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. Author manuscript; available in PMC: 2021 Nov 1.
Published in final edited form as: J Am Geriatr Soc. 2020 Oct 4;68(11):2431–2439. doi: 10.1111/jgs.16845

Rapid Integration of Home Telehealth Visits Amidst COVID-19: What Do Older Adults Need to Succeed?

Chelsea E Hawley *, Nicole Genovese †, Montgomery T Owsiany *, Laura K Triantafylidis †, Lauren R Moo ‡,§,, Amy M Linsky ∥,**,††, Jennifer L Sullivan ∥,‡‡, Julie M Paik *,§§,¶¶
PMCID: PMC8554768  NIHMSID: NIHMS1750263  PMID: 32930391

Abstract

OBJECTIVE:

Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits.

DESIGN:

We used an exploratory sequential mixed-methods design to conduct patient needs assessments, a home telehealth pilot, and formative evaluation of the pilot.

SETTING:

Veterans Affairs geriatrics-renal clinic.

PARTICIPANTS:

Patients with scheduled clinic visits from October 2019 to April 2020.

MEASUREMENTS:

We conducted an in-person needs assessment and telephone postvisit interviews.

RESULTS:

Through 50 needs assessments, we identified patient-perceived barriers in interest, access to care, access to technology, and confidence. A total of 34 (68%) patients were interested in completing a home telehealth visit, but fewer (32 (64%)) had access to the necessary technology or were confident (21 (42%)) that they could participate. We categorized patients into four phenotypes based on their interest and capability to complete a home telehealth visit: interested and capable, interested and incapable, uninterested and capable, and uninterested and incapable. These phenotypes allowed us to create trainings to overcome patient-perceived barriers. We completed 32 home telehealth visits and 12 postvisit interviews. Our formative evaluation showed that our pilot was successful in addressing many patient-perceived barriers. All interviewees reported that the home telehealth visits improved their well-being. Home telehealth visits saved participants an average of 166 minutes of commute time. Five participants borrowed a device from a family member, and five visits were finished via telephone. All participants successfully completed a home telehealth visit.

CONCLUSIONS:

We identified patient-perceived barriers to home telehealth visits and classified patients into four phenotypes based on these barriers. Using principles of implementation science, our home telehealth pilot addressed these barriers, and all patients successfully completed a visit. Future study is needed to understand methods to deploy larger-scale efforts to integrate home telehealth visits into the care of older adults.

Keywords: home telehealth, telehealth, virtual care, geriatrics, COVID-19

BACKGROUND

Before the COVID-19 pandemic, many older adults with complex medical conditions had limited access to care.1-6 Poor access is a serious concern, as those who have access to and attend frequent follow-up visits have significantly lower mortality rates compared with patients with limited access to care.7,8 COVID-19 exacerbated the access to care problem further due to reduced clinic visits, transportation restrictions, and other societal measures to mitigate the pandemic.9 Clinicians are seeking ways to provide effective virtual care for older patients in line with regulations to reduce the spread of COVID-19.9-13 Concurrently, reimbursement models, including Medicare, are adapting to enable clinicians to do so without financial penalty.9-12

Despite changes in reimbursement structures, video telehealth has not yet been widely integrated into clinical care due to time and personnel contraints.11,12,14,15 There may also be a lack of telehealth uptake caring for older patients because of misconceptions about older adults, their preferences, and their technological capabilities.13,16-18 Indeed, a recent study estimated that 38% of Medicare beneficiaries were unready to engage in home telehealth.19 However, when given the opportunity, many older patients can effectively engage in telehealth.13,20-25 We hypothesized that telehealth might improve access to care, but we were unsure if our patients were interested or if they had the technology and confidence to attempt a home telehealth visit.1

We were specifically interested in telehealth visits that occurred in patients’ homes, with synchronous audio and video. Herein, we refer to these types of visits as “home telehealth visits.” Our team used the VA Video Connect application for home telehealth. Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits into the geriatrics-renal clinic. In October 2019, we began a patient needs assessment to understand the barriers and facilitators of integrating home telehealth visits to improve access to care for older patients. Following the needs assessment, we planned to conduct a home telehealth pilot with several interested patients from the needs assessment. Two weeks into the pilot, Massachusetts issued a stay-at-home advisory amidst COVID-19. From that point forward, our team offered home telehealth or telephone visits to all previously scheduled patients.

