Perspectives of primary care clinicians in Massachusetts on use of telemedicine with adults aged 65 and older during the COVID-19 pandemic

Abstract

To learn how to improve telemedicine for adults >65, we asked primary care clinicians (“PCPs”) affiliated with one large Boston-area health system their views on using telemedicine (which included phone-only or video visits) with adults >65 during the COVID-19 pandemic. In open-ended questions, we asked PCPs to describe any challenges or useful experiences with telemedicine and suggestions for improving telemedicine as part of a larger web-based survey conducted between September 2020 and February 2021. Overall, 163/383 (42%) PCPs responded to the survey. Of these, 114 (70%) completed at least one open-ended question, 85% were non-Hispanic white, 59% were female, 75% were community-based, and 75% were in practice >20 years. We identified three major themes in participants’ comments including the need to optimize telemedicine; integrate telemedicine within primary care; and that PCPs had disparate attitudes towards telemedicine for older adults. To optimize telemedicine, PCPs recommended more effective digital platforms, increased utilization of home medical equipment (e.g., blood pressure cuffs), and better coordination with caregivers. For integration, PCPs recommended targeting telemedicine for certain types of visits (e.g., chronic disease management), enabling video access, and reducing administrative burdens on PCPs. As for PCP attitudes, some felt telemedicine enhanced the doctor-patient relationship, improved the patient experience, and improved show rates. Others felt that telemedicine visits were incomplete without a physical exam, were less rewarding, and could be frustrating. Overall, PCPs saw a role for telemedicine in older adults’ care but felt that more support is needed for these visits than currently offered.

Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Mixed Methods Study

“…Participants reasoned that follow-up visits do not require as comprehensive assessments as an initial consultation that would likely have components that benefit from an in-person assessment, such as a physical examination or certain cognitive tests. This aligns with findings by Watt et al [ 28 ] and studies that have evaluated physicians’ experiences in telehealth visits with older patients in the context of US practice [ 26 , 29 ].…”

“…This mixed methods study adds to the growing literature on the use of telemedicine to provide geriatric care before and during the COVID-19 pandemic, and we found similar findings to other recent studies that also explored geriatric care professional experiences with the use of telemedicine during the COVID-19 pandemic [ 22 , 25 - 29 ]. The ubiquitous transition to using telemedicine in the provision of geriatric care was uniformly driven by the COVID-19 pandemic.…”

“…Many of our study participants had indicated that their older patients often relied on the presence of a caregiver or a family member to access the communication technology and to manage the virtual care visit. This is also supported in recent studies in which primary care physicians found the assistance of family members and caregivers to be helpful in the facilitation of the telehealth visit for their older patients [ 22 , 29 ]. Additionally, our study found that the visits were even more effective for older patients who had monitoring devices that could provide basic health information, but not all older patients owned these devices.…”

Older adults' perspectives on primary care telemedicine during the COVID‐19 pandemic

“…46 PCPs may also need time to develop best communication practices for these visits. 47 Our study has limitations. Our findings are limited to one geographic area and one health system.…”

Model Development of Universal Hardware and Software Module for Medical Information System

“…Integrated MIS is needed to adequately address these challenges [14]. Innovative telemedicine networks involve program application to process information throughout the patient's entire movement cycle [15,16]. Support is provided to the patient at all stages, from diagnosis to treatment, and recommendations for avoiding recurrence.…”