Needs for Successful Engagement in Telemedicine Among RuralOlder US Veterans and Their Caregivers:Qualitative Study

Background: Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgoessential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration(VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialtycare for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during theCOVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access asoverburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessaryfor those who would forgo telemedicine if in-person care were available. Objective: In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting toprepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagementin a telemedicine visit. Methods: We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate inat least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverseGRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA'svideoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challengesand, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews wererecorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzedinterview transcripts using rapid qualitative analysis. Results: From 30 participant interviews, we identified the following 4 categories of supports participants described regardingsuccessful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, videofrom home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction andon-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closedcaptioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting thevarying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because ofpandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health carevisits