Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, FL, United States.
Division of Geriatrics and Palliative Care, Miller School of Medicine, University of Miami, Miami, FL, United States.
J Med Internet Res. 2022 Apr 8;24(4):e32570. doi: 10.2196/32570.
The recent shift to video care has exacerbated disparities in health care access, especially among high-need, high-risk (HNHR) adults. Developing data-driven approaches to improve access to care necessitates a deeper understanding of HNHR adults' attitudes toward telemedicine and technology access.
This study aims to identify the willingness, access, and ability of HNHR veterans to use telemedicine for health care.
WWe designed a questionnaire conducted via mail or telephone or in person. Among HNHR veterans who were identified using predictive modeling with national Veterans Affairs data, we assessed willingness to use video visits for health care, access to necessary equipment, and comfort with using technology. We evaluated physical health, including frailty, physical function, performance of activities of daily living (ADL) and instrumental ADL (IADL); mental health; and social needs, including Area Deprivation Index, transportation, social support, and social isolation.
The average age of the 602 HNHR veteran respondents was 70.6 (SD 9.2; range 39-100) years; 99.7% (600/602) of the respondents were male, 61% (367/602) were White, 36% (217/602) were African American, 17.3% (104/602) were Hispanic, 31.2% (188/602) held at least an associate degree, and 48.2% (290/602) were confident filling medical forms. Of the 602 respondents, 327 (54.3%) reported willingness for video visits, whereas 275 (45.7%) were unwilling. Willing veterans were younger (P<.001) and more likely to have an associate degree (P=.002), be health literate (P<.001), live in socioeconomically advantaged neighborhoods (P=.048), be independent in IADLs (P=.02), and be in better physical health (P=.04). A higher number of those willing were able to use the internet and email (P<.001). Of the willing veterans, 75.8% (248/327) had a video-capable device. Those with video-capable technology were younger (P=.004), had higher health literacy (P=.01), were less likely to be African American (P=.007), were more independent in ADLs (P=.005) and IADLs (P=.04), and were more adept at using the internet and email than those without the needed technology (P<.001). Age, confidence in filling forms, general health, and internet use were significantly associated with willingness to use video visits.
Approximately half of the HNHR respondents were unwilling for video visits and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, African American veterans; those with worse physical health; and those living in more socioeconomically disadvantaged neighborhoods. Our study highlights that HNHR veterans have complex needs, which risk being exacerbated by the video care shift. Although technology holds vast potential to improve health care access, certain vulnerable populations are less likely to engage, or have access to, technology. Therefore, targeted interventions are needed to address this inequity, especially among HNHR older adults.
最近向视频医疗的转变加剧了医疗保健获取方面的差距，尤其是在高需求、高风险（HNHR）成年人中。为了改善医疗保健的获取，需要制定数据驱动的方法，这就需要更深入地了解 HNHR 成年人对远程医疗和技术获取的态度。
本研究旨在确定 HNHR 退伍军人使用远程医疗进行医疗保健的意愿、访问权限和能力。
我们设计了一份通过邮件、电话或面对面进行的问卷。在使用国家退伍军人事务部数据进行预测建模确定的 HNHR 退伍军人中，我们评估了他们使用视频访问进行医疗保健的意愿、获得必要设备的情况以及使用技术的舒适度。我们评估了身体健康状况，包括虚弱程度、身体功能、日常生活活动（ADL）和工具性日常生活活动（IADL）的表现；心理健康；以及社会需求，包括区域贫困指数、交通、社会支持和社会孤立。
602 名 HNHR 退伍军人受访者的平均年龄为 70.6（SD 9.2；范围 39-100）岁；99.7%（600/602）的受访者为男性，61%（367/602）为白人，36%（217/602）为非裔美国人，17.3%（104/602）为西班牙裔，31.2%（188/602）至少持有大专学位，48.2%（290/602）对填写医疗表格有信心。在 602 名受访者中，327 名（54.3%）表示愿意接受视频访问，而 275 名（45.7%）不愿意。愿意接受视频访问的退伍军人更年轻（P<.001），更有可能拥有大专学位（P=.002），有健康素养（P<.001），居住在社会经济地位较高的社区（P=.048），IADL 方面更独立（P=.02），身体健康状况更好（P=.04）。更多愿意接受视频访问的退伍军人能够使用互联网和电子邮件（P<.001）。在愿意接受视频访问的退伍军人中，75.8%（248/327）拥有具备视频功能的设备。那些拥有视频功能技术的人更年轻（P=.004），健康素养更高（P=.01），不太可能是非裔美国人（P=.007），ADL 和 IADL 方面更独立（P=.005 和 P=.04），并且比没有所需技术的人更擅长使用互联网和电子邮件（P<.001）。年龄、填写表格的信心、总体健康状况和互联网使用与使用视频访问的意愿显著相关。
大约一半的 HNHR 受访者不愿意接受视频访问，而愿意接受视频访问的受访者中有四分之一缺乏必要的技术。在年龄较大、健康素养较低、非裔美国人和身体状况较差的退伍军人中，愿意接受视频访问的退伍军人与缺乏必要技术的退伍军人之间的差距更大；以及生活在社会经济地位较低的社区的退伍军人。我们的研究表明，HNHR 退伍军人的需求复杂，这可能会因视频医疗的转变而加剧。尽管技术具有改善医疗保健获取的巨大潜力，但某些弱势群体不太可能使用技术，或者没有技术可使用。因此，需要采取有针对性的干预措施来解决这一不平等问题，尤其是针对 HNHR 中的老年人群体。
