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Walji S, O'Brien P, Loi A, Rozmovits L, Bhattacharyya O. Implementing virtual primary care: experiences, perspectives and identification of improvement opportunities in an academic primary care setting. BMJ Open Qual 2024; 13:e002898. [PMID: 39117395 DOI: 10.1136/bmjoq-2024-002898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND One of the biggest changes to primary care triggered by the COVID-19 pandemic was the rapid integration of virtual care (VC). VC offers benefits to patients and providers but implementation presents challenges. METHODS This study is a secondary analysis of a 2021 quality improvement (QI) driven environmental scan comprising a survey and 1:1 interviews, at the Department of Family and Community Medicine at the University of Toronto. The scan aimed to understand the current and desired future use of VC at the 14 sites. RESULTS The survey was completed by all sites between July and October 2021 and 1:1 interviews were conducted between October and November 2021 with 12 of the 14 site/QI leads. VC was seen as convenient and flexible, and as enabling continuity of care for patients who could not easily attend in-person. Factors enabling implementation of VC included leadership at both the system and local level; a shared understanding of VC on the part of providers, patients and clinical staff; and technological and administrative readiness. Challenges included the need for triage algorithms; incongruent expectations of VC by patients and providers; technology issues; increased administrative burden; and impacts on medical education. All anticipated that some degree of VC would continue in future. CONCLUSIONS VC offered benefits but it also impacted clinical routines and administrative processes creating new forms of work for clinicians and staff. Patient education is needed to ensure that their expectations of VC align with those of providers. Research and QI efforts are required to optimise the use of VC in primary care.
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Affiliation(s)
- Sakina Walji
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia O'Brien
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Loi
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rozmovits
- Independent Qualitative Researcher, Toronto, Ontario, Canada
| | - Onil Bhattacharyya
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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Moschogianis S, Darley S, Coulson T, Peek N, Cheraghi-Sohi S, Brown BC. Patient experiences of an online consultation system: a qualitative study in English primary care post-COVID-19. Br J Gen Pract 2024; 74:e489-e497. [PMID: 38164550 PMCID: PMC10966478 DOI: 10.3399/bjgp.2023.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Online consultation systems (OCSs) allow patients to contact their healthcare teams online. Since 2020 they have been rapidly rolled out in primary care following policy initiatives and the COVID-19 pandemic. In-depth research of patients' experiences using OCSs is lacking. AIM Explore patients' experiences of using an OCS. DESIGN AND SETTING Qualitative study in English GP practices using the Patchs OCS (www.Patchs.ai) from March 2020 to July 2022. METHOD Thematic analysis of 25 patient interviews and 21 467 written comments from 11 851 patients who used the OCS from nine and 240 GP practices, respectively. RESULTS Patients cited benefits of using the OCS as speed, flexibility, and efficiency. Nevertheless, some patients desired a return to traditional consultation methods. GP practices often did not clearly advertise the OCS or use it as patients expected, which caused frustration. Patients reported advantages of having a written record of consultations and the opportunity to communicate detailed queries in free text. Views differed on how the OCS influenced clinical safety and discussions of sensitive topics. Patients who struggled to communicate in traditional consultations often preferred using the OCS, and male patients reported being more likely to use it. CONCLUSION Globally, this is the largest in-depth study of patient experiences of an OCS. It contributes new knowledge that the patient experience of using OCSs can be influenced by previously unreported patient characteristics and the conditions they consult about. Further, it contributes recommendations on the design and implementation of the OCS in practice.
