Emergency physician perspectives on using telehealth with older adults during COVID‐19: A qualitative study

Abstract

Objectives Emergency medicine physicians have played a pivotal role throughout the coronavirus disease 19 (COVID‐19) pandemic through in‐person and remote management and treatment. Our primary objectives were to understand emergency medicine physicians’ experiences using telehealth throughout the pandemic, any facilitators/barriers to successful usage, lessons learned during implementation, and successful/abandoned strategies used to engage with older adults. Methods Using a semi‐structured interview guide, we conducted 30‐min interviews. We used purposeful sampling to recruit emergency medicine physicians from all United States regions, rural–urban settings, and academic and community practices, who reported caring for patients 65 years or older in‐person or virtually during the pandemic. Interviews were audio‐recorded, transcribed, double‐coded, and analyzed for emergent themes using framework analysis. Results A total of 15 in‐depth interviews were completed from September to November 2020. Physicians had a median age of 37 years, 7 were women, and 9 had experience with telehealth before the pandemic. We identified several themes: (1) there were various motivations for telehealth use; (2) telehealth was used primarily to supplement, not replace in‐person care; (3) most platforms were easy to use; (4) patients and caregivers had high acceptability of telemedicine; and (5) older adults with sensory and cognitive impairments often relied on caregivers. Emergency medicine physicians played a critical role during primary care office closures during the first wave—dispelling misinformation about COVID‐19, triaging patients to testing and treatment, and providing care that would otherwise have been deferred. Conclusions Our data show that telemedicine gained acceptability among emergency medicine physicians and provided options to patients who may have otherwise deferred care. These findings can inform future healthcare delivery for acute care needs or pandemic responses.

Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics

“…Data for this study were collected as part of a larger study which included PCPs, geriatricians, and emergency medicine physicians. In previously published manuscripts ( Goldberg et al, 2021 ), we reported overall findings from the larger study on physicians’ experiences using telehealth to care for older adults during the COVID-19 pandemic, as well as findings specific to emergency medicine physicians ( Davoodi et al, 2021 ). Here, we focus on experiences in primary care and geriatrics, as these office-based staff had unique experiences from hospital-based clinicians.…”

Perceptions About Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers

“…Telemedicine has been explored in a variety of uses, including but not limited to patient examination [7], teleconsultation [8], telesurgery [9] and medical education [10]. However, many users still do not view telemedicine as a substitute for in-person care; physicians cited limitations in diagnostic ability [11] and training [12][13][14], whereas patients cited limited interactivity and difficulty of access [15]. Advances in technology hope to address some of these barriers, with augmented reality (AR) showing considerable potential.…”

Frontline Physician Perspectives on Their Experiences Working During the First Wave of the COVID-19 Pandemic

“… 4 As the pandemic progressed, more qualitative investigations were conducted exploring physician perspectives on working in subsequent waves of the pandemic, 5 , 6 the impact of COVID-19 on primary care, 7 , 8 integration of palliative medicine into intensive care units, 9 and telehealth. 10 – 16 …”

“…4 As the pandemic progressed, more qualitative investigations were conducted exploring physician perspectives on working in subsequent waves of the pandemic, 5,6 the impact of COVID-19 on primary care, 7,8 integration of palliative medicine into intensive care units, 9 and telehealth. [10][11][12][13][14][15][16] To inform future efforts in the COVID-19 pandemic and prepare for future crises, we must understand frontline physicians' perspectives from the first wave of the pandemic, when the least was known about this crisis. Given their central role in the healthcare system's response, further crisis management without exploration of the perspectives of frontline physicians risks missing opportunities for success as well as opportunities to anticipate and proactively address sequelae for both patients and clinicians.…”