Teleconsultation for chronic disease management among community-dwelling older adults: A call for innovation

Abstract

Objectives

Telehealth services have been around for a while but utilization of teleconsultation among older adults remains low despite its extensive and known benefits. Behavioural intentions are multifactorial and nuanced, and qualitative evidence describing the acceptance of teleconsults for chronic disease management is scarce. Hence, this study explored the perspectives of older adults towards teleconsultation use in the primary care setting.

Methods

A descriptive multi-site qualitative study was conducted. Semi-structured interviews guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) model were held with twenty community-dwelling older adults ≥ 65 years on routine follow-up for three common chronic diseases in Singapore: hypertension, hypercholesterol, and type II diabetes mellitus. Data was analysed using the inductive thematic approach.

Results

Five themes were yielded: (i) more than just a physical consult; (ii) the difference in modes – does it really matter?; (iii) psychological receptivity to new technology; (iv) appropriateness of teleconsultation for medical condition; and (v) moderating factors. Participants were generally ambivalent towards teleconsultation as they could foresee its advantages but also its limitations which were thought to affect treatment. Many lacked knowledge of this remote modality which led to preconceptions of it being non-intuitive and difficult to adopt in the absence of facilitators that promote their viability.

Conclusions

Older adults’ acceptance of teleconsultation for chronic disease management seems conditional and non-optimistic at present. Physician advocacy, digital trainings, structured policies and age-appropriate teleconsult configurations with matured features that can mitigate the shortfalls of remote consultation will help enhance older adults’ acceptance of such services.

Public interest summary

While the potential and proven merits of telemedicine are plentiful, this remote modality remains foreign and intimidating to the majority of older adults. This study explored teleconsult acceptability for chronic disease management with the UTAUT framework. Findings revealed several pressing concerns which indicate the need for more digital initiatives and healthcare advocacy for its uptake in the community. Besides user-related programs, there is room for system improvements to include mature features that may offload the burden on users to learn the technology.