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Affiliation(s)
- Susan Moschogianis
- School of Health Sciences, Health Services Research and Primary Care, University of Manchester, Manchester
| | - Sarah Darley
- School of Health Sciences, Health Services Research and Primary Care, University of Manchester, Manchester
| | | | - Niels Peek
- Imaging and Data Science, University of Manchester, Manchester Academic Health Science Centre, Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Sudeh Cheraghi-Sohi
- School of Health Sciences, Health Services Research and Primary Care, University of Manchester, Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Benjamin C Brown
- School of Health Sciences, Health Services Research and Primary Care, University of Manchester, Manchester; and chief medical officer, Patchs Health, London
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3
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Pasat Z, Sinn CLJ, Rahman B, Gayowsky A, Lokker C, Tarride JE, Alarakhia M, Costa AP. The relationship between patient experience and real-world digital health access in primary care: A population-based cross-sectional study. PLoS One 2024; 19:e0299005. [PMID: 38713719 PMCID: PMC11075820 DOI: 10.1371/journal.pone.0299005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/04/2024] [Indexed: 05/09/2024] Open
Abstract
Implementing digital health technologies in primary care is anticipated to improve patient experience. We examined the relationships between patient experience and digital health access in primary care settings in Ontario, Canada. We conducted a retrospective cross-sectional study using patient responses to the Health Care Experience Survey linked to health and administrative data between April 2019-February 2020. We measured patient experience by summarizing HCES questions. We used multivariable logistic regression stratified by the number of primary care visits to investigate associations between patient experience with digital health access and moderating variables. Our cohort included 2,692 Ontario adults, of which 63.0% accessed telehealth, 2.6% viewed medical records online, and 3.6% booked appointments online. Although patients reported overwhelmingly positive experiences, we found no consistent relationship with digital health access. Online appointment booking access was associated with lower odds of poor experience for patients with three or more primary care visits in the past 12 months (adjusted odds ratio 0.16, 95% CI 0.02-0.56). Younger age, tight financial circumstances, English as a second language, and knowing their primary care provider for fewer years had greater odds of poor patient experience. In 2019/2020, we found limited uptake of digital health in primary care and no clear association between real-world digital health adoption and patient experience in Ontario. Our findings provide an essential context for ensuing rapid shifts in digital health adoption during the COVID-19 pandemic, serving as a baseline to reexamine subsequent improvements in patient experience.
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Affiliation(s)
- Zain Pasat
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada
| | - Chi-Ling Joanna Sinn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada
| | - Bahram Rahman
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anastasia Gayowsky
- ICES McMaster, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Mohamed Alarakhia
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, Ontario, Canada
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada
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4
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Halas G, Baldwin A, LaBine L, MacKay K, Singer A, Katz A. A Phenomenological Inquiry of the Shift to Virtual Care Delivery: Insights from Front-Line Primary Care Providers. Healthcare (Basel) 2024; 12:861. [PMID: 38667623 PMCID: PMC11050693 DOI: 10.3390/healthcare12080861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The rapid deployment of virtual primary care visits served as a first-line response to COVID-19 and can now be examined for insights, particularly as virtual care is playing an ongoing role in patient care and consultations. Input from primary care providers directly responsible for virtual care delivery is needed to inform policies and strategies for quality care and interactions. The overarching goal of this research study was to examine the use of virtual care as a mechanism for primary healthcare delivery. A phenomenological approach investigated the shift in primary care service delivery as experienced by primary care providers and initiated during the COVID-19 pandemic. Focus groups were conducted with primary care providers (n = 21) recruited through email, advertisements, and professional organizations, exploring how virtual care was delivered, the benefits and challenges, workflow considerations, and recommendations for future use. Integrating virtual care was performed with a great deal of autonomy as well as responsibility, and overwhelmingly depended on the telephone. Technology, communication, and workflow flexibility are three key operational aspects of virtual care and its delivery. Providers highlighted cross-cutting themes related to the dynamics of virtual care including balancing risk for quality care, physician work/life balance, efficiency, and patient benefits. Primary care providers felt that virtual care options allowed increased flexibility to attend to the needs of patients and manage their practice workload, and a few scenarios were shared for when virtual care might be best suited. However, they also recognized the need to balance in-person and virtual visits, which may require guidelines that support navigating various levels of care. Overall, virtual care was considered a good addition to the whole 'care package' but continued development and refinement is an expectation for optimizing and sustaining future use.
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Affiliation(s)
- Gayle Halas
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Alanna Baldwin
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Lisa LaBine
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Kerri MacKay
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Community Partner, Winnipeg, MB R3E 0W3, Canada
| | - Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Alan Katz
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
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5
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Arsenault M, Long S, D'Souza V, Ilie A, Todd KJ. Telemedicine visits requiring follow-up in-person visits at an urban academic family medicine centre. Fam Pract 2024; 41:105-113. [PMID: 38382045 DOI: 10.1093/fampra/cmae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic setting, we analysed telemedicine visits carried out during the pandemic. METHODS We conducted a retrospective chart review of telemedicine visits from 2 clinical units within a family medicine centre. To investigate the association between incomplete visits and various factors (age, gender, presenting complaints, physician level of training [resident or staff] and patient-physician relational continuity), we performed a multivariable logistic regression on data from August 2020, February 2021, and May 2021. An incomplete visit is one that requires a follow-up in-person visit with a physician within 3 days. RESULTS Of the 2,138 telemedicine patient visits we investigated, 9.6% were incomplete. Patients presenting with lumps and bumps (OR: 3.84, 95% CI: 1.44, 10.5), as well as those seen by resident physicians (OR: 1.77, 95% CI: 1.22, 2.56) had increased odds of incomplete visits. Telemedicine visits at the family medicine clinic (Site A) with registered patients had lower odds of incomplete visits (OR: 0.24, 95% CI: 0.15, 0.39) than those at the community clinic (Site B), which provides urgent/episodic care with no associated relational continuity between patients and physicians. CONCLUSION In our urban clinical setting, only a small minority of telemedicine visits required an in-person follow-up visit. This information may be useful in guiding approaches to triaging patients to telemedicine or standard in-person care.
