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Older adults are a high priority for telemedicine given their elevated COVID-19 risk and need for frequent provider contact to manage chronic illnesses. It seems that many older adults now use smartphones but few studies have examined their overall readiness for telemedicine.
The aim of this study is to survey older primary care patients about their telemedicine preparedness, including internet usage, internet-capable devices, telemedicine experiences and concerns, and perceived barriers. Results were used to inform a telemedicine preparedness training program.
Community-dwelling older adult patients (aged 65-81 years; N=30) with a chronic health condition that could be managed remotely who were present at a family medicine clinic that primarily serves an urban African American population for a prescheduled in-person appointment were asked to complete a brief survey written for this study. Data were collected February-June 2021 at a large, urban, Midwestern hospital. To minimize patient burden, the survey was limited to 10 questions, focused on the most critical topics.
Most participants (21/30, 70%) reported having a device that could be used for telemedicine and using the internet. However, about half had only a single connected device, and messaging and video calling were the most commonly used applications. Few used email and none used online shopping or banking. Only 7 patients had had telemedicine appointments. Telemedicine users were younger than nonusers and used more internet functions than nonusers. Only 2 people reported problems with their telemedicine visits (technology and privacy). Nearly all respondents recognized avoiding travel and COVID-19 exposure as telemedicine benefits. The most common concerns were loss of the doctor-patient connection and inability to be examined.
Most older adults reported having devices that could be used for telemedicine, but their internet use patterns did not confirm the adequacy of their devices or skills for telemedicine. Doctor-patient conversations could be helpful in addressing telemedicine concerns but device and skill gaps must be addressed as well.
Since the COVID-19 pandemic began, telemedicine appointments have replaced many in-person health care visits [
Older adults face significant barriers to participation in telemedicine, including limited access to the internet and devices suitable for telemedicine [
We sought to recruit 30 participants, the minimum recommended sample size for estimating univariate averages, and a number thought adequate to identify common patient journeys that would guide our plans for telemedicine training [
Because existing surveys tend to lack the specificity needed to determine the adequacy of devices and skills for telemedicine, we designed and pretested a new survey instrument based on a review of the literature, and input from our primary care providers and a digital equity expert (
Patients present at an in-person primary care visit for issues that could be accomplished remotely were approached by a research assistant to complete the survey between February and June 2021. Data were collected on paper, with a research assistant available to read the survey questions and record responses if needed. The research assistant entered anonymous responses into a REDCap database to protect patient privacy. Descriptive statistics were calculated to inform our telemedicine readiness training plans. Chi-square tests were used to test for statistical significance, α=.05.
University Hospitals’ Institutional Review Board determined the study (2021611) to be no more than minimal risk and granted expedited approval. Written informed consent was not required but prior to beginning the study, participants received written information informing them that they were invited to participate in a voluntary research study and were free to decline participation.
Of 30 respondents, 25 (83%) said they had devices that could be used for a telemedicine visit and that they went on the internet, but just 7 of 30 (23%) had had telemedicine visits. However, few patients had advanced devices (iPhones, desktops, laptops, or tablets) that are best suited to telemedicine. In addition, 14 of 30 respondents (47%) had only a single device that was not an iOS-based mobile device (
Survey participant demographics and telemedicine readiness.
Demographics and telemedicine readiness | Participants, n | Participants, % | |||
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65-74 | 24 | 80 | ||
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75-80 | 5 | 17 | ||
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80-89 | 1 | 3 | ||
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1 | 5 | 17 | ||
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2 | 13 | 43 | ||
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3 | 10 | 33 | ||
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≥4 | 2 | 7 | ||
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Hypertension | 19 | 63 | ||
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Diabetes | 18 | 60 | ||
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iPhone | 5 | 17 | ||
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Desktop, tablet, laptop | 6 | 20 | ||
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Other smartphone only | 14 | 47 | ||
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0 | 5 | 17 | ||
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1 | 21 | 70 | ||
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≥2 | 4 | 13 | ||
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Telemedicine visit | 7 | 23 | ||
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Video calls | 9 | 30 | ||
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Entertainment | 5 | 17 | ||
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4 | 13 | |||
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Messaging only | 12 | 40 | ||
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Work, banking, shopping | 0 | 0 | ||
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No internet functions | 5 | 17 | ||
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1 internet function | 12 | 40 | ||
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2 internet functions | 8 | 27 | ||
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3 internet functions | 5 | 17 | ||
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No travel | 29 | 97 | ||
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Avoid COVID-19 | 25 | 83 | ||
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Doctor cannot examine me | 7 | 23 | ||
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Loss of personal connection | 10 | 33 | ||
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Inferior care quality | 4 | 13 | ||
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Lack of privacy | 7 | 23 | ||
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Other disadvantage | 3 | 10 |
aMean age 70.8 (SD 4.3) years; range 65-81 years.
Of 30 respondents, 7 (23%) had had a telemedicine appointment. Participants who owned a computer or iPhone were more likely to have had a telemedicine visit than others (
Comparisons of likelihood to have had a telemedicine visit by device ownership and device usage.
Internet uses and telemedicine attitudes by device type.
Devices and functions used | Internet uses | Telemedicine attitudes | ||||
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Mean number of ways participants use the internet | Messaging only, n (%) | Mean number of telemedicine disadvantages | Interest in future telemedicine visit, n (%) | ||
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iPhone | 2.4 | 0 (0) | 0.4 | 5 (100) | |
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iPad or computer | 2.3 | 1 (8) | 0.7 | 4 (67) | |
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Other mobile only | 1.2 | 11 (92) | 1.4 | 6 (43) | |
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None | 0.0 | 0 (0) | 1.2 | 1 (20) | |
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Used email | N/Aa | N/A | 0.5 | 4 (100) | |
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No email but used entertainment or video calling | N/A | N/A | 0.7 | 7 (77.8) | |
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Used messaging only | N/A | N/A | 1.4 | 4 (33.3) | |
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No internet use | N/A | N/A | 1.2 | 1 (20) |
aN/A: not applicable.
Comparison of device ownership, telemedicine experience, and internet uses by age group.
This small survey revealed significant gaps in telemedicine readiness among older adults who said they had devices that could be used for telemedicine and that they went online. No patients used key internet functions needed for staying safe during the COVID-19 pandemic, and few used internet applications that required the skills needed for accessing telemedicine. Few patients had devices that are optimal for older adults using telemedicine. Patients with more advanced devices used more internet functions and had more telemedicine experience and more favorable attitudes than others. Our results confirm previous studies [
Because of the survey’s limited nature, other important topics, such as home internet access and interest in digital skills training, could not be addressed. Results may not be generalizable to other contexts, such as specialty clinics or rural areas. Participants present in the clinic may be different from those not seeking care, which could bias our results. Larger studies are needed to confirm our results and apply multivariate analysis to understand the relationships among age, device quality, internet skills, and telemedicine attitudes. Development of validated scales of telemedicine readiness as well as telemedicine training to complement in-person care can help health systems offer precision-matched interventions to address barriers, facilitate increased adoption, and generally improve patients’ overall access to primary care and engagement with their primary care provider.
Survey questions.
The authors would like to thank the Family Medicine department staff and our patients for their assistance with completion of this project.
The Case Western Reserve University Department of Family Medicine provided funds to AS for expert consultation around digital health equity. The other authors declared no other conflicts of interest to report.