METHODS

Design

Study Overview

We used an exploratory sequential mixed-methods design to identify patient-perceived barriers to engaging in home telehealth visits. Our study had three phases: a patient needs assessment, a home telehealth pilot, and a formative evaluation of the pilot. The needs assessment took place from mid-October 2019 to mid-February 2020. We recruited interested patients for home telehealth visits from January to March 2020. Our state’s stay-at-home advisory began March 24th; after that, we offered home telehealth visits to all patients with scheduled visits in the geriatrics-renal clinic. We conducted our home telehealth pilot and evaluation from March to April 2020. This work was deemed to be quality improvement by our local Research and Development Committee and was exempt from Institutional Review Board oversight.

Implementation Framework

Implementation frameworks allow researchers to understand contextual factors affecting implementation, such as facilitators and barriers to implementing their intervention in a particular setting. We selected the Consolidated Framework for Implementation Research (CFIR) to guide our work.26 CFIR is composed of 39 constructs that act as a “menu” of targets that have been associated with effective implementation.26-30 Our goal was to identify patient-perceived barriers that aligned with specific CFIR constructs.30-32

Study Design

Based on previous literature and our experience, we selected 8 of 39 CFIR constructs to explore in our patient needs assessment (Table 1). The goal of the needs assessment was to identify patient-perceived barriers to completing a home telehealth visit (Supplementary Figure S1). Because we developed the needs assessment questions based on CFIR, we could correlate these barriers with specific CFIR constructs. We mapped the most frequently occurring barriers to evidence-based implementation strategies to overcome them based on the Expert Recommendations for Implementing Change.31,32 We included these strategies when we designed our home telehealth pilot to address these patient-perceived barriers.

Table 1.

CFIR Constructs and Questions for Needs Assessment and Interviews

CFIR construct Needs assessment questions Postvisit interview questions
Relative advantage: Do parties see the need to implement home telehealth visits? Please rate your need for home telehealth visits as part of renal care (4-point scale: not at all to very much) In your opinion, should the renal clinic continue to make home telehealth visits a priority?
Complexity: Do parties believe that home telehealth visits are complex based on their perception of radicalness, disruptiveness, and number of steps? (List of steps to complete visit): Do you feel like you can follow these steps? (yes, maybe, no) What did you find most complex about participating in the home telehealth visit? How can VA help with this in the future?
Patient needs and resources: Are patient needs, including barriers and facilitators to meet those needs, accurately known? (List of items needed to complete visit): Do you have these things? (Select all that apply: internet at home, device with camera and/or microphone) Tell me about your experiences with your home telehealth visit. What barriers did you face to participating in the visit?
Self-efficacy: Do parties have confidence in their capabilities to execute courses of action to complete a home telehealth visit? How confident are you that you could participate in a home telehealth visit? (4-point scale: not at all to very) How confident are you that you could teach someone else how to participate in a home telehealth visit?
Individual state of change: Are parties skilled or enthusiastic about using home telehealth visits in a sustained way? After you have VA training and assistance, how prepared will you be to participate in a home telehealth visit? (4-point scale: not at all to very) Have you recommended home telehealth visits to others? Why or why not?
Adaptability: Do parties believe home telehealth visits can be sufficiently adapted or tailored to meet local needs? What kinds of changes or alterations do you think you will need to make to participate in home telehealth visits? (Select all that apply: list of choices) In what care settings and how often should we offer home telehealth visits?
Structural characteristics: How does the social architecture, age, and size of the organization affect home telehealth visit implementation? What kind of changes or alterations do you think the clinic should make to best provide home telehealth visits? (Select all that apply: list of choices) What types of changes should we make to how we do home telehealth visits in the future?
Knowledge and beliefs: Do parties have negative attitudes toward and/or they are not familiar with facts, truths, and principles about home telehealth visits? When might you need a home telehealth visit, rather than in-person visit? (Select all that apply: list of choices) What value or benefit did you receive from the home telehealth visit?
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Abbreviations: CFIR, Consolidated Framework for Implementation Research; VA, Veterans Affairs.

