Rapid Integration of Home Telehealth Visits Amidst COVID‐19: What Do Older Adults Need to Succeed?

Abstract

Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits. DESIGN: We used an exploratory sequential mixedmethods design to conduct patient needs assessments, a home telehealth pilot, and formative evaluation of the pilot. SETTING: Veterans Affairs geriatrics-renal clinic. PARTICIPANTS: Patients with scheduled clinic visits from October 2019 to April 2020. MEASUREMENTS: We conducted an in-person needs assessment and telephone postvisit interviews. RESULTS: Through 50 needs assessments, we identified patient-perceived barriers in interest, access to care, access to technology, and confidence. A total of 34 (68%) patients were interested in completing a home telehealth visit, but fewer (32 (64%)) had access to the necessary technology or were confident (21 (42%)) that they could participate. We categorized patients into four phenotypes based on their interest and capability to complete a home telehealth visit: interested and capable, interested and incapable, uninterested and capable, and uninterested and incapable. These phenotypes allowed us to create trainings to overcome patient-perceived barriers. We completed 32 home telehealth visits and 12 postvisit interviews. Our formative evaluation showed that our pilot was successful in addressing many patient-perceived barriers. All interviewees reported that the home telehealth visits improved their wellbeing. Home telehealth visits saved participants an average of 166 minutes of commute time. Five participants borrowed a device from a family member, and five visits were finished via telephone. All participants successfully completed a home telehealth visit. CONCLUSIONS: We identified patient-perceived barriers to home telehealth visits and classified patients into four phenotypes based on these barriers. Using principles of implementation science, our home telehealth pilot addressed these barriers, and all patients successfully completed a visit. Future study is needed to understand methods to deploy larger-scale efforts to integrate home telehealth visits into the care of older adults.

Rapid implementation of telehealth in geriatric outpatient clinics due to COVID‐19

“…Telehealth provides a solution for delivering healthcare during COVID-19, as well as addressing barriers for patients such as long travel times or poor mobility. 6 Patients and carers may also feel more comfortable in their own home with less disruption of routines. 7 In this evaluation, time efficiency and location flexibility were reported as an advantage for staff.…”

“…10 Taken together, our findings, and those of others, suggest more support and equipment are required for older people. 6,7 Older people attending public hospital geriatric clinics often have multiple health conditions, are frailer than the general population, or may have low health literacy. Clinicians should expect they may require additional assistance with telehealth.…”

“…12 Strategies to improve patient uptake may require tailoring to the individual based on their interest and capability. 6 Additional calls to provide training, having a back-up plan, borrowing devices from family, 6 starting with telephone to facilitate confidence and rapport, or using familiar communication platforms and applications such as Whatsapp 8 have been previously recommended.…”

The qualitative experience of telehealth access and clinical encounters in Australian health care during COVID-19: Implications for policy

“…However, results from our study suggest there was a perceived the lack of respect for and preparation towards a telehealth consult among patients which led to unnecessary duplication of consults and delayed assessment. Indeed, previous research suggest that people from either rural areas, low literacy, low socio economic status or from cultural and linguistically diverse backgrounds nd telehealth the least accessible and may bene t from education (38).…”

Telehealth and Geriatrics

“…In 2020, the COVID-19 pandemic resulted in the need to make many adaptations to clinical care for older persons. Of these, the one positive would appear to be the increased awareness of the positive components of telehealth (18)(19)(20).…”