Photo: Denver Health
The COVID-19 public health emergency prompted a rapid shift to telemedicine as both a replacement and an adjunct to usual in-person care. However, based on the National Institute on Aging's National Health and Aging Trends Study, researchers estimated roughly one-third of older adults in the U.S. are not ready to participate in video visits.
Inexperience with technology was the major barrier – those who were older, Black or Hispanic tended to have less education and lower income and were more likely not to be ready. These findings have since been supported in subsequent observational studies on telehealth adoption during the pandemic.
The Denver Housing Authority is a community-based organization that administers housing vouchers and oversees low-income housing units in the Denver metropolitan area. In early 2021, DHA and health system Denver Health established a partnership to help bridge the digital divide in healthcare.
"DHA selected five of its senior and disabled residential communities to participate in programming delivered by Denver Health," said Dr. Amy Lu, internal medicine physician at Denver Health’s Westside Family Health Center. "Some 70% to 80% of these DHA residents are established patients at Denver Health.
"The majority of these patients are racial/ethnic minority populations (72%), dually eligible for Medicare/Medicaid, with multi-morbidity and high healthcare needs and lower health and digital literacy," she added.
Low-income seniors from disadvantaged backgrounds are less likely to be ready for the transition to telehealth while also having less control of chronic medical conditions that require regular follow-ups and higher rates of reliance on transportation for appointments, Lu explained.
"The goal of our partnership is to increase digital health literacy so older adults are better equipped to interface and participate in the modern healthcare delivery system, which includes using online patient portals to schedule appointments and access health information, and choose to receive care via telehealth instead of traditional clinic-based care," she continued.
"First, we conducted a needs assessment with DHA residents in the five selected communities on their comfort, use and interest in digital tools and telehealth for their healthcare needs," she said. "We also asked the residents what kinds of programming they would like Denver Health to bring into their communities."
While the residents expressed some uncertainty in how telehealth would fit their needs, they were overwhelmingly interested in learning more about digital health tools and wanted Denver Health to conduct educational workshops on digital health and a variety of health topics.
"Based on this feedback, we codesigned two main components of our program: one, educational workshops, and two, on-site telehealth equipment to alleviate potential technology barriers," Lu reported.
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MEETING THE CHALLENGE
Denver Health is uniquely positioned to develop and implement such a community partnership, because the majority of the DHA residents are established patients at Denver Health. This alignment allows the health system not only to provide hands-on tech support during workshops, but also to provide essential care navigation for patients who may have difficulty accessing help through traditional means.
Since January 2023, Denver Health has offered monthly health and digital literacy workshops at three of the five selected DHA communities. These workshops are open to all DHA residents regardless of where they receive their healthcare.
Depending on the availability of instructors, Denver Health has offered health workshops on alternating months than the digital literacy workshops. The health workshops are taught by internal medicine residency trainees from the University of Colorado School of Medicine and have covered a variety of common health topics such as high blood pressure, diabetes, arthritis and preventive care.
"When applicable, we also have incorporated health screenings such as blood pressure checks during workshops," Lu noted. "Our digital health workshops are taught by Denver Health’s virtual care navigation team, which supports broader patient navigation and education through all our virtual care services at Denver Health.
"During the workshops at DHA they have provided hands-on training on using the patient portal to schedule appointments, review test results and order medication refills, as well as how to participate in video visits," she added.
So far, the health system has installed a one-touch videoconferencing kiosk at one of the DHA buildings for video visits. This equipment allows residents who don’t own a smartphone or have their own access to the internet to be able to participate in video visits.
Residents who have their own devices and access to the internet can schedule video visits through the same channels as all patients at Denver Health. The health system conducted a pilot session in which eight DHA residents successfully completed video visits using the on-site kiosk.
"We have plans to install these kiosks at two additional buildings and to promote the availability of this option to all three buildings," Lu said.
So far, Denver Health has conducted a pilot session of a video visit using on-site equipment installed in one DHA building.
"We have held monthly workshops at three DHA communities with relatively good attendance – five to 15 participants per session," Lu reported. "Overall, we have increased online patient portal activation to 63% from 58% across the five DHA communities."
ADVICE FOR OTHERS
"Community partnerships are first and foremost relational," Lu advised. "It takes time and active engagement to establish trust and buy-in for change. Yet the gains from successful health system and community partnerships can be long-lasting and beneficial to both parties.
"In our case, equipping individuals with baseline health and digital literacy allows for greater engagement and ownership in their health and health information, which may lead to better health outcomes," she continued. "Building out digital tools and virtual care also will help Denver Health operate more efficiently and allow us to reallocate resources to close health equity gaps."