IntroductionTelemedicine (TM) has been adopted by many health authorities to limit unnecessary exposure during COVID-19. Prior to the pandemic, TM was associated with improvement of quality of life of older patients, low hospital admissions and nursing home placement, and high overall patients’ satisfaction due to convenience. However, older adults may face challenges to access TM, such as hearing, visual and cognitive decline, and limited access to Internet and devices. Ongoing vaccination campaigns and sanitary measures are keeping the pandemic under control, but new variants threaten public safety. Specific recommendations on TM use in high-risk populations, such as older adults, are therefore required.Methods and analysisTo assess the challenges of TM use in the routine primary healthcare practice of older adults. The research objective is to examine the potential effect of TM; (1) to describe the evidence of TM, (2) to understand the patients, caregivers and clinicians’ experiences with TM use and (3) to develop practice-based and evidence-based recommendations on effective use of TM. Multiphase design: (1) systematic mixed studies review on the evidence of TM use, (2) qualitative descriptive study on the experiences of the patients, caregivers and healthcare professionals. Recommendations will be proposed based on the integration of both studies. In accordance with PRISMA statement, the systematic mixed studies review will be conducted through multiple databases search: MEDLINE, PsycINFO, EMBASE, CINAHL, AgeLine, Cochrane Library. Population studied: Community-dwelling 65 years and older adults using two-way synchronous TM by phone or video in a primary care setting. The qualitative descriptive study will include individual interviews with older adults from four McGill university affiliated primary care practices and focus groups with their healthcare professionals.Ethics and disseminationEthics approval has been received. Results will inform healthcare professionals and policy-makers on sustainable use of TM in primary care for older adults.PROSPERO registration numberThe review protocol has been recorded at the PROSPERO, CRD42021237686 (https://www.crd.york.ac.uk/prospero/.
Background Family physicians had to deliver care remotely during the COVID-19 pandemic. Their efforts highlighted the importance of developing a primary care telemedicine (TM) model. TM has the potential to provide a high-quality option for primary care delivery. However, it poses unique challenges for older adults. Our aim was therefore to explore the effects of TM and the determinants of its use in primary care for older adults. Methods In this systematic mixed studies review, MEDLINE, PsycINFO, EMBASE, CINHAL, AgeLine, DARE, Cochrane Library, and clinical trials research registers were searched for articles in English, French or Russian. Two reviewers performed study selection, data extraction and assessment of study quality. TM’s effects were reported through the tabulation of key variables. TM use determinants were interpreted using thematic analysis based on Chang’s framework. All data were integrated using a joint display matrix. Results From 3,328 references identified, 20 studies were included. They used either phone (n = 8), videoconference (n = 9) or both (n = 3). Among studies reporting positive outcomes in TM experience, ‘user habit or preferences’ was the most cited barrier and ‘location and travel time’ was the most cited facilitator. Only one study reported negative outcomes in TM experience and reported ‘comfort with patient communication’ and ‘user interface, intended use or usability’ as barriers, and ‘technology skills and knowledge’ and ‘location and travel time’ as facilitators. Among studies reporting positive outcomes in service use and usability, no barrier or facilitator was cited more than once. Only one study reported a positive outcome in health-related and behavioural outcomes. Conclusions TM in older adults’ primary care generally led to positive experiences, high satisfaction and generated an interest towards alternative healthcare delivery model. Future research should explore its efficacy on clinical, health-related and healthcare services use.
Context: The COVID-19 pandemic has substantially changed the delivery of primary care health services. Indeed, more clinic-based care has turned into virtual remote care. Thus, it is necessary to develop a comprehensive remote virtual care method. Telemedicine (TM) has the potential to improve the quality of primary health care and increase accessibility to the population. Some studies indicated that TM was an efficient way to deliver medical services, especially to older people. Nevertheless, its use may represent a challenge to older populations as they may have different needs from general population due to potential age-related changes in perceptual, motor and cognitive capacities. Objective: To explore older adults' and family physicians' experience with telemedicine (TM) use during the COVID-19 pandemic, and to identify potential facilitators and barriers of TM use. Design and Analysis: Multi-phase design. Phase 1: Systematic review; Phase 2: Qualitative descriptive study; Phase 3: Integration of the results from Phase 1 and 2 using deliberative dialogue. Individual semi-structured interviews and focus groups findings were analyzed using inductive thematic analysis, based on the Consolidated Framework for Implementation Research. Setting: Montreal. Population studied: Individual semi-structured interviews with twenty-nine older adults from four McGill family medicine sites -Herzl, CLSC-CDN, Parc-Extension and Metro. Preliminary interviews findings informed focus groups with family physicians. Findings: Participants indicated that telemedicine contributed to maintain continuity of care and was convenient to resolve minor health issues, triage/preliminary consultations, and follow-up with their family physicians. TM was also considered particularly beneficial for persons with limited mobility; and reduced the exposure of older adults to potential high-risk environments. Nevertheless, participants expressed some concerns about the lack of visual contact, negatively impacting the physician-patient relationship and causing important details to be overlooked. Similarly, miscommunication difficulties may emerge due to language or hearing barriers. Family physicians perceived that most patients did not consider phone consultations as a medical act. Conclusion: Older adults consider TM to be a good alternative for accessing health-care services, when provided in a hybrid approach combined with inperson consultations with their family physician.
Background The COVID-19 pandemic transformed the health care systems, motivating Telemedicine's rapid evolution and implementation. Telemedicine (TM) can potentially improve the quality of primary health care and increase accessibility to the population. Nevertheless, its use may represent a challenge to older people as they may have different needs from the general population due to potential age-related changes in perceptual, motor and cognitive capacities. We thus aimed to identify potential facilitators and barriers to Telemedicine (TM) use in the primary care of older adults and develop recommendations. Methods We conducted a multi-phase study: 1. A systematic mixed-method review to explore determinants in the use of TM for older adults for papers published before July 2021; 2. Qualitative descriptive study, we interviewed 29 older adults and conducted three focus groups and one deliberative dialogue with healthcare professionals from four McGill family medicine sites. The findings were analyzed using deductive thematic analysis based on the Consolidated Framework for Implementation Research (CFIR); 3. We integrated the results from both phases and the deliberative dialogue using thematic analysis. Results The systematic review identified over 3,328 references. We included 21 articles, resulting in positive experiences and high satisfaction and generating interest in TM as a complementary healthcare delivery model. Participants agreed that TM contributed to maintaining the continuity of care and was convenient when there is a previous/established patient-physician relationship and to resolve minor health issues. TM was beneficial for persons with limited mobility; and reduced the exposure of older adults to potential high-risk environments. Nevertheless, participants expressed concerns about the lack of visual contact, causing essential details to be overlooked. Similarly, miscommunication difficulties may emerge due to language or hearing barriers. Family physicians perceived that most patients did not consider phone consultations a medical act. However, participants were amenable to a hybrid approach, combining in-person consultations and Telemedicine, depending on their health conditions. Conclusions Older adults and healthcare professionals consider Telemedicine a good alternative for accessing healthcare services, though it would be necessary to promote a hybrid approach and encourage and support familiarization, adaptability, and accessibility to technological tools.
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