To the EditorThe COVID-19 pandemic has facilitated increased use of telehealth for primary and specialty care encounters, and recently there have been calls to expand its use in post-acute and long-term care settings. 1,2 Telehealth expansion is particularly important for rural and underserved populations as it represents a medium to increase access and reduce disparities in health care delivery. 3 However, despite the increase in availability, relatively little is known about whether rural older adults are open to using telehealth. Methods SampleParticipants were adults aged 65 years from one clinic affiliated with a network of rural southeastern federally qualified health centers. These clinics serve more than 22,000 primarily rural patients, of which approximately 3000 are aged 65 years. Approximately 38% of patients are racial or ethnic minorities: 27% are black and 11% Hispanic/Latino. As part of a larger quality improvement (QI) initiative, older adults who were active patients (n ¼ 357) were contacted for participation in a brief survey. Sixty-five (18.2%) completed the survey (50 by e-mail, 15 by mail). Because this project was deemed QI, institutional review board approval was not required.
During the pandemic, providers shifted to telemedicine to ensure patient safety. Under a federally funded cooperative agreement, the Florida State University College of Medicine’s Department of Geriatrics partnered with a Federally Qualified Health Center to assess rural older adults’ perceptions about telehealth and identify potential barriers. The quality improvement study used a convenience sample to survey patients aged ≥ 65 (n=62) at one rural clinic. 54.8% of respondents indicated they would not use telehealth for any care or preferred to receive most or all care in person. Conversely, 32.8% indicated a willingness to receive some care via telehealth. The survey also assessed the need for self-management devices, including blood pressure cuffs. There was not a consistent positive relationship between persons requesting devices and those who were telehealth willing. Devices were distributed to enhance telehealth visits and at-home monitoring. Clinic staff provided patients hands on training for device use and connection to EMR. Informal qualitative reports suggest patients are more empowered to utilize telehealth services and self-manage conditions. COVID-19 also limited access to community blood pressure screenings. The Tallahassee Senior Center and FSU Physician Assistant program distributed devices to community-dwelling older adults. PA students provided hands on training to aid in device familiarity and digital connectivity. Almost all older adult participants aged >60 strongly agreed “after the presentation I feel ready to use the blood pressure cuff at home.” Clinical and community-based activities can help older adults who lack digital fluency feel more confident in using telehealth services and self-management devices.
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