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Affiliation(s)
- Mylène Arsenault
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Stephanie Long
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Vinita D'Souza
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
| | - Alexandru Ilie
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Keith J Todd
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
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Leighton C, Cooper A, Porter A, Edwards A, Joseph-Williams N. Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0177. [PMID: 37783479 PMCID: PMC11169987 DOI: 10.3399/bjgpo.2023.0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There is a focus on increasing asynchronous telemedicine use, which allows medical data to be transmitted, stored, and interpreted later; however, limited evidence of the quality of care it allows in general practice hinders its use. AIM To investigate uses and effectiveness of asynchronous telemedicine in general practice, according to the domains of healthcare quality, and describe how the COVID-19 pandemic changed its use. DESIGN & SETTING Systematic review in general practice. METHOD A systematic search was carried out across four databases using terms related to general practice, asynchronous telemedicine, uses, and effectiveness, and supported by citation searching. This was followed by screening according to pre-defined criteria, data extraction, and critical appraisal. Narrative synthesis was then undertaken guided by the six domains of healthcare quality and exploring differences in use before and following the COVID-19 pandemic. RESULTS Searches yielded 6864 reports; 27 reports from 23 studies were included. Asynchronous telemedicine is used by a range of staff and patients across many countries. Safety and equity are poorly reported but there were no major safety concerns. Evidence from other domains of healthcare quality show effectiveness in making diagnoses, prescribing medications, replacing other consultations, providing timely care, and increased convenience for patients. Efficiency is impacted by negative effects on workflow, through poor implementation and patient non-adherence, limiting usability and requiring new administrative approaches from healthcare staff. Asynchronous telemedicine use increased rapidly from March 2020, following the COVID-19 pandemic outbreak. CONCLUSION Asynchronous telemedicine provides quality care for patients but is limited by reports of increased workload and inefficient workflow compared with face-to-face consultations. Limits of evidence include heterogeneity and small-scale studies. Further research into cost-effectiveness, equity, safety, and sustained implementation will influence future policy and practice.
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Affiliation(s)
| | - Alison Cooper
- Division of Population Medicine Cardiff University, Cardiff, UK
| | | | - Adrian Edwards
- Division of Population Medicine Cardiff University, Cardiff, UK
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7
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Poitras ME, Couturier Y, Beaupré P, Girard A, Aubry F, Vaillancourt VT, Carrier JD, Fortin L, Racine J, Morneau J, Boudreault A, Cormier C, Morin A, McGraw M. Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review. J Interprof Care 2024; 38:331-345. [PMID: 37226329 DOI: 10.1080/13561820.2023.2213712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/06/2023] [Indexed: 05/26/2023]
Abstract
In the context of the COVID-19 pandemic, many healthcare and social services professionals have had to provide services through virtual care. In the workplace, such professionals often need to be sufficiently resourced to collaborate and address collaborative care barriers in telehealth. We performed a scoping review to identify the competencies required to support interprofessional collaboration among clinicians in telehealth. We followed Arksey and O'Malley's and the Joanna Briggs Institute's methodological guidelines, including quantitative and qualitative peer-reviewed articles published between 2010 and 2021. We expanded our data sources by searching for any organization or experts in the field via Google. The analysis of the resulting thirty-one studies and sixteen documents highlighted that health and social services professionals are generally unaware of the competencies they need to develop or maintain interprofessional collaboration in telehealth. In an era of digital innovations, we believe this gap may jeopardize the quality of the services offered to patients and needs to be addressed. Of the six competency domains in the National Interprofessional Competency Framework, it was observed that interprofessional conflict resolution was the competency that emerged least as an essential competency to be developed, while interprofessional communication and patient/client/family/community-centered care were identified as the two most reported essential competencies.
