Competencies for video telemedicine with older adult patients

Abstract

Background Telemedicine has recently become a part of mainstream clinical practice. Many curricula have been developed to teach general and specialty‐specific video telemedicine skills; however, a lack of defined best practices for translating comprehensive interprofessional geriatric care to the virtual setting presents a unique challenge to educators and clinicians. This manuscript introduces and describes the development of competencies for video telemedicine with older adults for all health professionals who treat them. Methods A modified Delphi process was used in competency development. In 2019, interprofessional clinicians and educators who had expertise in telemedicine formed a competency development workgroup. The aim was to draft competencies for interprofessional video telemedicine with older adults while not duplicating existing competencies in geriatrics, interprofessional care, or general telemedicine. Draft competencies were circulated among experts in geriatric telemedicine and geriatric education for two rounds of comments. The competencies incorporated comments from 41 clinicians representing 7 professions. Results Twenty‐three competencies were created spanning six domains. A temporal organization by domain was used: (1) Overarching considerations, (2) Pre‐visit preparation, (3) Beginning of the visit, (4) History taking and communication during the visit, (5) Exam during the visit (organized by the 5Ms: Mind, Mobility, Medication, Multicomplexity, and Matters Most), and (6) Post‐visit coordination. Conclusions These newly developed competencies fill a gap left by those developed for specific disciplines or that do not address considerations for older adults. They lay the groundwork for curriculum development and the development of virtual Age‐Friendly care.

Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study

“…Patients’ physical and psychological comfort should be addressed to ensure a positive experience that respects patient beneficence and autonomy. Other studies have identified previsit preparation as an important clinician competency domain for video telemedicine with older adult patients, including optimizing the clinician environment for audibility and visibility and identifying who should be included in the visit and their roles in the patient’s care [ 26 ]. Our results echo privacy concerns in the telemedicine community regarding the sharing of sensitive information and diagnoses with care partners or others who happen to be in the appointment environment, which in some situations can pose distress to patients or caregivers [ 32 , 33 ].…”

“…We conducted interviews using the same VA videoconferencing platform used for clinical visits, enabling us to observe and interact with participants as they navigated technological and communication challenges and, if needed, provide necessary technical support or instruction. While other studies have examined satisfaction with telemedicine in older adults [ 9 , 10 ] and competencies of providers, including previsit preparation [ 26 ], few studies have looked in-depth at the experiences of older patients inexperienced in telemedicine as they prepare to engage in visits. We sought to (1) elicit patient and caregiver experiences attempting to participate in a video visit with a GRECC Connect geriatric specialist, and (2) explore facilitators and barriers to successful engagement in a telemedicine visit among this group.…”