By Leah Karliner, MD, MAS, Professor of Medicine, University of California San Francisco
The COVID-19 pandemic led to rapid changes in how patients received healthcare. Many healthcare organizations turned to telemedicine – switching to virtual visits by telephone or video from in-person visits. However, many older patients may lack access to this technology.
At the University of California San Francisco (UCSF), we launched our Video Visits for Elders Project (VVEP). We conducted telephone outreach to more than 1,400 older primary care patients in the early months of the pandemic when we were not seeing patients in-person. Our patient population is diverse across multiple domains, including socioeconomic, race, ethnicity and language.
As detailed in the March 2022 issue of The Joint Commission Journal on Quality and Patient Safety, our goal was to help older adults log onto video for a video visit. If they couldn’t or didn’t want to, we reassured them that they could have a telephone visit. We wanted to maintain equitable clinical primary care access in a moment when many elders were isolated and vulnerable.
We found that while one-third were already video-enabled, a full 18% did not have access to any technology device. We were able to successfully assist another 15% with downloading and practicing a video connection. This sometimes took considerable time and effort. Fortunately, most of those patients did end up having a video visit. Another 33% declined our assistance, and many of those who declined ended up cancelling their appointments rather than converting to a virtual (video or telephone) visit.
Important takeaways from these results are:
- While some older adults are tech savvy, a substantial minority do not have any technology access.
- With some effort, care teams can assist older adults with new technology – this was done successfully over the phone, but would likely be easier to accomplish in person.
- For some older adults, virtual visits are not desired or ideal, and those patients strongly preferred to wait for in-person appointments.
Future Implications for Access to Healthcare
Much has changed since the early days of the pandemic, and likely many more older adults have experience now with video visits than at the time of this study. However, our findings have important implications for how we communicate with older adults and provide them access to care.
First, if healthcare systems want to maintain video visits as a viable option for all patients, including older adults, they should use their standing in the community to advocate for technology assistance for those without current access to a computer or smartphone.
Second, health systems should partner with local agencies or work internally to develop hands-on training sessions to assist patients with learning and practicing how to use the technology necessary to access their doctors and health information on their own devices. This extends beyond video visits to patient portals that health systems increasingly rely upon to communicate with patients.
Finally, health systems must remain mindful that with each new technological advance we incorporate into healthcare, some patients are likely to be left behind. These vulnerable groups – often older patients, and minority and linguistically diverse patients – must not be an afterthought once a project is completed. Rather, at the beginning of each improvement project, we must place them at the center, asking ourselves the question, “How might this change enhance equity or widen disparities, and for which patients?”
Healthcare organizations can start to measure patients’ technology access and literacy to identify those needing assistance and provide targeted VVEP-style outreach. This would help prepare in advance to care for vulnerable patients the next time face-to-face healthcare may not be an option.
Leah Karliner, MD, MAS, is a professor in the Division of General Internal Medicine in the Department of Medicine at the University of California San Francisco (UCSF). Dr. Karliner also is director of the Center for Aging in Diverse Communities and the Multiethnic Health Equity Center, both at UCSF. Her research focuses on improving the quality of care for limited English proficiency (LEP) patients, and the study of health disparities and communication at critical clinical junctures for older patients.