We measured our success in addressing patient-perceived barriers through a formative evaluation. Our evaluation included postvisit patient interviews (Supplementary Figure S2). We crafted the interview guide using the same 8 CFIR constructs as our patient needs assessment (Table 1). The formative evaluation was based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework, which focuses on essential program elements to improve the feasibility and sustainability of interventions.33,34 In line with our objectives, key RE-AIM outcomes were focused on addressing the patient-perceived barriers to home telehealth (Table 2).

Table 2.

RE-AIM Outcomes

Domain Outcomes
Reach

  • Percentage of patients identified, recruited, and who attempted and completed home telehealth visit training

  • Geographic reach of program

  • Patient perceptions of home telehealth visits related to time and travel
Effectiveness

  • Percentage of attempted home telehealth visits completed successfully via video platform

  • Patient-perceived quality of the home telehealth visit

  • Patient-perceived efficacy of our training approach and readiness to engage in another visit
Adoption

  • Percentage of patients who completed more than one home telehealth visit

  • Patient perceptions of how and when home telehealth visits should be used within the clinic

  • Patient perceptions of participating in future visits and recommending visits to others
Implementation

  • Patient time spent preparing for and completing home telehealth visit

  • Adaptations made from one visit to the next

  • Patient-perceived barriers to engaging in the home telehealth visit

  • Patient-perceived adaptations needed for future home telehealth visits
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Notes: We measured implementation success through the RE-AIM outcomes, excluding elements of Maintenance given the short follow-up timeframe.

Setting

The geriatrics-renal clinic has a unique, interprofessional model, but the location of this urban clinic makes it difficult for some older adults to access in-person care.1,35 Most visits within the clinic are for follow-up of kidney disease, monitoring chronic disease progression, and medication management.1

Participants

Our participants were veterans who attended a geriatrics-renal clinic visit from October 2019 to April 2020, either in person (October–February) or through video (March–April).

Procedures

Conducting Needs Assessments

From October 2019 to February 2020, we asked patients who attended an in-person clinic visit to complete a one-page paper needs assessment in their geriatrics-renal clinic room before or after their appointment. The needs assessment was voluntary and anonymous; patients who were interested in being contacted for our home telehealth pilot provided their name and contact information at the bottom of the needs assessment.

Training Patients for Home Telehealth Visits

To complete a home telehealth visit, patients needed: (1) internet access at home, (2) an internet-compatible device with a camera and microphone, and (3) the confidence to attempt the visit. All patients received the following standardized training:

  1. Our team contacted patients to schedule a home telehealth visit and discuss standard training procedures for visit capability. If patients needed a camera or microphone for their personal device, Veterans Affairs (VA) could furnish this equipment.

  2. A telehealth technician called each patient previsit to offer technical assistance. The technician instructed patients how to download and navigate the application. At that time, if patients were interested, the telehealth technician also completed a video test call. During a test call, the patient and telehealth technician completed a practice video visit from start to finish; the telehealth technician communicated with the patient over the telephone during the test call to troubleshoot any technical issues. This was optional.

  3. Our team sent an electronic one-page instructional guide to patients’ personal e-mail on how to use the home telehealth visit application.

We used questions from our needs assessment to determine each patient’s level of interest and capability to engage in a home telehealth visit and to tailor further training. Not all patients requested and received the same training: training was individualized and iterative. This is described further in the results.

Piloting and Evaluating Home Telehealth Visits

After they were trained, patients completed a home telehealth visit with one or more geriatrics-renal clinicians. All visits included a medication reconciliation and chronic kidney disease follow-up assessment. One week after each visit, we contacted patients by telephone for a postvisit interview to discuss their perceptions of the home telehealth visit. Our team transcribed interviews in real time and coded them using an adaptive deductive approach,36 specifying codes a priori and allowing for the emergence of new codes.37 A priori codes were defined based on our previous work21-25 and clinical experiences. Two members of our team who did not conduct the visits (C.H. and M.O.) coded interviews, and a third member (N.G.) acted as a referee to resolve coding discrepancies. After three rounds of coding the first four interviews, we finalized our codebook.

