Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers

Abstract

Objective: Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value.Data Sources: In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits.Study Design: A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges.Data Collection: We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach.Principal Findings: Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns.

Age‐Friendly Health Systems: Improving care for older adults in the Veterans Health Administration

“…McQuown 23 and Dryden 26 explore the benefits of and health outcomes from AFHS through the Geriatric Research, Education, and Clinical Center (GRECC) Connect (geriatric telemedicine), and the Supporting Community Outpatient, Urgent Care, and Telehealth Services (SCOUTS) programs. These programs align with the AFHS model and are associated with the expanded geriatric “5Ms” (adding multi‐complexity) as described by the American Geriatric Society's Health in Aging Foundation 27 .…”

“…These programs align with the AFHS model and are associated with the expanded geriatric “5Ms” (adding multi‐complexity) as described by the American Geriatric Society's Health in Aging Foundation 27 . Both programs provide opportunities to improve care and support caregivers, particularly in rural areas, and they met an unexpected surge in need during the height of the COVID‐19 pandemic 23,26 …”

“…26 Dryden reported the following AFHS outcomes related to geriatric specialty telemedicine: reduced polypharmacy (medication), improved physical and cognitive well-being (what matters, mobility, and mentation, for example, lower blood pressure, better sleep quality, improved memory, less anxiety, lower fall risk), and improved adherence to their treatment regimen. 26 Challenges noted by the Dryden and McQuown research teams include setting patient and caregiver expectations upfront and acknowledging the limits of what is known about cognitive impairment and its progression, awareness of racial and socioeconomic disparities in rural settings (e.g., reliable internet access), and meeting the complex needs of patients with hearing, visual, and cognitive impairment who may have difficulty absorbing and recalling information and connecting through telemedicine. 23,26…”

“…26 Challenges noted by the Dryden and McQuown research teams include setting patient and caregiver expectations upfront and acknowledging the limits of what is known about cognitive impairment and its progression, awareness of racial and socioeconomic disparities in rural settings (e.g., reliable internet access), and meeting the complex needs of patients with hearing, visual, and cognitive impairment who may have difficulty absorbing and recalling information and connecting through telemedicine. 23,26…”

“…As an alternative, geriatric ED aftercare may be provided via telemedicine and/or home visits 48-72 hours after discharge to reduce hospital readmissions, their associated costs, and increase patient satisfaction. [23][24][25] McQuown 23 and Dryden 26 explore the benefits of and health outcomes from AFHS through the Geriatric Research, Education, and Clinical Center (GRECC) Connect (geriatric telemedicine), and the Supporting Community Outpatient, Urgent Care, and Telehealth Services (SCOUTS) programs. These programs align with the AFHS model and are associated with the expanded geriatric "5Ms" (adding multi-complexity) as described by the American Geriatric Society's Health in Aging Foundation.…”