Factors Related to Telemedical Care Receipt Among Older Adults with Medical Conditions: A Secondary Data Analysis across Race/Ethnicity

Background/  Purpose

By using telecommunication technology and digital information, telemedical care is a potential tool to support patients and clinicians through improving patients’ self-management and reducing healthcare costs, especially among people with serious or chronic medical conditions. As a growing population, older adults with medical conditions face mobility and transportation issues that often limit their access to healthcare, making telemedical care a useful and promising intervention. The purpose of this study is to investigate factors associated with receipt of telemedical care among older adults with medical conditions, especially looking at the role of English proficiency in predicting telemedical care receipt among different race/ethnicity groups.

Methods

This study uses cross-sectional data merged from the 2015 and the 2016 California Health Interview Survey Adult Data Files. Participants 65 years and older with more than one medical condition were selected as the analytic sample for this study (N=10,755). Socio-demographics (i.e.,age, gender, urban/rural residence, marital status, educational level), health care (i.e.,having primary healthcare providers and frequency of visiting healthcare providers), health conditions (i.e.,health status, medical conditions, and psychosocial distress), and English proficiency were included within the analyses. Bivariate analyses were conducted to examine the correlation between each variable and receipt of telemedical care. Four separate binary logistic regression analyses were conducted to investigate the factors associated with receipt of telemedical care across four race/ethnicity groups (including Non-Hispanic White, Hispanic, Non-Hispanic African American, and Non-Hispanic Asian).

Results

More than two thirds of participants were Non-Hispanic White (70.7%), while only 12.7% were Hispanic, 5.3% were Non-Hispanic African American, and 11.5% were Non-Hispanic Asian. The overall rate of receiving telemedical care among older adults with medical conditions remained low (12.0%). According to regression analyses, English proficiency was significantly associated (p<.05) with receiving telemedical care among Hispanics (OR=2.223), Non-Hispanic African Americans (OR=.092), and Non-Hispanic Asians (OR=2.577). Moreover, health status was related to telemedical care receipt among Non-Hispanic Whites (OR=.712), Non-Hispanic African Americans (OR=.510), and Non-Hispanic Asians (OR=.614). Having more than 3 medical conditions was significantly predictive of telemedical care receipt among Non-Hispanic Whites (OR=1.245), Hispanics (OR=1.766), and Non-Hispanic African Americans (OR=2.118). Additionally, gender was related to telemedical care receipt only among Hispanics (OR=.643), whereas urban/rural residence (OR=1.718) and having a usual healthcare place (OR=2.232) were predictive factors of telemedical care receipt only among Non-Hispanic White. Visiting healthcare providers 3-5 times was predictive among Non-Hispanic Asians (OR=1.642), while visiting healthcare providers was significant only among Non-Hispanic Whites (OR=1.641). Having 2 medical conditions was predictive for telemedical care receipt among Non-Hispanic White (OR=1.228) and Non-Hispanic Asian (OR=1.602).

Conclusion/ Implications

The results suggest that English proficiency, health status, and having more than 3 medical conditions were important factors for most race/ethnicity groups. As a new path of healthcare, the implementation of telemedical care should provide multiple language support for minority groups. Although this study highlighted the low telemedical receipt level and its associated factors among older adults with medical conditions, continued research is needed to investigate additional barriers and facilitators of telemedical care use among this particular population.