Measurements

Our study had two instruments: a patient needs assessment and semistructured interviews. The needs assessment included 13 closed-ended questions (multiple choice, Likert scales) and one open-ended question (Supplementary Figure S1). The postvisit interview guide was designed to take 30 minutes (Supplementary Figure S2).

RESULTS

Patient-Perceived Barriers: Interest, Access, and Confidence

A total of 136 patients attended the once weekly geriatrics-renal clinic from October 2019 to January 2020; we completed 50 patient needs assessments during that time (Figure 1). Interest, access to technology, and confidence were patient-perceived barriers to engaging in home telehealth; access to care was a patient-reported barrier that could be addressed through telehealth.

Figure 1.

Figure 1.

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Patient phenotypes from our needs assessment. Four distinct patient phenotypes emerged from our needs assessment. A total of 34 (68%) were interested in completing a home telehealth visit. The Interested and Capable phenotype included 24 (48%) older patients who were interested in completing a home telehealth visit, had access to internet and a device, and felt confident that they could participate. The Interested and Incapable phenotype included 10 (20%) patients who were interested in completing a home telehealth visit but lacked the technology or confidence to do so. The Uninterested and Capable phenotype included 8 (16%) patients who were not interested in completing a home telehealth visit but had the technology and the confidence. We targeted these 42 (84%) patients for our home telehealth pilot. We did not target the 8 (16%) patients who were Uninterested and Incapable. Starting in March 2020, we offered the choice between a home telehealth or telephone visit for all patients with scheduled visits in the clinic, in line with the state’s stay-at-home advisory: 66 patients were scheduled for a visit during that time period. We contacted the 54 (82%) patients whose visits were considered clinically urgent by geriatrics-renal personnel to schedule a home telehealth or telephone visit. We reached 48 (89%) of these: 25 chose a telephone visit, and 23 chose a home telehealth visit. The phenotypes of the 23 patients who chose home telehealth were: Interested and Capable, 14 (61%); and Interested and Incapable, 9 (39%).

  1. Interest: more than half (34 of 50 (68%)) of needs assessment respondents were interested in completing a home telehealth visit. A total of 19 (38%) of these provided their contact information to participate in the home telehealth pilot.

  2. Access to care: patients reported traveling an average of 27 miles (90 minutes) round trip to the clinic, which was a barrier to accessing in-person care.

  3. Access to technology: 32 (64%) patients had access to internet and an internet-compatible device with a camera, 12 (24%) only had internet, and 6 (12%) did not have access to either.

  4. Confidence: less than half (21 (42%)) of individuals were confident that they could participate in a home telehealth visit.

Implementation Strategies to Address Patient-Perceived Barriers

We selected four implementation strategies31,32 to address patient-perceived barriers in interest, access, and confidence:

  1. Assessing for readiness and identifying barriers and facilitators: We categorized patients who responded to the needs assessment into four phenotypes based on their interest and capability to complete a home telehealth visit (Figure 1). These phenotypes allowed us to assess for readiness to engage in a home telehealth visit and to create trainings to overcome patient-perceived barriers. By grouping patients into these phenotypes, which we chose and labeled based on answer frequency in the needs assessment, we were able to target groups based on their self-identified facilitators and barriers.
    • The Interested and Capable phenotype included the 24 (48%) patients who were interested in home telehealth, had access to the internet and a device, and felt confident that they could participate.
    • The Interested and Incapable phenotype included the 10 (20%) patients who were interested in home telehealth but lacked the technology or confidence to do so.
    • The Uninterested and Capable phenotype included the 8 (16%) patients who were not interested in home telehealth but had technology and confidence.
    • The Uninterested and Incapable phenotype included the remaining 8 (16%) patients who were not interested in home telehealth and lacked technology or confidence.

