Telehealth satisfaction varies among older patients with advanced chronic kidney disease (CKD), their care partners, and nephrologists, according to a new qualitative study published in JAMA Network Open.
As part of the Decision Aid for Renal Therapy (DART) Trial (ClinicalTrials.gov NCT03522740), investigators conducted 60 semistructured interviews about telehealth visits conducted over the phone or computer during the pandemic. Of the 60 interviews, 16 involved nephrologists, 3 other clinicians, 30 patients aged 70 years or older with stage 4-5 CKD, and 11 care partners. Patients resided in Boston, Massachusetts, Chicago, Illinois, Portland, Maine, or San Diego, California.
Keren Ladin, PhD, MSc, of Tufts University in Medford, Massachusetts, and colleagues identified 4 themes about telehealth use:
Quality of Care
Most clinicians said telehealth compromised patient care because laboratory tests and physical exams such as accurate blood pressure and volume status exams could not be performed. Home diagnostics were often problematic. On the positive side, video visits allowed a glimpse into patients’ home environment and view of medication bottles.
The convenience of telehealth allowed more care partners to participate in their loved ones’ care. However, it was easier for telehealth visits to be double booked or skipped compared with in-person visits. Distractability was also high. Some telehealth visits lacked privacy.
Some patients claimed that remote visits were missing the visual and tactile cues, such as body language, of in-person visits. Remote visits appeared more sterile and lacked human banter. Older adults and minority patients (17 patients were non-Hispanic Black) tended to express mistrust that health providers understood their concerns. Clinicians said it was difficult to break bad news remotely. They suggested sharing detailed electronic medical record summaries with patients and care partners and having advance practice providers follow up after difficult conversations.
Some patients expressed the opposite opinion, suggesting that telehealth resulted in better listening and more focused attention.
Lack of devices and/or internet access, internet outages, problems with technology, and low volume were common obstacles to telehealth use. Older patients, patients of low socioeconomic status, and those with limited health literacy, hearing impairment, or non-English speaking reported worse telehealth experiences.
“The findings of this study suggest a spectrum of telehealth satisfaction among older patients with CKD and care partners and found nephrologists tended to be less satisfied with telehealth,” Dr Ladin’s team wrote. “Training clinicians in virtual physical examinations, interspersing in-person visits, and interventions to mitigate disparities is needed.”
In an accompanying editorial, Devika Nair, MD, MSc, of Vanderbilt University Medical Center in Nashville, Tennessee, added:
“Actualizing person-centered care for the rapidly aging population with kidney disease will require health systems to transform and expand on existing remote models of care delivery to acknowledge the unique symptom- and service-related needs of older adults.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
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. Published online December 6, 2021. JAMA Netw Open. doi:10.1001/jamanetworkopen.2021.37193
Nair D. Communication and remote care delivery for an aging population with kidney disease. Published online December 6, 2021. JAMA Netw Open. doi:10.1001/jamanetworkopen.2021.38694