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Ladin K, Porteny T, Perugini JM, et al. Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians. JAMA Netw Open. 2021;4(12):e2137193doi: 10.1001/jamanetworkopen.2021.37193.
Ladin, K., Porteny, T., Perugini, J. M., Gonzales, K. M., Aufort, K. E., Levine, S. K., Wong, J. B., Isakova, T., Rifkin, D., Gordon, E. J., Rossi, A., Koch-Weser, S., & Weiner, D. E. (2021). Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians. JAMA network open, 4(12), e2137193. https://doi.org/10.1001/jamanetworkopen.2021.37193
Ladin, Keren, et al. "Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians." JAMA network open vol. 4,12 (2021): e2137193. doi: https://doi.org/10.1001/jamanetworkopen.2021.37193
Ladin K, Porteny T, Perugini JM, Gonzales KM, Aufort KE, Levine SK, Wong JB, Isakova T, Rifkin D, Gordon EJ, Rossi A, Koch-Weser S, Weiner DE. Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians. JAMA Netw Open. 2021 Dec 01;4(12):e2137193. doi: 10.1001/jamanetworkopen.2021.37193. PMID: 34870680; PMCID: PMC8649833.
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JAMA Netw Open. 2021 Dec 01;4(12):e2137193. doi: 10.1001/jamanetworkopen.2021.37193.

Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians.

JAMA network open

Keren Ladin, Thalia Porteny, Julia M Perugini, Kristina M Gonzales, Kate E Aufort, Sarah K Levine, John B Wong, Tamara Isakova, Dena Rifkin, Elisa J Gordon, Ana Rossi, Susan Koch-Weser, Daniel E Weiner

Affiliations

  1. Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts.
  2. Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts.
  3. William B. Schwartz MD Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
  4. Department of Medicine, Tufts Medical Center, Boston, Massachusetts.
  5. Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
  6. Division of Nephrology, Veterans' Affairs Healthcare System, San Diego, California.
  7. University of California, San Diego.
  8. Department of Surgery-Division of Transplantation, and Center for Health Services and Outcomes Research, and Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
  9. Piedmont Transplant Institute, Atlanta, Georgia.
  10. Department of Public Health & Community Medicine, Tufts University School of Medicine, Massachusetts.

PMID: 34870680 PMCID: PMC8649833 DOI: 10.1001/jamanetworkopen.2021.37193

Abstract

IMPORTANCE: Telehealth has been posited as a cost-effective means for improving access to care for persons with chronic conditions, including kidney disease. Perceptions of telehealth among older patients with chronic illness, their care partners, and clinicians are largely unknown but are critical to successful telehealth use and expansion efforts.

OBJECTIVE: To identify patient, care partner, and nephrologists' perceptions of the patient-centeredness, benefits, drawbacks of telehealth compared to in-person visits.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used semistructured interviews conducted from August to December 2020 with purposively sampled patients (aged 70 years or older, chronic kidney disease stages 4 to 5), care partners, and clinicians in Boston, Massachusetts; Chicago, Illinois; Portland, Maine; and San Diego, California.

MAIN OUTCOMES AND MEASURES: Participants described telehealth experiences, including factors contributing to and impeding engagement, satisfaction, and quality of care. Thematic analysis was used to analyze data.

RESULTS: Of 60 interviews, 19 (32%) were with clinicians, 30 (50%) with patients, and 11 (18%) with care partners; 16 clinicians (84%) were nephrologists; 17 patient participants (43%) were non-Hispanic Black, and 38 (67%) were women. Four overarching themes characterized telehealth's benefits and drawbacks for patient-centered care among older, chronically ill adults: inconsistent quality of care, patient experience and engagement, loss of connection and mistrust (eg, challenges discussing bad news), and disparities with accessing telehealth. Although telehealth improved convenience and care partner engagement, participants expressed concerns about clinical effectiveness and limitations of virtual physical examinations and potentially widening disparities in access. Many participants shared concerns about harms to the patient-clinician relationship, limited ability to comfort patients in virtual settings, and reduced patient trust.

CONCLUSIONS AND RELEVANCE: Older patients, care partners, and kidney clinicians (ie, nephrologists and physician assistants) shared divergent views of patient-centered telehealth care, especially its clinical effectiveness, patient experience, access to care, and clinician-patient relationship. Understanding older patients' and kidney clinicians' perceptions of telehealth elucidate barriers that should be addressed to promote high-quality care and telehealth use.

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