EXECUTIVE SUMMARY
Patients older than age 50 years are less likely to have access to smartphones and computers to carry out video visits with providers, researchers noted.
- Researchers studied a primarily minority, low-income population.
- Participants indicated high confidence rating with quality of telehealth care for both audio visits and video visits.
- Telehealth options should remain available after the pandemic. These options can improve healthcare access for people who live far from health systems and face transportation challenges or other obstacles to in-person visits.
The results of recent research reveal telehealth visits can work with most patients, although age-related differences affect how visits are structured.1
Among patients older than age 50 years, more reported challenges with telehealth visits than did those younger than age 50 years, researchers found. Older adults were less likely to own smartphones with internet access and were less likely to prefer video telehealth visits.
“We did this study because we were really concerned when COVID-19 happened and everyone was changing to telehealth,” explains Mary M. Pasquinelli, DNP, APRN, FNP-BC, advanced practice nurse in pulmonary and medical oncology at the University of Illinois (UI) Health and adjunct clinical instructor at UIC College of Nursing. “We were concerned with our patient population having technology for telehealth. The aim of the study was satisfaction with telehealth technology and visits.”
UI Health is an urban academic safety-net hospital that serves a primarily minority population from a low-income economic background. About three in four patients are minorities.
“That’s why we were really concerned — because we knew this population of lower socioeconomic status may not have the technology needed to do telehealth visits, particularly video telehealth visits,” she adds.
Access to Technology Varies
Pasquinelli and colleagues found older patients had less access to the internet, less access to computers, and fewer smartphones.
“The concern is that if you have to do a video telehealth visit, a large proportion of older patients who have chronic conditions do not have access to technology for a video visit,” Pasquinelli says. “But all had access to some type of audio device — either a landline or non-smartphone, like a flip phone — to do some type of connection.”
Audio telehealth visits would work for some patients. “At the beginning of the pandemic, insurance companies said they’d pay for video visits at higher rates than they would for audio visits, but that changed in some states and with some insurance companies,” Pasquinelli explains. “This made a big difference because you want everyone to have access to telehealth for health equity.” Medicare pays the same for both audio and video visits, she adds.
It is possible payers could change how they reimburse for video and audio visits after the pandemic ends. But more patients benefit from the pandemic-era policies.
“We have the ability to meet our patients where they are with the technology they have,” Pasquinelli says. “If we could do only video telehealth visits, that creates health inequity to patients who don’t have video technology. Ensuring the equitable access for all modalities of telehealth across the age continuum is paramount.”
The age difference in technology access could disappear in hospitals that serve more affluent patients, where smartphone and computer use among older patients may be more common.
“But we provide healthcare to all people, and in our study, we found that older patients preferred audio over video,” Pasquinelli says. “We also found they had a very high confidence rating and felt confident they were receiving quality care through either audio or video calls.”
As physicians and case managers have become more comfortable with telehealth visits for monitoring patients and their chronic conditions, it is important to know this is not the best option for every patient.
“It’s important to have options,” Pasquinelli says. “It depends on what the situation is and the reasons for the visit.”
Patients who need blood work or need an in-person visit for other medical reasons may not benefit from remote monitoring.
“For other patients, video is OK for some things, and audio is good for other things,” she says. “For instance, I run a lung cancer screening clinic, and part of that clinic is doing in-depth smoking cessation. Our follow-up visits for smoking cessation are usually done by telehealth.”
In these visits, clinicians check on the patient’s progress, address barriers to smoking cessation, and provide medication management.
Even in cases where a patient has a rash, this can be done by video visits or even by audio visits, if the patient can send photos to the clinician.
“We have to meet our patients where they are,” Pasquinelli explains. “Many of our patients have significant barriers to healthcare, which is not unusual at our hospital or across the country.”
Even people who live near a health system might face transportation issues and other obstacles to an in-person visit.
“They may not be able to walk to a clinic, or they may need to take three buses,” Pasquinelli says. “It’s difficult.”
At least until the pandemic is over, it is important for health systems and providers to offer telehealth options for people with barriers to in-person visits.
Case managers and providers should assess patients for barriers by asking them these kinds of questions:
- Do you own a computer?
- Do you use a smartphone?
- Are you open to ongoing visits via telehealth?
- Are you open to a hybrid of telehealth and in-person visits?
- Could a case manager, pharmacist, or another healthcare professional call you at home to follow up on your symptoms and medication management?
- Could someone review your test results by phone or videoconference?
Providing follow-up on test results via telehealth could decrease the time between diagnosis and treatment.
“The approach in the future is to do a hybrid, to have the options for in-person and telehealth,” Pasquinelli adds. “When they don’t need to come in, we do the visit by telehealth; when they do need to come in or prefer to come in, we do it in person.”
For people who live in rural areas and must travel many miles to see a physician, the telehealth option can help with follow-up appointments after a hospital stay.
“People can come from far away to see a doctor for in-person visits. Subsequent visits could be through telehealth after a relationship is established,” she says.
Pasquinelli and colleagues also found most people would prefer telehealth as an option after the pandemic ends. Of those younger than age 50 years, 83% wanted telehealth as an option, while 17% wanted to return to all in-person visits. For those older than age 50, 65% wanted telehealth as an option.
“It’s great when they can come in for face-to-face visits, but when they can’t, you have options, and the provider will be reimbursed for that,” Pasquinelli says. “We’re meeting patients where they are with the access limitations they have. We’re continuing to provide good high-quality care, and we should be able to do that after the pandemic.”
REFERENCE
- Pasquinelli MM, Patel D, Nguyen R, et al. Age-based disparities in telehealth use in an urban, underserved population in cancer and pulmonary clinics: A need for policy change. J Am Assoc Nurse Pract 2022;Mar 30. doi: 10.1097/JXX.0000000000000708. [Online ahead of print].
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