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

Abstract

This qualitative study identifies patient, care partner, and clinicians’ perceptions of the patient-centeredness, benefits, and drawbacks of telehealth compared with in-person visits.

Key Points

Question

How are telehealth encounters perceived by older adults with chronic kidney disease, their care partners, and their clinicians?

Findings

In this qualitative study, involving 60 interviews conducted during 2020, lower satisfaction was associated with telehealth among older patients with lower socioeconomic status and among patients identifying as Black, Hispanic, and Native American. Drawbacks to telehealth included care quality concerns because of limited physical examination and laboratory tests and loss of social connection, while benefits included convenience, greater care partner engagement, and clinicians’ understanding of patients’ home environment.

Meaning

These findings suggest that while telehealth reduces barriers to care for some older adults, greater resources are needed to support many older adults with chronic illness, including limited English proficiency, hearing loss, and those with limited access to internet and technology.

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.