OBJECTIVE Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits .
DESIGN We used an exploratory sequential mixed-methods design to conduct patient needs assessments, a home telehealth pilot, and formative evaluation of the pilot .
SETTING Veterans Affairs Geriatrics-Renal clinic .
PARTICIPANTS Patients with scheduled clinic visits from October 2019-April 2020 . MEASUREMENTS We conducted an in-person needs assessment and telephone post-visit interviews .
RESULTS Through 50 needs assessments, we identified patient-perceived barriers in interest, access to care, access to technology, and confidence . 34 (68 %) patients were interested in completing a home telehealth visit, but fewer (32 , 64 %) had access to the necessary technology or were confident (21 , 42 %) that they could participate . We categorized patients into four phenotypes based on their interest and capability to complete a home telehealth visit: Interested and Capable, Interested and Incapable, Uninterested and Capable, and Uninterested and Incapable . These phenotypes allowed us to create trainings to overcome patient-perceived barriers . We completed 32 home telehealth visits and 12 post-visit interviews . Our formative evaluation showed that our pilot was successful in addressing many patient-perceived barriers . All interviewees reported that the home telehealth visits improved their wellbeing . Home telehealth visits saved participants an average of 166 minutes of commute time . Five participants borrowed a device from a family member and 5 visits were finished via telephone . All participants successfully completed a home telehealth visit .
CONCLUSIONS We identified patient-perceived barriers to home telehealth visits and classified patients into four phenotypes based on these barriers . Using principles of implementation science, our home telehealth pilot addressed these barriers, and all patients successfully completed a visit . Future study is needed to understand methods to deploy larger-scale efforts to integrate home telehealth visits into the care of older adults. This article is protected by copyright . All rights reserved.