Connecting the disconnected: Leveraging an in‐home team member for video visits for older adults

Abstract

BackgroundOlder adults are interested and able to complete video visits, but often require coaching and practice to succeed. Data show a widening digital divide between older and younger adults using video visits. We conducted a qualitative feasibility study to investigate these gaps via ethnographic methods, including a team member in older participants' homes.MethodsThis ethnographic feasibility study included a virtual medication reconciliation visit with a clinical pharmacist for Veterans aged 65 and older taking 5 or more medications. An in‐home study team member joined the participant and recorded observations in structured fieldnotes derived from the Updated Consolidated Framework for Implementation Research and Age‐Friendly Health Systems. Fieldnotes included behind‐the‐scenes facilitators, barriers, and solutions to challenges before and during the visits. We conducted a thematic analysis of these observations and matched themes to implementation solutions from the Expert Recommendations for Implementing Change.ResultsTwenty participants completed a video visit. Participants were 74 years old (range 68–80) taking 12 daily medications (range 7–24). Challenges occurred in half of the visits and took the in‐home team member and/or pharmacist an average of 10 minutes to troubleshoot. Challenges included notable new findings, such as that half of the participants required technology assistance for challenges that would not have been able to be solved by the pharmacist virtually. Furthermore, although many participants had a device or had used video visits before, some did not have a single device with video, audio, Internet, and access to their email username and password.ConclusionsClinicians may apply these evidence‐based implementation solutions to their approach to video visits with older adults, including having a team member join the visit before the clinician, involving tech‐savvy family members, ensuring the device works with the visit platform ahead of time, and creating a troubleshooting guide from our common challenges.

Supporting technology access for older adults through in‐home, intergenerational involvement: The case for ethnographic methods and student service‐learning courses

“…In this issue of the Journal, Hawley et al 1 greatly advance our knowledge of best practice delivery of video healthcare visits through their study involving 20 older adults using video technology to complete medication reconciliation with a clinical pharmacist. This work is timely; the landscape of video visits in healthcare has undergone significant transformation in the last 4 years.…”

“…The authors 1 achieved both goals through a mixed‐methods approach, which identified unmet needs that would have been missed using interviews or simple observations. Through direct observation, the in‐home researcher learned of technical challenges among half of participants, along with modifiable barriers to engagement in video‐based clinical care.…”

“…First , this study 1 makes an important advance in the field of Geriatrics through an innovative adaptation of ethnography, which is both a methodological approach and method of data collection and analysis. Ethnography traditionally involved researchers, often anthropologists, who traveled to distant places and lived in foreign communities for long periods of time.…”

“…Even now, when ethnographies are conducted in local communities and health sciences settings, ethnography typically involves immersion in a community 4 . The authors 1 do not take this traditional approach of deep immersion or address their role in the community directly (although they clearly represent members of the community of clinical care). Instead, they carefully adapt ethnographic methods, focusing on those which are most useful to implementation science.…”

“…Second, in terms of implementation strategies , the authors 1 identify champions as critical to success but also acknowledge the time intensity of having champions who can make home visits. They learned that the presence of an in‐home researcher made it possible to fix most problems within a few minutes.…”