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Affiliation(s)
- Marie-Eve Poitras
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Priscilla Beaupré
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | - Ariana Girard
- Centre de recherche en santé durable, Université Laval, Québec, Canada
| | - Francois Aubry
- Department of Social Work, Université du Québec en Outaouais, Gatineau, Canada
| | - Vanessa T Vaillancourt
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | | | - Laurie Fortin
- Direction des soins infirmiers, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
| | - Julie Racine
- Centre de recherche appliquée en intervention psychosociale, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Alma, Canada
| | - Jean Morneau
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
| | - Amélie Boudreault
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | - Caroline Cormier
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | - Anaëlle Morin
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
| | - Monica McGraw
- Department of Family Medecine and Emergency Medecine, Université de Sherbrooke, Saguenay, Canada
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Masriadi, Idrus HH. Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education [Letter]. J Multidiscip Healthc 2024; 17:673-674. [PMID: 38370608 PMCID: PMC10874183 DOI: 10.2147/jmdh.s463189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024] Open
Affiliation(s)
- Masriadi
- Department of Epidemiology, Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
| | - Hasta Handayani Idrus
- Biomedical Research Center, Research Organization for Health, National Research and Innovation Agency, Cibinong Science Center, Cibinong - Bogor, West Java, Indonesia
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Culmer N, Smith TB, Stager C, Wright A, Fickel A, Tan J, Clark C(T, Meyer H, Grimm K. Asynchronous Telemedicine: A Systematic Literature Review. TELEMEDICINE REPORTS 2023; 4:366-386. [PMID: 38143795 PMCID: PMC10739789 DOI: 10.1089/tmr.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
Background Asynchronous telemedicine (ATM), which describes telemedical interaction between a patient and provider where neither party communicates simultaneously, is an important telemedicine modality that is seeing increased use. In this article, we summarize the published peer-reviewed literature specifically related to ATM to (1) identify terms or phrases that are used to describe ATM, (2) ascertain how this research has thus far addressed the various aspects of the quadruple aim of medicine, and (3) assess the methodological rigor of research on ATM. We also divided the literature into pre- and post-COVID-19 onset periods to identify potential variations in the literature between these two periods. Methods This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search, utilizing multiple databases and applying inclusion and exclusion criteria, initially produced 2624 abstracts for review. De-duplication and screening ultimately yielded 104 articles for data extraction. Results "Store-and-forward" and variations of "e-visit" were the most frequently used alternative terms for ATM. Care quality was the most frequently addressed aspect of the Quadruple Aim of Medicine-more than double any other category-followed by patient satisfaction. We separated cost of care into two categories: patients' cost of care and providers' cost to provide care. Patient cost of care was the third most addressed aspect of the Quadruple Aim of Medicine followed by provider well-being and provider's cost to provide care. Methodological rigor of the studies was also addressed, with only 2 quantitative studies ranked "Strong," 5 ranked "Moderate," and 97 ranked "Weak." Qualitative studies were generally acceptable but struggled methodologically with accounting for all participants and articulation of results. Conclusions Although "store-and-forward" is somewhat more frequently used in the studies included in this review, variants of "e-visit," are growing in recent usage. Given the relative newness of modality, it is not surprising that quality of care is the most researched aspect of the Quadruple Aim of Medicine in ATM research. We anticipate more balance between these areas as research in this field matures. Primary areas of research need currently relate to practitioners-specifically their costs of providing care and well-being. Finally, future ATM research needs to address research challenges of selection bias and blinding in quantitative studies and improved participant tracking and articulation of both study design and results in qualitative studies.
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Affiliation(s)
- Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Todd Brenton Smith
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Catanya Stager
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Andrea Wright
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Jet Tan
- The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Hannah Meyer
- The University of Alabama, Tuscaloosa, Alabama, USA
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10
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Chung-Lee L, Catallo C, Meade A. What are COVID-19 Patient Preferences for and Experiences with Virtual Care? Findings From a Scoping Review. J Patient Exp 2023; 10:23743735231215603. [PMID: 38026065 PMCID: PMC10664431 DOI: 10.1177/23743735231215603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Virtual care became a routine method for healthcare delivery during the coronavirus disease 2019 (COVID-19) pandemic. Patient preferences are central to delivering patient-centered and high-quality care. The pandemic challenged healthcare organizations and providers to quickly deliver safe healthcare to COVID-19 patients. This resulted in varied implementation of virtual healthcare services. With an increased focus on remote COVID-19 monitoring, little research has examined patient experiences with virtual care. This scoping review examined patient experiences and preferences with virtual care among community-based self-isolating COVID-19 patients. We identified a paucity of literature related to patient experiences and preferences regarding virtual care. Few articles focused on patient experiences and preferences as a primary outcome. Our research suggests that (1) patients view virtual care positively and to be feasible to use; (2) patient access to technology impacts patient satisfaction and experiences; and (3) to enhance the patient experience, healthcare organizations and providers need to support patient use of technology and resolve technology-related issues. When planning virtual care modalities, purposeful consideration of patient experiences and preferences is needed to deliver quality patient-centered care.
