Virtual primary care for people living with dementia in Canada: Cross-sectional surveys of patients, care partners, and family physicians (preprint)

Background: Despite the importance of virtual primary care, the evidence informing optimal and sustainable provision of virtual care (VC) for people living with dementia (PLWD) and their care partners is scarce. We aimed to describe VC provided by family physicians (FPs) for PLWD in Canada. Methods: Concurrent mixed-methods design. We analyzed questions related to VC in three nationwide cross-sectional surveys conducted with PLWD, care partners, and FPs in the first year of the COVID-19 pandemic. Virtual care was defined as two-way synchronous communication by telephone and/or a web camera. The prevalence of VC use among FPs, PLWD, and care partners was described, and logistic regression models were used to determine factors (sociodemographic, urbanicity, frequency of and availability of support for connecting to FPs, and FPs’ practice characteristics) associated with VC use. Inductive thematic analysis was performed on responses to open-ended questions to explore FPs’ perceptions of barriers and facilitators to using VC. Results: 131 PLWD, 341 care partners, and 125 FPs participated. 61.2% of PLWD, 59.5% of care partners, and 77.4% of FPs had used VC. The models for PLWD (included age and ethnicity) and care partners (included gender, urbanicity, and receiving support from a family member/friend to connect with FP) were inconclusive. Among FPs, having more than 20 years of practice was significantly associated with a decreased likelihood of providing VC (OR=0.23, 95%CI: 0.08-0.62, p<0.01). Care preferences (decision stage), office/family support (preparation stage), technology and family presence (execution stage), and remuneration for FPs (compensation stage) were the most commonly recurring themes affecting VC use. Conclusions: Virtual primary dementia care uptake was substantial and mainly performed via telephone. From the perspective of FPs, optimal VC provision requires patient-care partner-physician shared decision-making, interoperability in healthcare, support for performing VC, and appropriate compensation. Virtual care facilitates access to primary care and minimizes potential disruptions to in-person care for PLWD; however, its outcomes need further investigation.

Telemedicine in primary care of older adults: Results of a multi-phase study (preprint)

Background The COVID-19 pandemic transformed the health care systems, motivating Telemedicine's rapid evolution and implementation. Telemedicine (TM) can potentially improve the quality of primary health care and increase accessibility to the population. Nevertheless, its use may represent a challenge to older people as they may have different needs from the general population due to potential age-related changes in perceptual, motor and cognitive capacities. We thus aimed to identify potential facilitators and barriers to Telemedicine (TM) use in the primary care of older adults and develop recommendations.Methods We conducted a multi-phase study: 1. A systematic mixed-method review to explore determinants in the use of TM for older adults for papers published before July 2021; 2. Qualitative descriptive study, we interviewed 29 older adults and conducted three focus groups and one deliberative dialogue with healthcare professionals from four McGill family medicine sites. The findings were analyzed using deductive thematic analysis based on the Consolidated Framework for Implementation Research (CFIR); 3. We integrated the results from both phases and the deliberative dialogue using thematic analysis.Results The systematic review identified over 3,328 references. We included 21 articles, resulting in positive experiences and high satisfaction and generating interest in TM as a complementary healthcare delivery model. Participants agreed that TM contributed to maintaining the continuity of care and was convenient when there is a previous/established patient-physician relationship and to resolve minor health issues. TM was beneficial for persons with limited mobility; and reduced the exposure of older adults to potential high-risk environments. Nevertheless, participants expressed concerns about the lack of visual contact, causing essential details to be overlooked. Similarly, miscommunication difficulties may emerge due to language or hearing barriers. Family physicians perceived that most patients did not consider phone consultations a medical act. However, participants were amenable to a hybrid approach, combining in-person consultations and Telemedicine, depending on their health conditions.Conclusions Older adults and healthcare professionals consider Telemedicine a good alternative for accessing healthcare services, though it would be necessary to promote a hybrid approach and encourage and support familiarization, adaptability, and accessibility to technological tools.