Starting in March 2020, we offered the choice between a home telehealth or telephone visit for all patients with scheduled visits in the clinic: 66 patients were scheduled for a visit during that time period. We contacted the 54 (82%) patients whose visits were considered clinically urgent by geriatrics-renal personnel to schedule a home telehealth or telephone visit. We reached 48 (89%) of these: 23 chose a home telehealth visit (see Figure 1 for their phenotypes).

  • Conducting ongoing training: We trained a total of 32 patients for the home telehealth pilot: these patients were a combination of patients who completed the needs assessment and patients who needed to be scheduled following the stay-at-home advisory (demographics found in Supplementary Table S1). We provided individualized, ongoing training based on patient phenotype.
    • Four of 20 (20%) Interested and Capable patients completed a test call with the telehealth technician. Nine (45%) requested additional instructions from our team (six requested written and verbal instructions, and three requested verbal instructions only), and six (30%) requested a test call with our team.
    • Two of 12 (17%) Interested and Incapable patients requested a test call with a telehealth technician. Seven (58%) requested additional written and verbal instructions from our team, and six (50%) requested a test call with our team.
    • The one patient who was Uninterested and Capable received a telephone call from our implementation team outlining the potential benefits of completing a home telehealth visit. This patient declined a home telehealth visit and instead opted to reschedule his follow-up visit several months later due to personal concerns related to COVID-19. The patient was not contacted again for the purposes of this study.

  • Conducting cyclical small tests of change: During implementation, we iteratively revised our strategies. Our most successful adaptation strategy involved calling patients after they were enrolled in telehealth but before their test call, to discuss how to download and navigate the application and how to adjust their audio and video. This was a separate process from the standardized training with telehealth personnel.

  • Obtaining and using patient feedback: We reached thematic saturation with 12 postvisit interviews.

Evaluation of Success Addressing Patient-Perceived Barriers

We measured our success in addressing patient-perceived barriers through a formative evaluation of the home telehealth pilot.

  1. Success addressing interest: A total of 19 individuals volunteered for the home telehealth pilot via the needs assessment: we were able to reach 12 (63%), nine of whom were still interested in participating. A total of 23 patients chose a home telehealth video during the stay-at-home advisory: we were able to reach all 23, and all were still interested in participating. We attempted and completed home telehealth visits with 32 patients. Eight of 32 (25%) patients completed at least one additional home telehealth visit with a non–geriatrics-renal clinician after completing a visit with our team. All 12 interviewees reported that home telehealth visits were beneficial to their personal health and well-being.

  2. Success addressing access to care: We calculated the estimated commute time saved for each individual who participated in the home telehealth pilot based on his/her zip code and the projected commute time via a web-based navigation application for an 8 am appointment. The average commute time was 83 minutes each way, with a range of 35 to 110 minutes. Among those who volunteered for a postvisit interview, all 12 interviewees repeatedly commented that home telehealth visits were convenient and time saving.

  3. Success addressing access to technology: In 5 of 32 total home telehealth visits, patients borrowed a device from a loved one or family member: no patients requested devices from VA. Three (25%) interviewees reported that they had help from a loved one or family member before the visit, and two (17%) had help during the visit. Seven (58%) reported that they did not experience technical challenges. The other five interviewees reported minor technical difficulties, all of which were resolved during the visit. Only five visits were not able to be completed via video: these visits began as video visits but were finished via telephone due to technical difficulties.

  4. Success addressing confidence: Most interviewees reported that our training and instructions were helpful (11 (92%)). Per documented time spent in electronic medical record notes, patients who required training spent an average of 30 minutes training for the visit, with an additional 15 to 30 minutes if they completed a test call. All interviewees would recommend home telehealth visits to others.

