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The ageing population is rapidly growing across OECD countries. By 2050, the share of the population aged 65 and over is projected to rise from 17.4% in 2017 to a staggering 27.1%. This unprecedented demographic shift is placing immense pressure on the finance and capacity of public healthcare systems. Governments across the OECD are grappling with the challenge of ensuring that older adults have access to high-quality medical services. The most imminent need is to provide innovative solutions that can cater to the growing healthcare needs of older adults.
Telemedicine emerged as a powerful tool to alleviate the pressure on overstretched healthcare systems during the COVID-19 pandemic. This innovative technology has the potential to transform patient outcomes and improve access to healthcare services. A comprehensive research study conducted by RAND has shed light on the transformative impact of telemedicine in Canada by illustrating how telemedicine, particularly in managing chronic conditions, can deliver equal, even superior healthcare outcomes for patients. Moreover, telemedicine has proven to be a significant economic boon for the Canadian economy, potentially generating as much as CAD 5bn annually.
For example, telehomecare, or home health monitoring, is a form of telemedicine that is changing the lives of older adults managing chronic conditions such as cardiomyopathy and chronic obstructive pulmonary disease (COPD). Telehomecare focuses on empowering patients to learn how to manage chronic conditions to help prevent complications that can often result in emergency room admissions. According to an OECD Health Working Paper “Bringing Health care to the patient”, in Canada telehomecare has reduced hospital admissions by 60% to 80%. As expressed by a seventy-seven-year-old Ontario patient: “Telehomecare has definitely improved my quality of life. I feel like my nurse is there with me every day,” she says. “I have personally learned a lot in the process, like understanding the impact that managing my diet, exercising and thinking positively can have on my health.”
Also on the Forum Network: Mind the Gaps and Overlaps: Integrating care services for older people by Ana Llena-Nozal, Eileen Rocard & Sillitti Paola
Demand for long-term care is on the rise, and as more people live longer complex health and care needs are becoming much more common. Policy changes in governance, funding and the workforce can help address current shortcomings and improve the quality of life for older people.
By enabling patients in remote or underserved areas to receive medical attention without travelling, telemedicine also reduces wait times and transportation costs, potentially mitigating greenhouse gas emissions. With these remarkable advantages, telemedicine is poised to play a pivotal role in reducing the burden on healthcare systems and delivering improved patient and environmental outcomes in the future.
With 46 residents in five Ontario long-term care homes, digital technology was used to help reduce ‘confinement syndrome’ for long-term care residents by connecting them to family, friends, and other residents. Seniors reported reduced feelings of boredom and isolation, with an improved sense of connectedness and health.
For example, empowering seniors with intuitive and engaging digital tools can help to reduce the risk of social isolation. In 2021 TELUS and the Ministry of Health of Ontario supported a study on Digital Connectivity in Long Term Care Homes in Central Ontario. With 46 residents in five Ontario long-term care homes, digital technology was used to help reduce ‘confinement syndrome’ for long-term care residents by connecting them to family, friends, and other residents. Seniors reported reduced feelings of boredom and isolation, with an improved sense of connectedness and health.
As the COVID-19 pandemic recedes, the promise of telemedicine has lost some momentum, and obstacles to its implementation remain. To overcome these barriers, we must carefully consider the difficulties encountered by both older patients and healthcare professionals and tailor telemedicine to better meet their needs.
Understanding Patient and Healthcare Professionals’ Perspectives
According to a recent pan-Canadian survey called OurCare, most patients (92%) consider it important for their healthcare team to truly know and advocate for them, while 88% value a provider who stands up for their needs. In Canada, 97% of patients believe that primary care should be a fundamental right. Unfortunately, telemedicine is often perceived as lacking these essential qualities. While patients have given positive ratings to telemedicine outcomes during the Covid pandemic, they still prefer in-person care - perceived as more human-centric. While some healthcare professionals embrace telemedicine, others are sceptical, citing concerns such as losing the personal touch, overlooking critical issues, and disrupting existing practices.
Empowering patients and healthcare professionals to recognise the value of telemedicine requires an investment in education and training. Highlighting benefits, including its ability to deliver human-centric care, better education and training can build confidence and reduce negative perceptions.
To genuinely empower older adults, telemedicine providers must focus on three core aspects: personalised care, accessibility, and patient advocacy. Firstly, personalised care necessitates a tailored approach where the unique needs and circumstances of each older patient are addressed, matching the attentiveness and individualised care that one would expect from an in-person consultation. Secondly, the importance of accessibility can't be overstated - telemedicine services must be easily usable and available, with technology interfaces designed to be intuitive and supportive for older adults who may not be digital natives. Thirdly, patient advocacy in telemedicine means ensuring that patients' rights and interests are protected, that they are well informed about their health status and treatment options, and that their voices are heard and valued in the care process.
Another crucial area for enhancement lies in the integration of telemedicine into existing healthcare systems. By achieving this, we can provide a seamless and positive healthcare experience for older patients, eliminating any disjointed transitions between different care modalities.
By investing in universal access to high-speed internet, policymakers can ensure that everyone, regardless of where they live can access the increased life expectancy, reduced morbidity, and greater well-being associated with telemedicine.
By implementing these strategies, we can lay the foundation for a more efficient and effective healthcare system that fully harnesses the potential of telemedicine, thereby improving the overall health outcomes for our older population.
Connectivity for All: Access and Digital Skills
The lack of reliable internet access remains an obstacle to the widespread adoption of telemedicine, particularly among older adults in remote or rural areas. In part and as a result of the pandemic, many OECD governments have increased public subsidies to support private-sector investment. In Canada, the Universal Broadband Fund (UBF) is an initiative aimed at bridging the digital divide. The UBF aims to invest CAD 3.2bn to provide high-speed broadband access to 98% of Canadians by 2026. By investing in universal access to high-speed internet, policymakers can ensure that everyone, regardless of where they live can access the increased life expectancy, reduced morbidity, and greater well-being associated with telemedicine.
The Path Forward: A Collaborative Effort
As OECD nations take on the exciting challenge of integrating telemedicine, a balanced orchestration of diverse interests from a myriad of stakeholders - older patients, care providers, healthcare professionals, and policymakers - is absolutely essential. Providers must rise to the occasion, putting personalised care at the forefront, designing technology that is intuitively user-friendly, and championing robust patient advocacy. The seamless fusion of telemedicine into our existing healthcare infrastructures is a pivotal step, along with robust investment in universal high-speed internet and digital literacy programs, especially for our older citizens in remote areas. The key to unlocking the transformative potential of telemedicine lies in the close-knit collaboration among all stakeholders, working in unison to optimise telemedicine's benefits and elevate healthcare outcomes for our older adults. This is not just a mere possibility, but an attainable reality we should strive towards in our collective healthcare journey.
To learn more, read the OECD report: The COVID-19 Pandemic and the Future of Telemedicine
The use of telemedicine was quite limited in most OECD countries before the COVID-19 pandemic, held back by regulatory barriers and hesitancy from patients and providers. In early 2020, as COVID-19 massively disrupted in-person care, governments moved quickly to promote the use of telemedicine. The number of teleconsultations skyrocketed, playing a vital role in maintaining access to care, but only partly offsetting reductions in in-person care. This report provides an overview of the use of telemedicine in OECD countries, describing how governments scaled up remote care during the pandemic and exploring the impact that this massive shift to remote care has had on health care system performance. Telemedicine may be here to stay, but questions remain concerning how to regulate its use, how to pay for it, how to integrate it with in-person care, and how to make sure that it constitutes good value for money for all. This report puts forth priorities for policy makers to inform the discussion and to promote the best use of remote care services in the future.