Challenges Delivering Telehealth Visits to Older Adults (Preprint)

BACKGROUND The shift to video care during the COVID-pandemic exacerbated disparities in health care access, especially among high-need, high-risk (HNHR) adults. OBJECTIVE Our objective was to quantify the ability of HNHR older Veterans to use video-visits for healthcare, and identify factors associated with successful video-visit completion. Setting: A VA Frailty Intervention and Treatment (FIT) clinic, that switched to virtual visits during the pandemic. Participants: Patients with scheduled clinic visits from April to Oct 2020. METHODS Veterans in the FIT clinic underwent a physical, functional, psychological, social, and technology assessment. We sorted patients into four groups: video-visit, telephone-visit, declined, and not reached. We performed appropriate tests to identify factors associated with completing video- vs telephone-visits. RESULTS We contacted 110 FIT clinic Veterans. They were 73.5  5.6 years old on average, 46 (41.8%) were White, 46 (41.8%) Black, and 17 (15.5%) Hispanic; Sixty-seven (60.9%) had at least some college education, and 49 (44.5%) were very confident filling out medical forms. Of the 65 patients who agreed to a virtual visit, 19 (29.2%) patients completed a video-visit successfully, while 37 (57%) completed a telephone-visit; 19/25 (76%) of those who scheduled a video-visit completed it successfully. In a four-way comparison of Veterans who (1) completed video-visit, (2) completed telephone-visit, (3) reached but no visit, and (4) unable to contact, Veterans who completed a video-visit were the most likely to have access to high speed interet (P=.01), use email (P=.02), be enrolled in My HealtheVet (P=.01), and were less likely to have issues with walking stepping or balance (P=.03), have a better self-perception of aging (P=.04), and more likely to have caregivers (P=.02). Veterans who completed a video-visit, compared to the telephone-visit group, were more likely to have access to a computer with a camera and microphone (P=.001) and high speed internet/data plan (P=.03), use e-mail (P=.02), and be confident in internet use (P=.05). They were more likely to have a higher health literacy score (P=.04) and be cognitively intact with a MoCA score of ≥26 (P=.02), and were less likely to have issues with walking, stepping and balance (P=.03). CONCLUSIONS : Our study found that competing a video-visit requires technology access, ability, and willingness. Among HNHR older Veterans, only a quarter completed a video-visit, and comprised patients who already had access to video-capable technology, used it, and were comfortable with it, and were more likely to have caregivers. Patients who used video-visits were more likely to be physically and cognitively intact than those who used telephone visits. Strategies to expand the use of video-visits into the care of older adults should increase access to and simplify home telehealth technology and leverage caregivers. CLINICALTRIAL TBD