DISCUSSION

Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits into the geriatrics-renal clinic. A recent systematic review identified several studies supporting home telehealth.38 Methods were heterogeneous, but overall, home telehealth was feasible, acceptable, and effective across several populations of older adults.38 Our results aligned with existing studies and illuminated several key findings. First, we found that interest, access to technology, and confidence were patient-perceived barriers to engaging in home telehealth; access to care was a patient-reported barrier that could be addressed through telehealth. Second, based on these barriers, our patients could be classified into one of four phenotypes: interested and capable, interested and incapable, uninterested and capable, and uninterested and incapable. Third, using principles of implementation science, our home telehealth pilot addressed patient-perceived barriers to engaging in home telehealth. Notably, when we provided individualized training based on patient-perceived barriers and phenotype, all N = 32 patients in our pilot successfully completed a visit.

Our study revealed barriers to patient interest in telehealth. Our needs assessment showed that 34 (68%) of respondents were interested in home telehealth, yet 19 (38%) of these volunteered for a home telehealth visit, and 9 (18%) actually participated. Few studies have discussed interest as a barrier to older adults engaging in a telehealth visit. One study of veterans with dementia offered home teleneurology visits: 184 (83%) families were not interested in televisits, citing not having a home computer as the top barrier (30%).24 We were unable to address interest in completing an initial home telehealth visit in our study: among those who were uninterested in home telehealth, only one agreed to be contacted for the pilot, but that individual declined to participate. Further study is needed to explore the uninterested and capable/incapable phenotypes, to understand why patients may accept or decline a home telehealth visit. In line with many other studies, once our older patients participated in a home telehealth visit, they reported that home telehealth was satisfying and met their needs.13,21,24,38-42

Our study confirmed that older patients may travel several hours to access in-person care, and that home telehealth may address this.1,13,21,38,39,43 Convenience is a primary reason that older adults engage in home telehealth.24,38,43 This was similar to our study, where all interviewees reported that the visits were convenient. Thus, offering home telehealth visits addressed the access to care barrier for many patients. Across all patient phenotypes, interviewees consistently reported that home telehealth visits improved their access to care.

In line with many studies, our patients reported barriers to accessing technology. Older adults may have less experience with technology or may have aging-related barriers to using it.13,40,44 Previous studies provided and/or installed equipment for older adults to engage in home telehealth.21,24,38,43,45 Our study is novel in that all equipment that participants used belonged to them or to a family member. Access to technology was a barrier in the interested and incapable and uninterested and incapable phenotypes. In our study, seven interviewees (58%) reported that they did not experience challenges accessing or using the technology; the other five interviewees reported minor technological difficulties that were resolved during their visit. Five visits were switched to telephone midvisit due to technological difficulties. Our pilot demonstrated that technological challenges during home telehealth will occur, but with individualized training and a telephone visit back-up plan, patients and clinicians were able to solve technological challenges during this visit. This was contrary to misconceptions about older adults and their abilities to use technology.16-18

Finally, our study revealed barriers in patient confidence, which has not been well studied. Older adults and their family members expressed apprehension using home telehealth technology in two studies.24,45 We addressed the confidence barrier with individualized training. Clinicians may consider these patient phenotypes and our exemplar scenarios (Figure 2) to guide their approach to home telehealth visits for certain clinical scenarios. With this individualized training, all 32 patients successfully completed a home telehealth visit.

Figure 2.

Figure 2.

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Exemplar patient cases. Our patients identified barriers in four areas: interest, access to care, access to technology, and confidence. Our patients also could be classified into four distinct phenotypes based on their interest and ability to engage in a home telehealth visit: Interested and Capable, Interested and Incapable, Uninterested and Capable, and Uninterested and Incapable. We applied individualized approaches and tailored training to individual patient needs based on their phenotype. Clinicians may consider these patient phenotypes and our exemplar scenarios to guide their approach to home telehealth visits for certain clinical scenarios. With this individualized training, all 32 patients in our home telehealth pilot successfully completed a home telehealth visit.