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Affiliation(s)
| | | | - Ava Meade
- Toronto Metropolitan University, Toronto, Canada
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11
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McLeod SL, Tarride JE, Mondoux S, Paterson JM, Plumptre L, Borgundvaag E, Dainty KN, McCarron J, Ovens H, Hall JN. Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care. CMAJ 2023; 195:E1463-E1474. [PMID: 37931947 PMCID: PMC10627570 DOI: 10.1503/cmaj.230492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Virtual urgent care (VUC) is intended to support diversion of patients with low-acuity complaints and reduce the need for in-person emergency department visits. We aimed to describe subsequent health care utilization and outcomes of patients who used VUC compared with similar patients who had an in-person emergency department visit. METHODS We used patient-level encounter data that were prospectively collected for patients using VUC services provided by 14 pilot programs in Ontario, Canada. We linked the data to provincial administrative databases to identify subsequent 30-day health care utilization and outcomes. We defined 2 subgroups of VUC users; those with a documented prompt referral to an emergency department by a VUC provider, and those without. We matched patients in each cohort to an equal number of patients presenting to an emergency department in person, based on encounter date, medical concern and the logit of a propensity score. For the subgroup of patients not promptly referred to an emergency department, we matched patients to those who were seen in an emergency department and then discharged home. RESULTS Of the 19 595 patient VUC visits linked to administrative data, we matched 2129 patients promptly referred to the emergency department by a VUC provider to patients presenting to the emergency department in person. Index visit hospital admissions (9.4% v. 8.7%), 30-day emergency department visits (17.0% v. 17.5%), and hospital admissions (12.9% v. 11.0%) were similar between the groups. We matched 14 179 patients who were seen by a VUC provider with no documented referral to the emergency department. Patients seen by VUC were more likely to have a subsequent in-person emergency department visit within 72 hours (13.7% v. 7.0%), 7 days (16.5% v. 10.3%) and 30 days (21.9% v. 17.9%), but hospital admissions were similar within 72 hours (1.1% v. 1.3%), and higher within 30 days for patients who were discharged home from the emergency department (2.6% v. 3.4%). INTERPRETATION The impact of the provincial VUC pilot program on subsequent health care utilization was limited. There is a need to better understand the inherent limitations of virtual care and ensure future virtual providers have timely access to in-person outpatient resources, to prevent subsequent emergency department visits.
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Affiliation(s)
- Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Jean-Eric Tarride
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Shawn Mondoux
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - J Michael Paterson
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Lesley Plumptre
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Emily Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Katie N Dainty
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Joy McCarron
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Howard Ovens
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Justin N Hall
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
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12
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Lambrecht J, Abir M, Seiler K, Kamdar N, Peterson T, Lin P, Nham W, Greenwood-Ericksen M. Conceptualizing lifer versus destination patients for optimized care delivery. BMC Health Serv Res 2023; 23:1190. [PMID: 37915060 PMCID: PMC10619315 DOI: 10.1186/s12913-023-10214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Patients presenting to academic medical centers (AMC) typically receive primary care, specialty care, or both. Resources needed for each type of care vary, requiring different levels of care coordination. We propose a novel method to determine whether a patient primarily receives primary or specialty care to allow for optimization of care coordination. OBJECTIVES We aimed to define the concepts of a Lifer Patient and Destination Patient and analyze the current state of care utilization in those groups to inform opportunities for improving care coordination. METHODS Using AMC data for a 36-month study period (FY17-19), we evaluated the number of unique patients by residence zip code. Patients with at least one primary care visit and patients without a primary care visit were classified as Lifer and Destination patients, respectively. Cohen's effect sizes were used to evaluate differences in mean utilization of different care delivery settings. RESULTS The AMC saw 35,909 Lifer patients and 744,037 Destination patients during the study period. Most patients were white, non-Hispanic females; however, the average age of a Lifer was seventy-two years whereas that of a Destination patient was thirty-eight. On average, a Lifer had three times more ambulatory care visits than a Destination patient. The proportion of Inpatient encounters is similar between the groups. Mean Inpatient length of stay (LOS) is similar between the groups, but Destination patients have more variance in LOS. The rate of admission from the emergency department (ED) for Destination patients is nearly double Lifers'. CONCLUSION There were differences in ED, ambulatory care, and inpatient utilization between the Lifer and Destination patients. Furthermore, there were incongruities between rate of hospital admissions and LOS between two groups. The Lifer and Destination patient definitions allow for identification of opportunities to tailor care coordination to these unique groups and to allocate resources more efficiently.
