense experience of telehealth increased the odds of accepting to participate to future projects by 3.1 times (95% C.I. 1.04-9.25), compared to non-users; (iii) the more telehealth was experienced, the higher the willingness to substitute in-person with online contacts.

CONCLUSIONS

Our study contributes to enlighten the crucial role played by the telehealth experience in determining patients' preferences.

Impact of Advance Care Planning on the Hospitalization-Associated Utilization and Cost of Patients with Alzheimer's Disease-Related Disorders Receiving Primary Care via Telehealth in a Provider Shortage Area: A Quantitative Pre-Study

Telehealth has been adopted as an alternative to in-person primary care visits. With multiple participants able to join remotely, telehealth can facilitate the discussion and documentation of advance care planning (ACP) for those with Alzheimer's disease-related disorders (ADRDs). We measured hospitalization-associated utilization outcomes, instances of hospitalization and 90-day re-hospitalizations from payors' administrative databases and verified the data via electronic health records. We estimated the hospitalization-associated costs using the Nevada State Inpatient Dataset and compared the estimated costs between ADRD patients with and without ACP documentation in the year 2021. Compared to the ADRD patients without ACP documentation, those with ACP documentation were less likely to be hospitalized (mean: 0.74; standard deviation: 0.31; p < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; p < 0.01). The hospitalization-associated cost estimate for ADRD patients with ACP documentation (mean: USD 149,722; standard deviation: USD 80,850) was less than that of the patients without ACP documentation (mean: USD 200,148; standard deviation: USD 82,061; p < 0.01). Further geriatrics workforce training is called for to enhance ACP competencies for ADRD patients, especially in areas with provider shortages where telehealth plays a comparatively more important role.

Perceived Impact of Virtual Visits on Access to Care in Family Medicine During the COVID-19 Pandemic: A Qualitative Study of Benefits and Challenges

BACKGROUND

The COVID-19 pandemic in 2020 led to the rapid adoption of telemedicine, including virtual visits, to minimize face-to-face contact between clinicians and patients. Family medicine clinics across the nation had to transform how they provided primary care while maintaining the core values of family medicine. The objective of this study was to analyze how family medicine faculty perceived the impact of virtual visits on patient access to care.

METHODS

This qualitative study took place in an academic primary care setting. We interviewed clinical faculty who utilized virtual visits about their experiences from June to December 2020. We used qualitative content analysis to evaluate the results of the interviews.

RESULTS

The study included a total of 20 participants. The mean age was 43.4 years, and 85% of participants were female. Researchers developed 3 themes, "Logistics of virtual visits," "reigniting the concept of home visits," and "barriers and benefits that affect specific patient populations" that describe how virtual visits have impacted patients' access to care. The results highlight how virtual visits improve access to care by increasing flexibility for patients and providers and provide a new perspective into a patient's home life. Challenges of virtual visits include language barriers, technological issues, and issues unique to vulnerable patient populations.

CONCLUSION

Virtual visits can enhance family medicine's ability to provide accessible care, but there are concerns it may worsen health disparities. Further research and quality improvement projects are needed to examine ways to implement innovative care delivery solutions to avoid further exacerbating these disparities.

Racial and Ethnic Disparity in 4Ms among Older Adults Among Telehealth Users as Primary Care

Telehealth has been widely accepted as an alternative to in-person primary care. This study examines whether the quality of primary care delivered via telehealth is equitable for older adults across racial and ethnic boundaries in provider-shortage urban settings. The study analyzed documentation of the 4Ms components (What Matters, Mobility, Medication, and Mentation) in relation to self-reported racial and ethnic backgrounds of 254 Medicare Advantage enrollees who used telehealth as their primary care modality in Southern Nevada from July 2021 through June 2022. Results revealed that Asian/Hawaiian/Pacific Islanders had significantly less documentation in What Matters (OR = 0.39, 95%, p = .04) and Blacks had significantly less documentation in Mobility (OR = 0.35, p < .001) compared to their White counterparts. The Hispanic ethnic group had less documentation in What Matters (OR = 0.18, p < .001) compared to non-Hispanic ethnic groups. Our study reveals equipping the geriatrics workforce merely with the 4Ms framework may not be sufficient in mitigating unconscious biases healthcare providers exhibit in the telehealth primary care setting in a provider shortage area, and, by extrapolation, in other care settings across the spectra, whether they be in-person or virtual.