Source / information
Source:
King S. et al. Perhaps give me a call: An Intervention to Reduce Telemedicine No Show Rates in a Geriatric Primary Care Clinic. Presented at: American Geriatrics Society Annual Scientific Meeting; 13.-15. May 2021 (virtual meeting).
Disclosure:
King does not report any relevant financial information.
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New research suggests that one letter may be enough to reduce telemedicine no-shows among elderly patients, even during a pandemic.
Sarah King, MD, a fellow at a geriatric clinic affiliated with Boston Medical Center, told Healio Primary Care that “Despite the fact that patients did not have to physically come to the clinic, we still had a high percentage of telemedicine visits that we did not receive Had contact ”. our patients. “
Reference: King S, et al. Perhaps give me a call: An Intervention to Reduce Telemedicine No Show Rates in a Geriatric Primary Care Clinic.
King and his colleagues have set themselves the goal of reducing the number of telemedicine no-shows at their clinic by 25% in 3 months. They asked patients about obstacles to telemedicine and their “preferred method of visiting reminders”.
According to the researchers, some common issues emerged, including the fact that patients frequently missed reminders, did not call doctors at the exact appointment, and that patients preferred reminders. As a result, the clinic has introduced a new policy that sends patients a reminder 2 weeks before a scheduled telemedicine visit.
Sarah King
“The letter was a very simple reminder that said, ‘You have an upcoming telemedicine visit to your doctor,’ and the date and time that the provider would call, usually a 30-minute period,” King said in the interview .
According to the researchers, the clinic’s no-show rate for the 8 weeks prior to the intervention was 13.6%, compared to the personal no-show rate of 7.8%. Six weeks after the start of the intervention, the telemedicine no-show rate fell to 9.1% and the on-site no-show rate fell to 7.3%. Overall, the researchers said their intervention was associated with a 33.1% decrease in the telemedicine no-show rate and an 8% decrease in the in-person no-show rate.
“Most of the hospital staff agreed with this change and we were able to arrange the schedule so that all letters for the following week were printed and mailed to all patients on Friday afternoon. I think they reserved some time for this assignment, which made this a more accepted and sustainable change, ”King continued. She was not aware of any negative feedback from patients about the reminders.
“It is important to evaluate ways to improve access to telemedicine in the future as it is an important tool in reaching out to patients who may have difficulty getting to the clinic and may not come to the clinic as often have to, “said King.
Some of the telehealth services that CMS allowed during the pandemic have become permanent fixtures. However, a review published in February indicated that telemedicine does not necessarily “address the needs of older people with specific physical and cognitive disabilities,” and a JAMA study published in 2018 found that 38% of older adults in the United States were not ready to participate in telemedicine visits.
References:
DoraiswamyS. et al. Int J Environ Res Public Health. 2021; doi: 10.3390 / ijerph18041755.
K. Lam et al. JAMA Intern Med. 2020; doi: 10.1001 / jamainternmed.2020.2671.
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Andrea Wershof Schwartz, MD, MPH
Telemedicine provides an incredibly important resource for older adults, especially those with limited mobility or cognitive impairments for whom getting to the clinic could be challenging. Dr. King and colleagues is an important reminder that small procedures can improve continuity and access to care for patients in geriatric clinics.
At my own clinic, we’ve been able to significantly improve our no-show rate by offering telemedicine to older adults who find it difficult to leave the house or who depend on others when traveling. 19 pandemic to avoid exposure. Nationwide, Veterans Affairs has a program called Digital Divide that gives veterans who meet certain criteria a broadband-enabled tablet device to connect to for their telemedicine visits. Programs like this help overcome some of the social determinants of health that act as barriers to telemedicine engagement in older adults.
There is tremendous heterogeneity in telemedicine use among older adults, some of whom use technology as part of their work or as part of their daily life, and some of whom have greater difficulty using it. A recent study found that 13 million older adults – or 38% of all older adults in the United States – were unwilling to attend doctor’s visits in 2018, while another recent study found access and confidence to the barriers to more elderly people Adults include telemedicine.
What is so important about King and his colleagues’ study is that it was really an attempt to have the telemedicine experience in parallel with the personal clinical experience that patients are now expecting. The general idea of having a similar reminder structure to ensure that the person is available at the time of the appointment is very important, especially for an elderly person with cognitive impairment. These patients may need this additional reminder for the telemedicine appointment when no one shows up to pick them up to take them to an in-person appointment.
While telemedicine cannot yet achieve some things, when used properly it is a valuable tool to improve access to care for older adults. The study also shows that small patient-centered changes such as a structured reminder system can help better integrate telemedicine into standard care for older adults and improve access to health care.
References:
Hawley CH, et al. J Am Geriatr Soc. 2020; doi: 0.1111 / jgs.16845.
K. Lam et al. JAMA Intern Med. 2020; doi: 10.1001 / jamainternmed.2020.2671.
Andrea Wershof Schwartz, MD, MPH
Assistant Professor of Medicine, Harvard Medical School> br /> Medical Director, Geriatrics Consult Clinic at VA Boston Healthcare
System Director, Aging and End of Life, Harvard Medical School
Associate Fellowship Director, Harvard Multicampus Geriatrics Fellowship
Disclosure: Schwartz does not report any relevant financial information.
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