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Affiliation(s)
- Jacob Lambrecht
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mahshid Abir
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Kristian Seiler
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Tim Peterson
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Wilson Nham
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine Research, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Greenwood-Ericksen
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
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13
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Quesada-Caballero M, Carmona-García A, Chami-Peña S, Caballero-Mateos AM, Fernández-Martín O, Cañadas-De la Fuente GA, Romero-Bejar JL. Telemedicine in Elderly Hypertensive and Patients with Chronic Diseases during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6160. [PMID: 37834803 PMCID: PMC10574013 DOI: 10.3390/jcm12196160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND One aspect of the distancing measures imposed in response to the COVID-19 pandemic is that telemedicine consultations have increased exponentially. Among these consultations, the assessment and follow-up of patients with chronic diseases in a non-presential setting has been strengthened considerably. Nevertheless, some controversy remains about the most suitable means of patient follow-up. OBJECTIVE To analyze the impact of the telemedicine measures implemented during the COVID-19 period on chronic patients. MATERIAL AND METHODS A systematic review was carried out using the following databases: PubMed, Pro-Quest, and Scopus. The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search equation utilized descriptors sourced from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "hypertension AND older AND primary care AND (COVID-19 OR coronavirus)" and its Spanish equivalent. RESULTS The following data were obtained: 14 articles provided data on 6,109,628 patients and another 4 articles focused on a study population of 9684 physicians. Telemedicine was less likely to be used by elderly patients (OR 0.85; 95% C.I. 0.83-0.88; p = 0.05), those of Asian race (OR 0.69; 95% C.I. 0.66-0.73; p = 0.05), and those whose native language was not English (OR 0.89; 95% C.I. 0.78-0.9; p = 0.05). In primary care, lower use of telemedicine was associated with residents of rural areas (OR 0.81; p = 0.05), patients of African American race (OR 0.65, p = 0.05), and others (OR 0.64; p = 0.05). A high proportion (40%) of physicians had no prior training in telemedicine techniques. The highest quality in terms of telephone consultation was significantly associated with physicians who did not increase their prescription of antibiotherapy during the pandemic (OR = 0.30, p = 0.05) or prescribe more tests (OR 0.06 p = 0.05), i.e., who maintained their former clinical criteria despite COVID-19. CONCLUSIONS Telemedicine is of proven value and has been especially useful in the COVID-19 pandemic. A mixed remote-presential model is most efficient. Appropriate training in this area for physicians and patients, together with correct provision, is essential to prevent errors in implementation and use.
