Whose voice counts? Family caregivers' roles in shared decision making for chronic illness in urban South Korea: A qualitative study.

Medications are one of the primary interventions in the treatment and prevention of disease. Older adults with chronic diseases face the difficulty of managing medication regimens and polypharmacy, as well as the challenges of mobility and transportation to get to care [,]. Lack of access to health care is a system-level issue affecting health care organizations, including the Veterans Affairs (VA), the largest integrated health care system in the United States. There are paths to ameliorating medication-related health care challenges for older patients. The first is using clinical pharmacy practitioners (CPPs) to deliver patient-centered comprehensive medication reconciliation in which all a patient’s medications—prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements—are assessed to establish whether the medications are safe, effective, and can be taken as intended. The second is geriatric telemedicine, which seeks to address access issues []. However, there remains an important gap in our understanding, as older adults are rarely included in studies on telemedicine [], even though telemedicine eliminates the need for transportation, thereby reducing logistical barriers, allowing for more effective medication management, and potentially improving adherence to medication regimens []. A home video appointment format for medication management allows individuals to show the label on a bottle and how medications are stored directly to the provider. This allows the provider to make a more accurate assessment of the impacts of prescribed medications and appropriate storage []. Additionally, conducting appointments in the home environment gives patients an opportunity to engage with the provider in a more comfortable environment, affording the provider a multidimensional picture of their cognitive and emotional state, something not as easily attained in a clinical setting []. However, certain barriers may limit the widespread adoption and success of CPP-delivered telemedicine among older adults. Access to the necessary technology, such as smartphones, tablets, or stable internet connections, may be constrained due to financial, geographic, or infrastructural limitations []. Furthermore, older adults may hold varying levels of technological literacy, influenced by generational differences in familiarity with digital tools []. Beliefs about age and capability may also affect confidence and willingness to engage with technology []. When technological issues arise, such as connectivity problems or user interface difficulties, older adults may experience discomfort or frustration, particularly if they lack the skills or resources to troubleshoot effectively []. Distractions may exist in the home that do not exist in the office and may hamper the effectiveness or acceptability of telemedicine appointments.