Elderly acceptance of telemedicine use in Hong Kong during and after the COVID-19 pandemic: a cross-sectional cohort survey

  1. Maxwell Chun Yin Choi
  2. Shing Him Chu
  3. Lok Lam Siu
  4. Anakin Gajy Tse
  5. Justin Che Yuen Wu
  6. Hong Fung
  7. Billy Chi Fai Chiu
  8. Vincent Chung Tong Mok

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Abstract

Background

Telemedicine services worldwide have experienced an unprecedented boom since the beginning of the COVID-19 pandemic. Multiple studies have noted telemedicine as an effective alternative to traditional face-to-face management of patients. This study provides insight into public perception and impression of telemedicine in Hong Kong, specifically among the elderly who are the most vulnerable to COVID-19.

Methods

Face-to-face surveys were conducted on elderly relatives of current medical students at the Chinese University of Hong Kong who were aged ≥ 60 years. The survey included socio-demographic details; past medical history; and concerns towards telemedicine use. Univariate and multivariable regression analyses were conducted to examine statistically significant associations. The primary outcomes are consideration of telemedicine use during: (1) a severe outbreak; and (2) after the COVID-19 pandemic.

Results

109 surveys were conducted. Multivariable regression analyses revealed that expectation of government subsidies for telemedicine services was the strongest common driver, and also the only positive independent predictors of telemedicine use for both during a severe outbreak, as well as after the COVID-19 pandemic. No negative independent predictors of telemedicine use during severe outbreak were found. Negative independent predictors of telemedicine use after the COVID-19 pandemic included old age, and living in the New Territories.

Conclusions

Government support such as telemedicine-specific subsidies will be crucial in promoting telemedicine use in Hong Kong both during a severe outbreak and after the current COVID-19 pandemic. Robust dissemination of information regarding the pros and cons of telemedicine towards the public, especially towards the elderly population, is warranted.

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    SciScore for 10.1101/2021.07.15.21260346: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: The surveys were to be completed and submitted online; consent was obtained from the participants before the start of each survey, which would be administered by a trained medical student helper.
    Sex as a biological variablenot detected.
    RandomizationUnder this consideration, we deemed random visits of elderly face-to-face to have a high risk of infection.[11] Therefore, our study opted to interview the close relatives of our medical students who live within the same household as a safer and more effective way for medical students and participants to reduce the risk of infection.[11] A total of 59 medical student helpers (Supplementary Data 2) were recruited in September 2020.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: Data analysis was carried out using IBM Statistical Package for Social Sciences (SPSS) Version 26.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This may be explained by the fear of COVID-19 infection within the Hong Kong population, prompting citizens to avoid public transport and practice social distancing.[15] Having previously experienced the SARS epidemic of March 2003, many Hong Kong citizens are still fearful of unknown infectious diseases.[16] Given that telemedicine carries no risk of infection compared to traditional face-to-face consultations,[17] it certainly has value under an epidemic or pandemic scenario; however, it has been shown in literature that telemedicine would underperform in hands-on procedures, such as physical examination or postoperative care.[18] Nonetheless, with rapid technological advancements, these limitations may soon be overcome. Hence, it is therefore reasonable to infer that the nature and benefits of telemedicine potentially outweigh its limitations under a severe outbreak scenario, including an epidemic or even pandemic. For both “severe outbreak” and “after pandemic” scenarios, expectation of government subsidies for telemedicine services was the strongest common driver of telemedicine use. It was also the only statistically significant positive independent predictors of considering telemedicine use for after the COVID-19 pandemic ends. For example, the Elderly Health Care Voucher Scheme was launched in Hong Kong in 2009, aiming to provide financial incentives to elderly when seeking medical services in the private sector so as to alleviate stress placed on the public healthcar...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.07.15.21260346v1 on medRxiv