JMIR Publications

ABSTRACT

Background:

The shift to video care during the COVID-19 pandemic exacerbated disparities in health care access, especially among frail high-need, high-risk (HNHR) older adults.

Objective:

Our objective was to quantify the ability of HNHR older Veterans to use video visits for healthcare, and identify factors associated with successful video visit completion.

Methods:

Veterans in a VA Frailty Intervention and Treatment (FIT) clinic underwent a physical, functional, psychological, social, and technology assessment at baseline. During the pandemic, the FIT clinic switched to virtual visits. We sorted patients into four groups: video visit, telephone-visit, reached but no visit, and unable to contact. We performed t-test for comparing normal variables, and chi-square test for comparing categorical variables, to identify factors associated with successfully completing a video- vs telephone-visit.

Results:

We attempted to contact 110 FIT clinic patients. They were 73.5 ± 5.6 years old on average, 46 (41.8%) were White, 46 (41.8%) Black, and 17 (15.5%) Hispanic; Sixty-seven (60.9%) had at least some college education, and 49 (44.5%) were very confident filling out medical forms. Of the 110, 72 were reached, and 65 agreed to a virtual visit. Of the 65, 19 (29.2%) patients completed a video visit successfully, while 37 (57%) completed a telephone-visit; 19/25 (76%) of those who scheduled a video visit completed it successfully. Veterans who completed a video visit, compared to the telephone-visit group, were more likely to have access to a computer with a camera and microphone (P=.001) and high-speed internet/data plan (P=.03), use e-mail (P=.02), and be confident in internet use (P=.05). They were more likely to have a higher health literacy score (P=.04) and be cognitively intact with a MoCA score of ≥26 (P=.02), and were less likely to have issues with walking, stepping and balance (P=.03).

Conclusions:

Our study found that competing a video visit requires technology access, ability, and willingness. Among frail older Veterans, only a quarter completed a video visit, and comprised of patients who already had access to video-capable technology, used it, and were comfortable with it. They were also more likely to be physically and cognitively intact than those who used telephone visits. Strategies to expand the use of video visits into the care of older adults should screen older adults to identify those more likely to succeed, and increase access to simple home telehealth technology. Clinical Trial: TBD