Table 1.

Strategies for addressing barriers to VTH use with older adults

Barrier	Strategies
Acceptance of VTH	Provide effective training to both patients and providers • Emphasize usefulness and ease of use when introducing VTH. • Highlight benefits of using VTH regularly. • Teach troubleshooting and emphasize the usefulness of learning those strategies for general use of technology. • Train providers in documentation and reimbursement.
Physical and cognitive limitations	Educate patients and providers on a variety of adaptive strategies • Keep up to date on innovations in adaptive equipment. • Adopt adaptive equipment tailored to patient. • Focus on VTH repetition and practice. • Use simple analogies and metaphors. • Provide paper copies of instructions.
Access	Understand factors affecting equitable access • Assess availability of broadband, Internet, and equipment. • Understand that attitudes toward VTH are influenced by experience with technology. • Understand and address cultural barriers to using VTH • Adapt VTH programs for varying levels of health literacy.
Establishing rapport	Use rapport-building strategies during VTH visits • Encourage more patient participation in VTH visits. • Slow speech during visits to help with understanding. • Train providers in interpersonal communication strategies using VTH. • Practice technical troubleshooting strategies in advance.
Privacy	Train providers in methods of maintaining privacy during VTH • Provide training on issues such as HIPAA compliance, maintaining a secure virtual environment, and dealing with multiple participants during VTH visits.
Safety	Train providers in possible safety issues during VTH visits • Create a safety plan for medical emergencies. • Provide training in identifying abuse and neglect using VTH. • Practice methods of separating multiple participants during VTH visits for private interviews.
Reimbursement	Be aware of documentation and reimbursement • Document VTH visits in compliance with reimbursement rules. • Advocate for reimbursement parity for VTH visits.