Telemedicine in the Care of Older People in Primary Care: A systematic mixed studies review

Marwa Ilali¹, Mélanie Leberre², Vladimir Khanassov¹, Isabelle Vedel¹ 

¹Department of Family Medicine, McGill University, Montreal, QC, Canada 
²Rehabilitation Science, Université de Montréal, QC, Canada 

Corresponding Author: Marwa Ilali,

email marwa.ilali@mail.mcgill.ca 

Background

The COVID-19 pandemic has created substantial changes in the methods used to deliver primary health care services. While there has been an important increase in the number of virtual or remote clinical services, most primary care doctors had not been provided with adequate training to adapt to this new reality. Although telemedicine, telehealth, virtual care, and eHealth have existed in Canada for decades, the current pandemic has increased the importance of implementing a complete virtual health strategy. Telemedicine has the potential to improve the quality of primary health care and to increase its accessibility to the general population. However, elderly patients may experience challenges to telemedicine use, such as hearing or visual impairment, cognitive impairment, and limited access to Internet, telephone or video devices.

Objectives

To address these challenges, we are conducting a systematic mixed methods review about synchronous telemedicine use among elderly populations living in community settings. The objectives are: 1) to identify the types of synchronous telemedicine used by older people in primary care (quantitative phase), and 2) to describe the various barriers and facilitators to the use of synchronous telemedicine in primary care from the perspective of older people and health care professionals (qualitative phase).

Methods

Our mixed-methods approach will integrate results from qualitative studies and quantitative studies. A sequential mixed methods exploratory design will be utilized. The research question consists of describing synchronous telemedicine use in the routine primary care practice of elderly patients. We will utilize key variable tabulation as a quantitative synthesis method and thematic synthesis to inform the qualitative phase. Using a narrative approach, we will compare results for each phase in a final interpretation stage to provide a comprehensive description of telemedicine. Two researchers will independently extract the following information from each study: characteristics of the study participants (e.g., sample size, diagnoses), type of telemedicine and its components (e.g., phone vs web camera based), description of the family medicine practice (e.g., solo vs team-based, healthcare professionals), and characteristics of the study and outcomes (e.g., frequency of emergency department visits, satisfaction with care, experience of the participants etc.).

Implications

Our results are expected to provide recommendations that will assist in finding methods and guidelines to improve the current use of telemedicine among elderly patients in routine primary care consultations.