Factors associated with virtual care access in older adults: a cross-sectional study

Abstract

Background: virtual care has been critical during the COVID-19 pandemic, but there may be inequities in accessing different virtual modalities (i.e. telephone or videoconference).

Objective: to describe patient-specific factors associated with receiving different virtual care modalities.

Design: cross-sectional study.

Setting and subjects: we reviewed medical records of all patients assessed virtually in the geriatric medicine clinic at St. Michael's Hospital, Toronto, Canada, between 17 March and 13 July 2020.

Methods: we derived adjusted odds ratios (OR), risk differences (RDs) and marginal and predicted probabilities, with 95% confidence intervals, from a multivariable logistic regression model, which tested the association between having a videoconference assessment (vs. telephone) and patient age, sex, computer ability, education, frailty (Clinical Frailty Scale score), history of cognitive impairment and immigration history; language of assessment and caregiver involvement in assessment.

Results: our study included 330 patients (227 telephone and 103 videoconference assessments). The median population age was 83 (Q1-Q3, 76-88) and 45.2% were male. Frailty (adjusted OR 0.62, 0.45-0.85; adjusted RD -0.08, -0.09 to -0.06) and absence of a caregiver (adjusted OR 0.12, 0.06-0.24; adjusted RD -0.35, -0.43 to -0.26) were associated with lower odds of videoconference assessment. Only 32 of 98 (32.7%) patients who independently use a computer participated in videoconference assessments.

Conclusions: older adults who are frail or lack a caregiver to attend assessments with them may not have equitable access to videoconference-based virtual care. Future research should evaluate interventions that support older adults in accessing videoconference assessments.

Keywords: caregiver; frailty; older people; telemedicine; virtual care.