The Use of Telemedicine in Older-Adults During the COVID-19 Pandemic: a Weekly Cross-Sectional Analysis in Ontario, Canada

Older Adults' Experiences of Emergency Department Admission Decisions: A Qualitative Study in a Public Safety Net Hospital

BACKGROUND

Hospital admission is a significant event in the healthcare trajectory of older adults (age 60 +). Numerous harms such as delirium, falls, and adverse medication events can arise that outweigh the benefits of admission. Little is known about how older adults feel about being hospitalized or what they think admission will achieve for them. These issues are particularly important to understand in socioeconomically disadvantaged patients, who have poor access to outpatient care and higher hospitalization rates.

METHODS

We performed semi-structured interviews with emergency department (ED) patients aged 60 and older who were being admitted. The study site was a public hospital serving a socioeconomically disadvantaged, predominantly Hispanic and Black patient population. Interviews focused on experiences of the admission decision, expectations of hospitalization, and health outcome goals. We coded data using an inductive approach.

RESULTS

Twenty-seven older adults were interviewed about their experiences. Most participants belonged to minoritized racial or ethnic groups (70%, n = 19), and 41% (n = 11) spoke Spanish as their primary language. Approximately one-third were admitted for ambulatory care-sensitive conditions, i.e., conditions that can be managed in the outpatient setting to prevent hospitalization. Four themes emerged: (1) participants felt that clinicians made admission decisions for, rather than with, them; (2) participants sought to avoid admission due to family caregiving and work obligations; (3) participants with chronic conditions viewed their admission as resulting from poor access to care over the longer term; (4) participants expected hospitalization to improve their chronic symptom burden, mobility, and abilities to perform activities of daily living.

CONCLUSIONS

Older adults' expectations of hospitalization exceed stabilization of acute illness. Hospital admission of older adults presents an opportunity for shared decision-making and communication about likely outcomes of hospitalization. Incorporating patient-centered outcomes into admission decisions may help align care with older adults' priorities in the ED.

Multi-Stakeholder Validation of an Entrustable Professional Activities Framework for Canadian Geriatrics Residency Programs

Background

Entrustable Professional Activities (EPAs) have become a cornerstone for an increasing number of competency-based medical education programs. Today, frameworks of EPAs are being used in most, if not all, medical specialties. These frameworks can break a discipline down to its constituting tasks, and structure the training and evaluation of residents. In 2018, The Royal College of Physicians and Surgeons of Canada created an EPA framework for Geriatric Specialty residency programs nationwide. The present study aims to evaluate this EPA framework through focus groups consisting of several stakeholder groups.

Methods

Participants were recruited to be part of one of five focus groups-one for each stakeholder group of interest. The five focus groups consisted of: physician faculty, residents, allied health professionals, administrators/managers, and patients. Each focus group met once virtually over ZOOM® for no longer than 90 minutes. Meeting transcripts were iteratively coded based on emerging themes, and were compared for similarities and gaps between stakeholder perspectives.

Results

Multi-stakeholder consultation yielded feedback on many specific EPAs, suggestions for new EPAs, and additional input which gave rise to four themes: (i) EPA scope, (ii) Operationalization, (iii) Interprofessional Collaboration, and (iv) Patient Advocacy. Lastly, we received their thoughts on how the framework defines Geriatrics relative to the work of Care of the Elderly physicians in Canada.

Conclusions

Consulting a variety of stakeholder groups generates a robust and diverse supply of feedback that holistically augments EPA frameworks to be more practical, appropriate, socially accountable and patient-centred.

The Mediating Role of Digital Competence in the Associations Between the Factors Affecting Healthcare Utilization and Access to Care

Objectives: To examine with a population-based longitudinal survey design whether poor health, longstanding activity limitation, impaired cognitive functioning, mental distress, or loneliness predict poor access to healthcare and whether digital competence mediates these associations. Methods: The data were from the longitudinal FinHealth -survey gathered in Finland in 2017 and 2020 including 3,771 respondents (57.1% women). Linear regression analyses were used to examine the associations of factors affecting healthcare utilization with access to care adjusted for age, sex, and education. Counterfactual causal mediation framework was used to examine the mediating role of digital competence in the relationships among these factors and access to healthcare. Results: Factors affecting healthcare utilization were associated with poor access to care and these associations were partly mediated by low digital competence. Low digital competence mediated 12%, 9% and 8%, of the associations of impaired cognitive functioning, longstanding activity limitation, and loneliness with poor access to care, respectively. Conclusion: According to our results, one way to improve the access to healthcare among vulnerable groups could be to improve their digital competence.

Telemedicine for Individuals with epilepsy: Recommendations from International League Against Epilepsy Telemedicine Task Force

Worldwide, People with Epilepsy (PWE) are confronted with several barriers to face-to-face consultations. These obstacles hamper appropriate clinical follow-up and also increase the treatment gap for Epilepsy. Telemedicine holds the potential to enhance management as follow-up visits for PWE are focused on more on clinical history and counselling rather than physical examination. Besides consultation, telemedicine can also be used for remote EEG diagnostics and tele-neuropsychology assessments. In this article, the Telemedicine Task Force of the International League Against Epilepsy (ILAE) outlines recommendations regarding optimal practice in utilizing in the management of individuals with epilepsy. We formulated recommendations for minimum technical requirements, preparing for the first tele-consultation and the specificities for follow-up consultations. Special considerations are necessary for specific populations, including paediatric patients, patients who are not conversant with tele-medicine and those with intellectual disability. Telemedicine for individuals with epilepsy should be vigorously promoted with the aim of improving the quality of care and ultimately reduce the wide clinician access related treatment gap across several regions of the globe.