A Qualitative Evaluation of a Telemedicine-Enhanced Emergency Care Program for Older Adults

Authors

  • Manish N. Shah MD, MPH,

    Corresponding author
    1. Department ofCommunity and Preventive Medicine, University of Rochester Medical Center, Rochester, New York
    2. Division of Aging/Geriatrics, Department of Medicine, University of Rochester Medical Center, Rochester, New York
    • Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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  • Dylan Morris BA,

    1. Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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  • Courtney M. C. Jones MPH,

    1. Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
    2. Department ofCommunity and Preventive Medicine, University of Rochester Medical Center, Rochester, New York
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  • Suzanne M. Gillespie MD, RD,

    1. Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
    2. Division of Aging/Geriatrics, Department of Medicine, University of Rochester Medical Center, Rochester, New York
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  • Dallas L. Nelson MD,

    1. Division of Aging/Geriatrics, Department of Medicine, University of Rochester Medical Center, Rochester, New York
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  • Kenneth M. McConnochie MD, MPH,

    1. Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
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  • Ann Dozier PhD

    1. Department ofCommunity and Preventive Medicine, University of Rochester Medical Center, Rochester, New York
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  • This work was presented at the 2012 Annual Meeting of the Society for Academic Emergency Medicine in Chicago, Illinois.

Address correspondence to Manish N. Shah, MD, MPH, University of Rochester Medical Center, 265 Crittenden Blvd, Box 655C, Rochester, NY 14642. E-mail: manish.shah@rochester.edu

Abstract

Objectives

To document the experiences of patients, their caregivers, healthcare personnel, and staff members with a program that provides telemedicine-enhanced emergency care to older adults residing in senior living communities (SLCs) and to delineate perceived barriers and facilitators.

Design

Qualitative study.

Setting

A primary care geriatric medicine practice.

Participants

Stakeholders associated with telemedicine visits: patients, family caregivers, telemedicine dispatcher, certified telemedicine assistants, telemedicine providers, and SLC staff.

Measurements

Between June and August 2011, telemedicine encounters were observed, and field notes were recorded. After each telemedicine visit, all participants were interviewed using a semistructured guide. Discrete statements from interviews and field notes were coded and arranged into themes. Concordance or discordance in field notes and stakeholder responses were grouped for analysis.

Results

After 10 telemedicine visits and 34 interviews from 21 unique participants, redundancy was achieved. Participants and their families overwhelmingly reported satisfaction with their care, remarking particularly on the convenience, speed, and completeness of the evaluation. Participants reported some unmet expectations regarding provider presence at home and visit length. Providers thought telemedicine made them more efficient overall and improved diagnostic certainty but considered in-person visits to be superior. All stakeholders, including patients, noted inadequate telemedicine technician training, leading to low confidence levels and performance difficulties. Participants, providers, and telemedicine technicians cited problems with the reliability, weight, and size of the equipment as serious challenges, decreasing their satisfaction and increasing their frustration.

Conclusion

Telemedicine-enhanced emergency care is an acceptable method of providing emergency care to older adults in SLCs. Stakeholders report a number of advantages. Training and technology barriers require particular attention.

Ancillary