Abstract
Background
Clinicians identify challenges in using telehealth with older adults, yet they continue to use it at high rates. We conducted a nation-wide survey of US clinicians to assess the views and uses of telehealth for older adults (≥65 years old); as well as the perceived advantages and challenges of telehealth and use of age-friendly telehealth practices.
Materials/Methods
We distributed an online survey (Wallin Opinion Research) to assess the use of telehealth and clinicians' views on advantages/challenges of telehealth in care of older adults. Respondents were eligible if they were active US clinicians with self-attestation of patient population ≥10% older adults. The survey was distributed through established professional networks. Eligible respondents received a gift card for participation, fulfilled by a third-party vendor. Survey participation was voluntary. Completion of the survey was considered consent to participate. The study was reviewed and determined exempt by the WCG's IRB Affairs Department. SPSS Version-26 was used for descriptive statistics.
Results
Approximately 13,300 surveys were distributed and there were 7,246 (55%) respondents. Over half (56%) respondents were licensed independent practitioners. The majority of respondents practiced geriatric medicine (22%) or primary care (9.7%). The most common use was in hospitals (53%), long-term care facilities (47%), and outpatient (47%) settings. The majority of respondents (55%) selected "telehealth improves healthcare for older adults by enhancing engagement between stakeholders" as a top advantage. Fewer primary care clinicians (47%) reported sufficient support in the use of telehealth, as compared with clinicians in geriatrics (62%) or other specialties (60%). A majority (65%) of respondents reported use one or more age-friendly practice (40% often; 25% always). Only 5% of respondents reported that their telehealth program never utilized age-friendly practices.
Discussion and Conclusion
Clinicians use telehealth in care of older adults, across clinical roles, sites, and purposes. Our survey results suggest perceived advantages of telehealth outweigh challenges, in care of older adults. This highlights an opportunity for guidance and resources to optimizing telehealth with older adults.
Introduction
When COVID-19 caused a public health emergency (PHE) in March of 2020, stay-at-home orders caused many clinician offices to temporarily close, thus making it difficult for older adults (65+) to get access to health care. At this time, few Medicare beneficiaries had ever used telehealth and most clinicians serving older adults did not offer telehealth.1 The use of telehealth to serve older adults had historically been low because of reimbursement and policy-related challenges as well as concerns around access, equity, and safety.2–4
However, also in March of 2020, the Center for Medicare and Medicaid Services (CMS) implemented waivers relaxing restrictions for the use of telehealth for Medicare beneficiaries, which, combined with older adults' reluctance to leave home, resulted in a dramatic increase in the use of telehealth to serve older adults. For example, before the PHE, about 13,000 Medicare fee-for-service beneficiaries received telehealth visits each week; by late April 2020, however, this number reached nearly 1.7 million, with telehealth accounting for nearly half of all primary care visits (43.5%) for Medicare beneficiaries.5,6
By late 2021, many older adults were vaccinated against COVID-19, reducing the risks associated with seeking care. Clinics were also incrementally reopening their doors to see patients in-person as vaccinations increased and clinics became more facile at managing social distancing and other requirements. Medicare claims analyses show that telehealth utilization was lower in late 2021 than it was during the height of the pandemic, indicating that once the risks associated with COVID were reduced, clinicians and older adults relied less heavily on telehealth than they had in the previous year.
Despite telehealth utilization rates decreasing below the levels seen early in the pandemic, 2-year trends of telehealth among Medicare beneficiaries continue to be higher than pre-pandemic levels.7
What is driving this continued use of telehealth to serve older adults despite reduced concerns over COVID exposure? One possibility is that clinicians' views on telehealth became more positive as their experiences with it grew. Clinicians are often the “gatekeepers” of telehealth in that their decisions about whether to use telehealth are one of the greatest factors driving its use. Therefore, the continued use of telehealth to serve older adults may be directly related to clinicians' more positive views on doing so.8,9
Research supports this hypothesis by showing that clinicians' views on telehealth, including their perceptions of its advantages and disadvantages, are directly associated with rate of telehealth use.8,10,11 A recent clinician-focused survey shows a direct association between clinicians' attitudes toward telehealth and their utilization of telehealth in terms of both modality used and rate of use.10–12
Another possibility for the continued use of telehealth with older adults at relatively high rates could be related to providers' beliefs about older adults' views on telehealth, with the logic being that clinicians' beliefs about older adults' views on telehealth may impact their willingness to offer telehealth services to older adults. If clinicians believe that older adults are unable or unwilling to use telehealth, clinicians may be less likely to offer it to older adults.
If clinicians believe older adults are able and willing to use telehealth, they may be more likely to offer it. Finally, another (not mutually exclusive) possibility is that the existence of CMs' telehealth waivers continues to drive utilization and that their expiration may greatly reduce the use of telehealth to care for older adults.
We administered a survey to clinicians with six objectives, aiming at understanding (1) where and how often clinicians are using telehealth to care for older adults; (2) the challenges of providing telehealth care to older adults; (3) the perceived benefits of doing so; (4) clinicians' beliefs about older adults' views on telehealth; (5) the rate at which delivery of telehealth to older adults follows age-friendly principles; and (6) how clinicians would respond to the expiration of CMs' telehealth waivers.