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

ABSTRACT

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.