Qualitative interviews with physicians: Overcoming barriers to access to bring telehealth to older adults during COVID-19

Abstract

Introduction: While the COVID-19 pandemic increased telehealth uptake, concerns surrounding access to telehealth visits emerged for older adults, especially those that are under-resourced, rural, and non-English speaking. We aimed to identify strategies employed by physicians to improve access to medical care via telehealth for older adults during the pandemic. Methods: Using purposeful sampling, we recruited physicians for 30-minute semi-structured interviews. The interviews focused mainly on telehealth’s usability for older patients, and specific strategies physicians employed to facilitate access to care for older adults with varied needs and skills. Interviews were coded using NVivo software and analyzed using framework matrix analysis. Results: Of 48 physicians (geriatrician n = 18, primary care n=15, emergency n=15) interviewed, median age was 37 (interquartile range 34-45), and 27 (56%) were women. Our data suggests that older adults who were under-resourced, rural, or non-English speaking faced greater challenges in using telehealth. Physicians addressed these barriers with strategies tailored to individual patient needs and practice setting resources. Strategies included employing auditory augmentation and speech modifications to enhance understanding, using caregivers and home services to overcome inexperience with navigating technology, device distribution programs for those without equipment access, and real-time interpreter technologies. Physicians reported that telehealth was successful in reducing transportation barriers, whether due to distance or mobility impairments, especially among older adult populations and reducing “no-show” appointment rates. Conclusions: Adoption of strategies to overcome technological and systemic barriers may improve equitable access to age-friendly telehealth for older adult patients. Physicians reported optimism that telehealth could be used to expand access to medical care for older adults with the right technological infrastructure, payment models, and support. Although challenges remain, they may be overcome with additional technical training for clinicians and patients, investment in telehealth infrastructure and broadband internet, and policy changes to promote telehealth access for this diverse patient population.