Determinants of having online health consultations during the COVID-19 Pandemic among middle-aged and older adults in Germany: Representative longitudinal survey study

Abstract

Background: During the COVID-19 pandemic, telemedicine services represented a widely implemented alternative to in-person doctor and therapist appointments. Consequently, rates of telemedicine use rapidly increased worldwide, also in Germany. Research regarding longitudinal determinants of telemedicine use is needed, particularly from nationally representative German samples, to improve understanding of the use behavior of major target groups such as middle-aged and older adults. Objective: This study aimed to longitudinally investigate determinants of online health consultation use among middle-aged and older individuals during the COVID-19 pandemic in Germany. Methods: Nationally representative longitudinal data of German middle-aged and older adults (≥46 years old) were taken from the German Ageing Survey (DEAS). Data from the Compact Survey (conducted between June and July 2020) and wave 7 (conducted between November 2020 and March 2021) of the DEAS were observed (pooled analytic sample N=5456). Having experienced consultations with doctors or therapists on online platforms served as the outcome measure. Associations with socioeconomic, health- and health behavior–related, psychological, and COVID-19–related determinants were tested using random effects logistic regressions. Results: In our sample, 49% (2673/5456) of participants were female and the mean age of the participants was 67.8 (SD 9.4) years. Past experience with online health consultations was reported by 10.3% (561/5456) of the sample. Online health consultation use was associated with high education (OR 1.43, 95% CI 1.06‐1.93; P=.02), poor self-rated health (OR 0.60, 95% CI 0.49‐0.75; P<.001), and higher frequency of physical activity (reference: low frequency; medium frequency: OR 1.58, 95% CI 1.15‐2.17; P=.005; high frequency: OR 1.73, 95% CI 1.09‐2.76; P=.02). Moreover, greater levels of loneliness (OR 1.43, 95% CI 1.06‐1.93; P=.04) and life satisfaction (OR 1.33, 95% CI 1.02‐1.73; P=.04) as well as perceiving the COVID-19 crisis as a greater personal threat (OR 1.08, 95% CI 1.01‐1.15; P=.02) were associated with having online health consultations during the COVID-19 pandemic. Conclusions: Online health consultation use does not seem to be exclusively associated with the health of middle-aged and older patients. Study findings emphasize the longitudinal association of education and psychosocial factors as well as health factors with telemedicine use during the COVID-19 pandemic in Germany. This knowledge may help to improve and adapt services to this patient group, which could contribute to higher utilization rates in the future. Future studies are needed to verify these initial findings under postpandemic circumstances and across different countries.