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Affiliation(s)
- Miguel Quesada-Caballero
- Centro de Salud Albayda La Cruz, Distrito Sanitario Granada-Metropolitano, Servicio Andaluz de Salud, Calle Virgen de la Consolación 12, 18015 Granada, Spain;
| | - Ana Carmona-García
- Critical Care and Emergency Unit (UCCU), Distrito Sanitario Granada-Metropolitano, Servicio Andaluz de Salud, Calle Virgen de la Consolación 12, 18015 Granada, Spain
| | - Sara Chami-Peña
- Hospital de la Serranía de Ronda, Servicio Andaluz de Salud, Carretera San Pedro Km 2, 29400 Ronda, Spain
| | - Antonio M. Caballero-Mateos
- Gastroenterology and Hepatology Department, San Cecilio University Hospital, Av. del Conocimiento s/n, 18016 Granada, Spain
| | - Oscar Fernández-Martín
- Centro de Salud Guadix, Área de Gestión Sanitaria Nordeste Granada, Servicio Andaluz de Salud, Ctra. de Murcia s/n, 18800 Baza, Spain
| | - Guillermo A. Cañadas-De la Fuente
- Faculty of Health Sciences, University of Granada, Avda. Ilustración 60, 18016 Granada, Spain;
- Brain, Mind and Behaviour Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - José Luis Romero-Bejar
- Statistics and Operational Research Department, University of Granada, Avda. Fuentenueva s/n, 18071 Granada, Spain;
- Institute of Mathematics, University of Granada (IMAG), Ventanilla 11, 18001 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain
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14
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Braund H, Dalgarno N, Ritsma B, Appireddy R. Exploring virtual care clinical experience from non-physician healthcare providers (VCAPE). SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100289. [PMID: 37283887 PMCID: PMC10228159 DOI: 10.1016/j.ssmqr.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
COVID-19 has caused an urgent implementation of virtual care (VC). Most research has focused on patient and physician experience with virtual care. Non-physician healthcare providers have played an active role in transitioning to virtual care, yet little is known about their experiences. This study explored their lived experiences in caring for patients virtually. Forty non-physician healthcare providers from local hospitals, community, and home care settings in Kingston, ON, Canada, participated and included nurse practitioners, occupational therapists, physiotherapists, psychologists, registered dietitians, social workers, and speech-language pathologists. Data were collected using semi-structured interviews between February and July 2021 and were analyzed thematically. The study was guided by organizational change theory. Four themes were identified from the data: 1) Quality of care, 2) Resources and training, 3) Healthcare system efficiency, and 4) Health equity and access for patients. Providers suggested that VC increased patient-centredness and had clear benefits for patients. Participants had little to no training in conducting patient care, virtually stating this as a key challenge. They believed that VC increased the efficiency of the healthcare system and was more proactive. Despite concerns regarding inequities across healthcare, participants reported that VC could improve equity as long as patients had access to technology. The study highlights the urgent need to support all healthcare providers in delivering optimal patient-centred care. We should leverage some of the advantages offered by VC to improve the efficiency of healthcare delivery, reduce provider burnout, and increase capacity across organizational systems.
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Affiliation(s)
- Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Science, Queen's University, Kingston, ON, K7L2V7, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Science, Queen's University, Kingston, ON, K7L2V7, Canada
| | - Benjamin Ritsma
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, K7L2V7, Canada
| | - Ramana Appireddy
- Department of Medicine, Queen's University, Kingston, ON, K7L2V7, Canada
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15
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Adams AM, Williams KKA, Langill JC, Arsenault M, Leblanc I, Munro K, Haggerty J. Telemedicine perceptions and experiences of socially vulnerable households during the early stages of the COVID-19 pandemic: a qualitative study. CMAJ Open 2023; 11:E219-E226. [PMID: 36882210 PMCID: PMC10000894 DOI: 10.9778/cmajo.20220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, efforts to decrease risk of viral transmission triggered an abrupt shift from ambulatory health care delivery toward telemedicine. In this study, we explore the perceptions and experiences of telemedicine among socially vulnerable households and suggest strategies to increase equity in telemedicine access. METHODS Conducted between August 2020 and February 2021, this exploratory qualitative study involved in-depth interviews with members of socially vulnerable households needing health care. Participants were recruited from a food bank and primary care practice in Montréal. Digitally recorded telephone interviews focused on experiences and perceptions related to telemedicine access and use. In our thematic analysis, we employed the framework method to facilitate comparison, and the identification of patterns and themes. RESULTS Twenty-nine participants were interviewed, 48% of whom presented as women. Almost all sought health care in the early stages of the pandemic, 69% of which was received via telemedicine. Four themes emerged from the analysis: delays in seeking health care owing to competing priorities and perceptions that COVID-19-related health care took precedence; challenges with appointment booking and logistics given complex online systems, administrative inefficiencies, long wait times and missed calls; issues around quality and continuity of care; and conditional acceptance of telemedicine for certain health problems, and in exceptional circumstances. INTERPRETATION Early in the pandemic, participants report telemedicine delivery did not accommodate the diverse needs and capacities of socially vulnerable populations. Patient education, logistical support and care delivery by a trusted provider are suggested solutions, in addition to policies supporting digital equity and quality standards to promote telemedicine access and appropriate use.
