GERIATRIC PATIENT RECEPTIVITY TO THE INTEGRATION OF TELEHEALTH IN UROGYNECOLOGY CARE

ABSTRACT

Introduction: Several urogynecology conditions can be managed through telehealth visits as this is a combined surgical and medical specialty. However, geriatric patients may experience difficulty using such a modality due to the inherent ageism within the medical system. This manifests in portal developers and providers presuming the elderly's obligatory conformance to what is provided and a limited interest in this population's constraints, thus disregarding their needs when designing the interface as well as forgoing conversations on patient portals with their patients. With the COVID-19 pandemic catalyzing the digitalization of medicine, excluding the needs of this patient population risks impacting their care. Online health portal use must be optimized accordingly to improve access to geriatric urogynecology patients. Objective: To identify facilitators, concerns, technical or personal issues encountered, and the desired features of the online patient portals among geriatric urogynecology patients. Methods: This is a cross-sectional study of patients (> = 65 years of age) at an academic medical center in Northwest Ohio, where telehealth practices had been well established since early 2020. The data collection occurred between June 1-30, 2021. Two focus groups were conducted with the identified themes used to devise the anonymous survey. The questions addressed comfort with telehealth visits for urogynecology-specific conditions and the practicality of patient portals for physician visits. The promoters and deterrents were compared using the Pearson's Chi-squared test between those comfortable and uncomfortable having telehealth visits for preoperative, postoperative, and medical management. Results: A total of 205 patients completed the study (91% response rate, 225 surveys distributed). Mean age was 68.9 (SD 4.9) with 81% of participants being Caucasian and 10% being African American. Promoters of patient portal use identified included provider encouragement, enrollment on-site with concurrent education, and clarification of relevance of the telehealth to one's care (Table 1). Patients who were uncomfortable with telehealth use reported anxiety and technical issues as deterrents for using such technology. This included difficulty using the hardware, accessing the portal, and significant input needed to log on. More than half of the patients were comfortable having online visits for preoperative (51.7%), postoperative (66.3%), and medical management (73.7%) (Table 2). Up to 60.5% of the patients believed that telehealth visits were equally stressful as in-person visits, while 24.4% believed that the logistics of in-person visits were the cause of stress. Most of the patients who considered in-person visits stressful reported provider encouragement, enrollment by the hospital, and clarification of benefits as major promoters for portal use. Specific design features such as additional drop-down lists, colors, and icons in addition to an intuitive design were desired. Patients who preferred in-person visits were deterred primarily by technical and privacy concerns, anxiety, and cost of use (Figure 1). Conclusions: To improve access to care, augment the utilization of online patient portals, and combat ageism, enhancing the geriatric urogynecologic patient portal experience is vital. Investment in this population's needs includes education of patients, active enrollment, engagement by healthcare systems, and addressing technical concerns (Table Presented).