Is an iPad Enough? Barriers to the Access of Video Telemedicine Services by Outpatient Limited English Proficiency (LEP) Geriatric Psychiatry Latinx Patients During the COVID-19 Pandemic.

Abstract

IntroductionThe Covid-19 pandemic has caused a massive shift from in-person healthcare delivery to telemedicine to protect patients and healthcare providers. Older adults are at an elevated risk of exposure and complications from this virus, making video visits an ideal and safer alternative to in-person care. Data from clinical encounters at our ambulatory Psychiatric clinic in Boston, Massachusetts, revealed that older Latinx patients, whose preferred language was Spanish, were more likely to make a phone visit rather than video visit, as compared to other subpopulations. This pilot study is based in administering a survey to older Latinx adults from our ambulatory psychiatric clinic.MethodsWe aimed to recruit 50 older Latinx adults age 60 years and older who identified Spanish as their preferred language and required the assistance of an interpreter for their medical appointments. These individuals were connecting via phone visits only and not video telemedicine. We developed a 33-question survey containing information on demographics, literacy, technology use, sensory functions, personal concerns and preferences about video visits. A Spanish medical interpreter administered the survey over the phone.ResultsCurrently 43 patients have been enrolled and 36 have completed the study, i.e., answered the survey. Preliminary descriptive data revealed a majority female group (85.7%), with median age of 67.5 years, mainly born and raised in the Caribbean. A minority of patients (2.9%) felt comfortable communicating in English. Less than 15% of our sample had more than high school level and most (95%) completed their studies outside of the United States. While 74.3 % of our sample could read ‘very well’ in Spanish, only 2.9 % could do so in English. Most of our sample was not working (91.4 %). Most of our population had internet (74.3%) and an electronic device with which to make video calls (80%). Notably 60% of our sample had an email address, however 85 % did not use it to communicate. Our patients could send/receive text messages from their cell phones in 77% of the cases, and 65.7 % had made video calls using mostly WhatsApp (42.9%), Zoom (14.3 %) and Facetime (14.3 %) as most common platforms. Most patients reported eyesight problems (20 % “a lot” and 71.4 % “Yes, a little bit”), some hearing problems (5.7% “a lot” and 25.7 “a little”) and over half (20% “a lot” and 37.1 “a little”) complained of subjective memory problems. Of our sample, 31.5 % reported worries about videocall appointments, mostly described as technical problems they could not solve (25.7 %), having no privacy (14.3 %) and appearance not being well groomed (11.4 %). One third of our group (31.4 %) reported having no one who could help them with internet/technology connection.ConclusionsBased on these preliminary data, connection to video telemedicine by geriatric low English-proficiency (LEP) patients is challenging when there is limited technology literacy, education and language limitations, sensory deficits, and direct personalized guidance and support. Sensory functions (vision and hearing) and memory difficulties can also affect our patient's ability to access technology for clinical care and should be considered. The implementation of direct supports, such as care navigators, technology educators and connection to other support systems in their preferred language may be necessary to improve their access to video telemedicine.This research was funded byBrigham and Women's Hospital Covid-19 Grant Funding (Institutional Funding)