Our main strength was that we identified barriers perceived by older adults and addressed those barriers to successfully complete 32 home telehealth visits. Our study augments the current literature, which has called for studies discussing the implementation of home telehealth visits in light of the COVID-19 pandemic.9-13,19 Our study complements one such study,13 but adds a methodological approach rooted in implementation science. Our implementation methods are valid and have been applied to improving care for older adults in a variety of settings.29,46-49

Most visits within the geriatrics-renal clinic are for follow-up of common comorbidities in the geriatric population (chronic kidney disease, hypertension, and diabetes mellitus) and medication management of these comorbidities. This was a strength of our study, as other similar studies focused on specific diseases, rather than older adults with complex medical conditions.38 Other than the need for routine laboratory monitoring, the team could effectively complete their visits through telehealth. This may be the case for other clinics caring for older adults where in-person physical examination may not always be necessary, and our methods and results may be translatable to these settings. This may also be relevant to those caring for older adults in settings where face-to-face care may not be possible.

Despite the aforementioned strengths, our study has limitations, including a short duration, small sample size, and completion at a single VA facility. Most of our home telehealth visits (28 (70%)) and all of our postvisit interviews occurred during COVID-19; as such, this may not reflect care provided under usual care settings and thus may limit generalizability. We had strong institutional support, including VA telehealth technicians, which was critical to our implementation success and that of Dewar et al.13 Our aim was to understand the perceptions of our older patients to create a tailored training and implementation blueprint. We did not consider the perceptions and experiences of clinicians. Further study is needed to define whether the clinician and institutional perspectives align with patient perspectives.13

CONCLUSIONS

Interest, access to technology, and confidence were patient-perceived barriers to engaging in home telehealth; access to care was a patient-reported barrier that could be addressed through telehealth. We categorized patients into four phenotypes based on their interest and capability to complete a home telehealth visit. Using principles of implementation science, our home telehealth pilot addressed patient-perceived barriers to engaging in home telehealth, and all N = 32 patients in our pilot successfully completed a visit. Future study is needed to understand to whom, when, and how clinicians and institutions should deploy larger-scale efforts to integrate home telehealth visits into the care of older adults amidst the COVID-19 pandemic and beyond.

Supplementary Material

Supplement

Supplementary Figure S1: Patient needs assessment. Based on previous literature and our experience, we selected 8 of 39 CFIR constructs to explore in our patient needs assessment. The goal of the needs assessment was to identify patient-perceived barriers to completing a home telehealth visit. The needs assessment included 13 closed-ended questions (multiple choice, Likert scales) and one open-ended question; these assessed travel for in-person clinic visits, interest in a home telehealth visit, access to technology, and self-efficacy to participate in a home telehealth visit.

Supplementary Figure S2: Postvisit patient interview guide. The goal of the postvisit interview was to understand patients’ experiences with the home telehealth visit, their perceptions of visit benefit, and barriers to engaging in the visit. We crafted the interview guide using the same 8 CFIR constructs as our patient needs assessment. The postvisit interview guide was designed to take 30 minutes.

Supplementary Table S1: Patient Demographics

Footnotes

Conflict of Interest: The authors have no conflicts to declare.

Preliminary results from this article were accepted as a poster at the 2020 American Geriatrics Society Annual Scientific Meeting.

Sponsor’s Role: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs or the U.S. government.

SUPPORTING INFORMATION

Additional Supporting Information may be found in the online version of this article.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement

Supplementary Figure S1: Patient needs assessment. Based on previous literature and our experience, we selected 8 of 39 CFIR constructs to explore in our patient needs assessment. The goal of the needs assessment was to identify patient-perceived barriers to completing a home telehealth visit. The needs assessment included 13 closed-ended questions (multiple choice, Likert scales) and one open-ended question; these assessed travel for in-person clinic visits, interest in a home telehealth visit, access to technology, and self-efficacy to participate in a home telehealth visit.

Supplementary Figure S2: Postvisit patient interview guide. The goal of the postvisit interview was to understand patients’ experiences with the home telehealth visit, their perceptions of visit benefit, and barriers to engaging in the visit. We crafted the interview guide using the same 8 CFIR constructs as our patient needs assessment. The postvisit interview guide was designed to take 30 minutes.

Supplementary Table S1: Patient Demographics

NIHMS1750263-supplement-Supplement.pdf (103KB, pdf)

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