key: cord-0777430-dfy5qtjx
authors: Howren, M. Bryant; Castagna, Nicolette; Katz, Paul R.
title: Openness to Use of Telehealth During and After the COVID-19 Pandemic in a Sample of Rural Older Adults in a Federally Qualified Health Center
date: 2021-07-02
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2021.06.028
sha: a6bf79a0515d0949fab8d572de0d6f185999f67c
doc_id: 777430
cord_uid: dfy5qtjx

nan

The COVID-19 pandemic has facilitated increased use of telehealth for primary and specialty care encounters and recently there have been calls to expand its use in post-acute and long-term care settings. 1, 2 Telehealth expansion is particularly important for rural and underserved populations as it represents a medium to increase access and reduce disparities in healthcare delivery. 3 However, despite the increase in availability, relatively little is known about whether rural older adults are open to using telehealth.

Participants were adults aged 65+ from one clinic affiliated with a network of rural Southeastern FQHCs. These clinics serve over 22,000 primarily rural patients, of which approximately 3,000 are aged 65+. Approximately 38% of patients are racial/ethnic minorities: 27% are Black and 11% Hispanic/Latino. As part of a larger quality improvement (QI) initiative, older adults who were active patients (N=357) were contacted for participation in a brief survey. Sixty-five (18.2%) completed the survey (50 by email, 15 by mail). Because this project was deemed QI, IRB approval was not required.

Included in a survey on COVID-19 healthcare needs and utilization, patients were asked three questions about using telehealth: (1) "If available, would you be willing to use video conferencing with members of your healthcare team (i.e., a telehealth visit) to receive care or medical advice about your emotional health?"; (2) "How would you describe your level of comfort at the prospect of using video conferencing with members of your healthcare team to receive care or medical advice about your emotional health?"; (3) "In the future, after the J o u r n a l P r e -p r o o f COVID-19 crisis has resolved, which of the following BEST reflects your attitude towards telehealth?". Use of telehealth for mental healthcare vs. all types of healthcare was emphasized as appropriate in the survey. Table 1 summarizes descriptive data for each item. Regarding item one, 37/65 (56.9%) indicated that they would not be willing to use telehealth for mental health during COVID-19 compared to 28/65 (43.1%) who would. Regarding item two, nearly half (32/65, 49.2%) indicated being somewhat or very uncomfortable at the prospect of using telehealth for mental health. Regarding item three, over one quarter (17/62, 27.4%) indicated that they would not use telehealth for any healthcare needs after COVID-19; an equal number (17/62, 27.4%) indicated they would prefer to receive care mostly or all in person. All 28 who indicated a willingness to use telehealth for mental health during COVID-19 also indicated some degree of openness to telehealth for all care as appropriate after COVID-19.

This brief exploratory QI study queried older, rural adults about openness to using telehealth.

Most indicated an unwillingness to use telehealth for mental health, many of whom expressed feeling uncomfortable about the prospect of doing so. Moreover, a majority indicated that they either would not use telehealth for any care or prefer to receive most or all care in person once the COVID-19 crisis subsides.

Recent research regarding openness to using telehealth similarly found that older adults are less willing. 4 However, as rural residents may be less likely to access mental health services overall, 5 older adults in this sample indicating unwillingness to use and high discomfort with telehealth J o u r n a l P r e -p r o o f for emotional needs deserves further study. Indeed, a recent study found that rural residents were more interested in telehealth for mental health than their urban counterparts; however, younger residents and those with greatest existing access to mental healthcare were most interested. 6 Although older adults may be less willing to use telehealth, the present data suggest that a sizable minority are open to its use and while some may be against using it for mental health, there are other contexts for which telehealth may improve access and quality of care. Older patients are often complex and face numerous physical and behavioral health comorbidities. Given that rural patients often also live in health professional shortage areas and face access challenges to receiving specialized care of all types, 7, 8 providers and organizations should consider other opportunities to incorporate telehealth into practice. Research shows that negative attitudes toward telehealth utilization are related to exposure and community-based strategies may improve uptake. 9 This study is limited by its small convenience sample from a single clinic and limited response rate (18.2%) but provides a valuable snapshot of rural older adults' attitudes toward telehealth.

As its availability is not likely to diminish and infrastructure continues to improve, interventions are needed to increase awareness and engagement in telehealth for older adults, including those that highlight its benefits and provide instruction, particularly for rural residents with limited access to care. 10 

Trends in the use of telehealth during the emergence of the COVID-19 pandemic-United States

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Connected health: A review of technologies and strategies to improve patient care with telemedicine and telehealth

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Rural residents with mental health needs have fewer care visits than urban counterparts

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Utilization barriers and medical outcomes commensurate with the use of telehealth among older adults: systematic review