JMIR Publications

ABSTRACT

Background:

Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic to maintain access to healthcare without increasing risk of exposure. While pre-pandemic studies suggest that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving non-rural patients, no studies have compared telephone versus video visits in geriatric primary care.

Objective:

To determine whether video visits had 1) longer duration, 2) more visit diagnoses, and 3) more advance care planning discussions than telephone visits during the rapid implementation of telemedicine during the COVID-19 pandemic, and to determine whether disparities in visit type exist based on patient characteristics.

Methods:

We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23, 2020 to May 22, 2020. Approximately 25% of telephone and video appointments during this time underwent chart review. Measurements included patient characteristics, visit characteristics, duration of visits, number of visit diagnoses and presence of advance care planning discussion in clinical documentation.

Results:

Of 190 appointments reviewed, 47% were video visits. Compared to telephone appointments, those using videoconferencing were seven minutes longer (P<.001) and had 1.3 more visit diagnoses (P=.001). Video and telephone visits had similar rates of advance care planning. Having hearing, vision or cognitive impairment did not result in different rates of video or telephone appointments. Patients who were non-white, needed interpreter services or received Medicaid were less likely to have video visits (P<.001 and P=.003, respectively).

Conclusions:

Although clinicians spent more time for video visits than telephone visits, more than half of older patients did not use video visits, especially if they were patients from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential healthcare disparity merits greater attention.