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Telehealth use increased dramatically during the COVID-19 pandemic among older adults with chronic conditions, including chronic kidney disease (CKD). Understanding older patients’ and kidney clinicians’ perceptions of telehealth elucidate barriers that should be addressed to promote high-quality care and telehealth use. Many participants shared concerns about harms to the patient-clinician relationship, limited ability to comfort patients in virtual settings, and reduced patient trust.Ĭonclusions 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. 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.
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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.
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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. Thematic analysis was used to analyze data. Main Outcomes and Measures Participants described telehealth experiences, including factors contributing to and impeding engagement, satisfaction, and quality of care. Objective To identify patient, care partner, and nephrologists’ perceptions of the patient-centeredness, benefits, drawbacks of telehealth compared to in-person visits.ĭesign, 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. 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. Importance Telehealth has been posited as a cost-effective means for improving access to care for persons with chronic conditions, including kidney disease.