Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.
J Am Geriatr Soc. 2021 Sep;69(9):2404-2411. doi: 10.1111/jgs.17163. Epub 2021 Apr 13.
BACKGROUND/OBJECTIVES: To identify major barriers to video-based telehealth use among homebound older adults.
Cross-sectional survey.
A large home-based primary care (HBPC) program in New York City (NYC) serving 873 homebound patients living in the community.
Sixteen primary care physicians.
An 11-item assessment of provider perceptions of patients' experience with and barriers to telehealth.
According to physicians in the HBPC program, more than one-third (35%) of homebound patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020 during the first COVID-19 surge in NYC. The majority (82%) required assistance from a family member and/or paid caregiver to complete the visit. Among patients who had not used telehealth, providers deemed 27% (n = 153) "unable to interact over video" for reasons including cognitive or sensory impairment and 14% lacked access to a caregiver to assist them with technology. Physicians were not knowledgeable of their patients' internet connectivity, ability to pay for cellular plans, or video-capable device access.
The COVID-19 pandemic resulted in a large and dramatic shift to video-based telehealth use in home-based primary care. However, 4 months into the pandemic a majority of patients had not participated in a video-based telehealth encounter due to a number of barriers. Patients lacking caregiver support to assist with technology may benefit from novel approaches such as the deployment of community health workers to assist with device setup. Physicians may not be able to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video-based telehealth use.
背景/目的：确定居家老年患者在使用基于视频的远程医疗方面的主要障碍。
横断面调查。
在纽约市（NYC）的一个大型居家初级保健（HBPC）项目中，该项目服务于 873 名居住在社区中的居家患者。
16 名初级保健医生。
对提供者对患者使用远程医疗的体验和障碍的看法进行了 11 项评估。
根据 HBPC 项目中的医生介绍，在 2020 年 4 月至 6 月期间，NYC 第一波 COVID-19 疫情期间，超过三分之一（35%）的居家患者（平均年龄 82.7 岁；46.6%患有痴呆症；平均每位患者有 4 种合并症）进行了首次基于视频的远程医疗接触。大多数（82%）患者需要家庭成员和/或付费护理人员的帮助才能完成就诊。在未使用远程医疗的患者中，提供者认为有 27%（n=153）“无法通过视频进行互动”，原因包括认知或感觉障碍，14%的患者没有护理人员来帮助他们使用技术。医生不了解患者的互联网连接、支付手机计划的能力或视频功能设备的访问权限。
COVID-19 大流行导致居家初级保健中大规模、戏剧性地转向基于视频的远程医疗。然而，在大流行 4 个月后，由于存在多种障碍，大多数患者仍未参与基于视频的远程医疗接触。缺乏护理人员支持来协助使用技术的患者可能受益于新方法，例如部署社区卫生工作者来协助设置设备。医生可能无法识别患者在使用远程医疗方面的潜在可修改障碍，这突显了在进行有针对性的干预措施以增加基于视频的远程医疗使用之前，需要更好地进行系统数据收集。
