ABSTRACT
Introduction The start of the Covid-19 pandemic placed an unprecedented demand on health systems to rapidly shift ambulatory in-person care to virtual care. Geriatric patients, at increased risk of morbidly and mortality from Covid-19 infection, face more challenges with video visit access compared to younger patients due to discomfort with technology and less access to necessary devices and broadband internet. Thus, it is a priority to enhance remote connections between geriatric patients and their providers. Methods The aim of this project was to facilitate the transition to video telemedicine for the geriatric population by creating a well-organized training program for volunteers to guide patients and caregivers to make the conversion from phone to video visits. A 28-page volunteer manual was created that included a structured process for how to call patients, including our three-call model, a walk-through of the video modalities, an algorithm for choosing which modality is best for each patient (Figure 1), and troubleshooting resources. Virtual training sessions oriented volunteers to the process and connected them with the faculty they would work with for the duration of the project. Volunteers provided patients with one-to-one remote guidance, identifying and overcoming barriers, with practice sessions to increase comfort with the technology. Initial volunteer work began in the Michigan Medicine Geriatric Psychiatry Clinic. With expansion of our team to 26 total individuals we also began servicing the Michigan Medicine Geriatric General Medicine Clinics. Quantitatively, we measured the proportion of video visits before and after intervention with the program. Qualitatively, we solicited feedback from providers, patients, and volunteers. Results The GET Access Program volunteers were successful in teaching and converting many visits to video that the schedulers were unable to do on a first pass. Of 95 contacted patients, 80 agreed to participate, and 71 switched from a phone visit to video visit, representing a conversion rate of 88.75% from phone to video visits. During a 10-week evaluation period of the two clinics GET Access serviced, 1942 patients had 2865 visits. Of 59 providers within the clinics studied, 12 providers with the lowest video visit rates received help from GET Access. Averaged over the evaluation period, visits after participation in the program were associated with video format 43% compared to 19.2% for visits prior to participation (adjusted OR 3.38 [95% CI 2.49, 4.59]) and visit by non-participating providers (32.1%, adjusted OR 1.65 [1.31, 2.08]) as shown in Figure 2. Conclusions A program dedicated to personalized virtual technological instruction and practice helped geriatric patients transition from phone to video visits, to provide a platform for stronger connection with their providers. Sustainability of the program beyond the immediate need of it due to Covid-19 was achieved with creation of a robust leadership structure. We are currently working with the telehealth administration at Michigan Medicine to expand GET Access to more clinics at Michigan Medicine. This expansion will allow our program to service more patients at Michigan Medicine, and results of the extension are expected to be available in March 2021.