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

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 video conference 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 video conference assessments.

Automated summary

This study revealed that older adults who are frail or lack caregiver support may face inequitable access to videoconference-based virtual care during the COVID-19 pandemic. Future research should focus on interventions to support this population in participating in video conference assessments.