title: A qualitative evaluation of a telemedicine-enhanced emergency care program for older adults.
abstract: OBJECTIVE
  To document the experiences of patients, their caregivers, healthcare personnel, and staff members with a program that provides telemedicine-enhanced emergency care to older adults residing in senior living communities (SLCs) and to delineate perceived barriers and facilitators.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  A primary care geriatric medicine practice.
  
  
  METHODS
  Stakeholders associated with telemedicine visits: patients, family caregivers, telemedicine dispatcher, certified telemedicine assistants, telemedicine providers, and SLC staff.
  
  
  METHODS
  Between June and August 2011, telemedicine encounters were observed, and field notes were recorded. After each telemedicine visit, all participants were interviewed using a semistructured guide. Discrete statements from interviews and field notes were coded and arranged into themes. Concordance or discordance in field notes and stakeholder responses were grouped for analysis.
  
  
  RESULTS
  After 10 telemedicine visits and 34 interviews from 21 unique participants, redundancy was achieved. Participants and their families overwhelmingly reported satisfaction with their care, remarking particularly on the convenience, speed, and completeness of the evaluation. Participants reported some unmet expectations regarding provider presence at home and visit length. Providers thought telemedicine made them more efficient overall and improved diagnostic certainty but considered in-person visits to be superior. All stakeholders, including patients, noted inadequate telemedicine technician training, leading to low confidence levels and performance difficulties. Participants, providers, and telemedicine technicians cited problems with the reliability, weight, and size of the equipment as serious challenges, decreasing their satisfaction and increasing their frustration.
  
  
  CONCLUSIONS
  Telemedicine-enhanced emergency care is an acceptable method of providing emergency care to older adults in SLCs. Stakeholders report a number of advantages. Training and technology barriers require particular attention.
authors: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA. manish.shah@rochester.edu
authors: Manish N
authors: MN
authors: Shah
authors: Dylan
authors: D
authors: Morris
authors: Courtney M C
authors: CM
authors: Jones
authors: Suzanne M
authors: SM
authors: Gillespie
authors: Dallas L
authors: DL
authors: Nelson
authors: Kenneth M
authors: KM
authors: McConnochie
authors: Ann
authors: A
authors: Dozier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D017216:Telemedicine / Q000379:methods*; D014481:United States