Integration of telemedicine into primary care to support elderly caregivers and underserved communities

Population aging is poised to become one of the most significant social transformations of the twenty-first century, with ramifications for nearly every sector—including as well as family structure and intergenerational ties.¹ In 1991 the United Nations General Assembly adopted the Principles for Older Persons, affirming rights to independence, social participation, care, self-fulfillment and dignity. It also highlighted the precarious situation.² In Colombia's regions, demographic profiles have changed significantly. The population is distributed almost equally between urban and rural areas, with a predominance of older adults. This demographic shift challenges the health system to ensure adequate social and medical support. Chronic diseases in older adults frequently create dependence on family members, fundamentally altering the lives of both patients and caregivers and compromising caregivers’ quality of life, especially because of travel requirements for medical appointments and follow-up visits. Caregiving is more than a set of tasks; it is a complex activity laden with emotional implications.³

This study proposes a comprehensive telehealth model for primary care to impact acute respiratory infection rates among older adults and their caregivers in rural areas of Córdoba, Colombia. The model combines synchronous teleconsultation and remote monitoring. A cross-sectional descriptive study was conducted with 384 patients and caregivers, characterizing their knowledge, attitudes, and health care practices. The result was the creation of a person- and caregiver-centered care protocol to facilitate early health education, follow-up, and mitigate the emotional and logistical burden on caregivers. It was concluded that context-adapted primary telecare models that promote health and predict disease are needed to expand health outcomes and reduce caregiver physical and emotional strain in regions with difficult access to health services due to road access.

Telemedicine, which encompasses activities such as diagnosis, treatment, prevention and rehabilitation, has emerged as a viable and effective means of delivering medical care to remote locations. This modality not only reduces contagion risk by avoiding unnecessary travel but also broadens the reach of health services, benefiting populations previously excluded from care.⁴ Documented advantages include shorter care times, more timely diagnoses and treatments, improved service quality, reduced transportation costs, continuous follow-up, more appropriate therapies, lower occupational risks, opportunities for inter-consultation, wider coverage and timely preventive campaigns, among many other benefits.⁵ The guideline prioritizes person- and caregiver-centered care, facilitates early education, facilitates follow-up, and mitigates the emotional and logistical burden associated with in-person visits. The findings underscore the need for innovative and culturally tailored solutions that strengthen in-person services through preventive, promotive, and predictive primary telecare models, thereby expanding coverage and reducing caregiver fatigue in underserved regions. The care protocol for patients and caregivers is presented in Table 1.

Table 1.

Phased telemedicine workflow in primary care.

1. Before the teleconsultation (planning)During the teleconsultation	2. During the teleconsultation (assessment and empowerment)	3. After the teleconsultation (evaluation and feedback)
Patient caregiver actionsPatient preparation	Health and wellbeing assessment	Evaluation of the care provided
Appointment confirmation and reminders	History-taking and virtual physical exam (If applicable)	Patient satisfaction survey on the teleconsultation
Orientation to the platform and digital tools	Identification of risk factors and health needs Emotional and social status assessment	Analysis of care quality and goal fulfillment Communication of evaluation results to the health-care team
Collection of relevant information (medical history, medication lists, etc.

Health-professional actionsReview of patient information	Health-promotion and disease-prevention interventions for patient and caregivers Education on healthy lifestyles	Feedback to patients and caregivers
Preparation of materials and resources for the teleconsultation Verification of connectivity and digital tools	Information on infectious disease prevention, including COVID-19 (modes of transmission, protective measures, etc.)	Identification of improvement areas and protocol adjustments Follow-up and coordination with other health services, when required

Source: Prepared by the authors. Results of the care protocol.

Implementing information and communication technologies (ICTs) in the health system enables comprehensive, high-quality care for the entire population by facilitating diagnosis, treatment, rehabilitation and, crucially, health-promotion plans. One of telemedicine's chief advantages is its ability to overcome geographic barriers and bring medical attention to populations far from urban centers. Nevertheless, successful implementation depends on more than technology alone. Synergy between clinical protocols and technological platforms. Tele-home care allows patients to receive medical attention at home, engaging their caregivers⁶ and shifting the focus from the individual to the collective.

Ethical considerations

This study was approved for Comité de ética institucional Acta No. 005 de 2020. Informed consent was obtained from all subjects involved in the study.

Funding

This work has been funded by the University of Sinú-Elías Bechara Zainúm.

Conflict of interest

The authors declare no conflicts of interest.