Factors associated with access to virtual care in older adults: A cross-sectional study

Abstract

Background During the COVID-19 pandemic, virtual care (i.e. telephone or videoconference) has played a critical role. However, concerns were raised regarding equitable access for older adults, in particular, given potential advantages of videoconference- as opposed to telephone-based assessment. Our objective was to describe patient-specific factors associated with different modes of virtual healthcare. Methods We reviewed medical records of all patients assessed virtually in a geriatric medicine clinic in Toronto, Canada, between March 17 and July 13, 2020. We derived adjusted odds ratios (OR), risk differences (RD), and marginal and predicted probabilities, with 95% confidence intervals, from a multivariable logistic regression model, which tested the association between having a videoconference assessment (vs. a telephone assessment) and patient age, sex, ability to use a computer, education, frailty (measured on the Clinical Frailty Scale), history of cognitive impairment, and immigration history; language of assessment, and caregiver involvement in assessment. Results Our study included 330 patients (227 telephone and 103 videoconference assessments). Frailty (adjusted OR 0.62, 0.45 to 0.85; adjusted RD -0.08, -0.09 to -0.06) and absence of a caregiver (adjusted OR 0.12, 0.06 to 0.24; adjusted RD -0.35, -0.43 to -0.26) were associated with lower odds of videoconference assessment. For example, an 80-year-old woman with mild frailty who immigrated to Canada, speaks English, attained a post-secondary education, does not have cognitive impairment, and uses a computer had a 60% (39% to 80%) predicted probability of videoconference assessment if a caregiver was present compared to 15% (3% to 26%) without a caregiver. Only 32 of 98 (32.7%) patients who could independently use a computer participated in videoconference assessments. Conclusion Given the recent expansion of virtual care, we must urgently implement and evaluate strategies that optimise equitable access to videoconference-based virtual care for older adults.

Telemedicine Readiness Across Medical Conditions in a US National Representative Sample of Older Adults

“…Prior to the COVID-19 pandemic, US seniors engaged more in telemedicine, contacting physicians or filling prescriptions using telephone, cell phone or computers, despite regulatory restrictions (Levine et al, 2016). In regard to the modality of communication, older adults preferred telephone over videoconference (Levine et al, 2016), and recent work in a Canadian cohort indicated that frailty and absence of a caregiver were associated with lower likelihood for a videoconference assessment in seniors (Liu L et al, 2020).…”