Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics

Abstract

Objectives: Our objective was to interview primary care physicians (PCPs) and geriatricians on their experiences using telemedicine during the COVID-19 pandemic to examine strategies used to maintain continuity of care with their patients, ages 65 and older. Methods: Using purposive sampling, we selected physicians based on community size (metro/suburban/rural) and practice setting (academic/community) and conducted semi-structured interviews via Zoom (mean: 30 minutes). Interviews were recorded, transcribed, coded, and analyzed using framework analysis. Results: We enrolled 33 physicians (15 PCPs and 18 geriatricians) from July to November 2020. Findings indicate that many physicians successfully bridged the digital divide by: assessing patients’ technological readiness in advance, being flexible with telehealth modes, using available home or facility-based staff, educating patients on telehealth privacy and usefulness, making accommodations for disabilities, and involving caregivers. Discussion: These findings can inform future policy and practice and assist physicians in resolving addressable barriers to telehealth use among older patients.

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

“…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.…”

“…Our study findings also raised additional unique insights being experienced by Ontario geriatric care professionals. Notably, our study was able to explore the range of strategies adopted by Ontario geriatric care professionals to complete their clinical assessments virtually, whereas other recent studies have largely focused on navigating the technological aspect of telemedicine use to overcome barriers [ 22 , 26 ]. As noted in Adaptability , Ontario geriatric care professionals quickly adopted the use of validated clinical tools that could enable them to virtually conduct their assessments or better prioritize assessment components when certain aspects were hindered by the challenges in using telemedicine technologies.…”

“…The reality, however, is that only a certain portion of older Ontarians have the means and ability to support the effective use of telemedicine services. It is less likely for older persons to use telemedicine technologies if they lack confidence with using related technologies [ 11 , 22 , 26 ] or to receive virtual care visits via videoconferencing if their caregivers could not be present [ 34 ]. Recent studies also indicate that older persons at the lower end of the socioeconomic spectrum are often overlooked as they lack equitable access to the appropriate resources and support to facilitate virtual care visits [ 25 , 26 , 35 ], and geriatric care professionals have observed worsening of this disparity during the COVID-19 pandemic [ 25 ].…”

“…Therefore, this study aims to determine the benefits and challenges Ontario geriatric care professionals have faced in using telemedicine technologies to provide routine consultations and follow-up care to their older patients with complex needs, their families, and their caregivers, as well as the conditions under which this method proves to be or not be an effective way to provide care. Moreover, identifying frontline benefits and challenges would also provide new learning opportunities for geriatric care professionals across different health care settings and regions in the use of telemedicine technologies [ 22 ], which is still a novel approach in the practice of geriatric medicine [ 13 ].…”