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Affiliation(s)
- Alayne M Adams
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que.
| | - Khandideh K A Williams
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Jennifer C Langill
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Mylene Arsenault
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Isabelle Leblanc
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Kimberly Munro
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
| | - Jeannie Haggerty
- Department of Family Medicine (Adams, Williams, Arsenault, Leblanc, Munro, Haggerty); Department of Geography (Langill), McGill University; Groupe de médecine de famille universitaire (GMF-U) Herzl Family Practice Centre (Arsenault); GMF-U St. Mary's Family Medicine Centre (Leblanc); GMF-U Village Santé (Munro), CLSC Site Parc-Extension; St. Mary's Research Centre (Haggerty), Montréal, Que
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16
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Parpia C, Moore C, Beatty M, Miranda S, Adams S, Stinson J, Desai A, Bartlett L, Culbert E, Cohen E, Orkin J. Evaluation of a Secure Messaging System in the Care of Children With Medical Complexity: Mixed Methods Study. JMIR Form Res 2023; 7:e42881. [PMID: 36821356 PMCID: PMC9999262 DOI: 10.2196/42881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The Connecting2gether (C2) platform is a web and mobile-based information-sharing tool that aims to improve care for children with medical complexity and their families. A key feature of C2 is secure messaging, which enables parental caregivers (PCs) to communicate with their child's care team members (CTMs) in a timely manner. OBJECTIVE The objectives of this study were to (1) evaluate the use of a secure messaging system, (2) examine and compare the content of messages to email and phone calls, and (3) explore PCs' and CTMs' perceptions and experiences using secure messaging as a method of communication. METHODS This is a substudy of a larger feasibility evaluation of the C2 platform. PCs of children with medical complexity were recruited from a tertiary-level complex care program to use the C2 platform for 6 months. PCs could invite CTMs involved in their child's care to register on the platform. Messages were extracted from C2, and phone and email data were extracted from electronic medical records. Quantitative data from the use of C2 were analyzed using descriptive statistics. Messaging content codes were iteratively developed through a review of the C2 messages and phone and email communication. Semistructured interviews were completed with PCs and CTMs. Communication and interview data were analyzed using thematic analysis. RESULTS A total of 36 PCs and 66 CTMs registered on the C2 platform. A total of 1861 messages were sent on C2, with PCs and nurse practitioners sending a median of 30 and 74 messages, respectively. Of all the C2 messages, 85.45% (1257/1471) were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on parent education, proactive check-ins, and nonmedical aspects of the child's life. Four themes emerged from the platform user interviews related to C2 messaging: (1) connection to the care team, (2) efficient communication, (3) clinical uses of secure messaging, and (4) barriers to use. CONCLUSIONS Overall, our study provides valuable insight into the benefits of secure messaging in the care of children with medical complexity. Secure messaging provided the opportunity for continued family teaching, proactive check-ins from health care providers, and casual conversations about family and child life, which contributed to PCs feeling an improved sense of connection with their child's health care team. Secure messaging can be a beneficial additional communication method to improve communication between PCs and their care team, reducing the associated burden of care coordination and ultimately enhancing the experience of care delivery. Future directions include the evaluation of secure messaging when integrated into electronic medical records, as this has the potential to work well with CTM workflow, reduce redundancy, and allow for new features of secure messaging.
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Affiliation(s)
- Camilla Parpia
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Clara Moore
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Sherri Adams
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Stinson
- SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Arti Desai
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Leah Bartlett
- Royal Victoria Regional Health Center, Barrie, ON, Canada
| | | | - Eyal Cohen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada
| | - Julia Orkin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
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17
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Lovis C, Fraser M, Tuna M, Bruntz C, Dahrouge S. The Impact of an Electronic Portal on Patient Encounters in Primary Care: Interrupted Time-Series Analysis. JMIR Med Inform 2023; 11:e43567. [PMID: 36745495 PMCID: PMC9941901 DOI: 10.2196/43567] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/15/2022] [Accepted: 01/08/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Electronic patient portals are online applications that allow patients access to their own health information, a form of asynchronous virtual care. The long-term impact of portals on the use of traditional primary care services is unclear, but it is an important question at this juncture, when portals are being incorporated into many primary care practices. OBJECTIVE We sought to investigate how an electronic patient portal affected the use of traditional, synchronous primary care services over a much longer time period than any existing studies and to assess the impact of portal messaging on clinicians' workload. METHODS We conducted a propensity-score-matched, open-cohort, interrupted time-series evaluation of a primary care portal from its implementation in 2010. We extracted information from the electronic medical record regarding age, sex, education, income, family health team enrollment, diagnoses at index date, and number of medications prescribed in the previous year. We also extracted the annual number of encounters for up to 8 years before and after the index date and provider time spent on secure messaging through the portal. RESULTS A total of 7247 eligible portal patients and 7647 eligible potential controls were identified, with 3696 patients matched one to one. We found that portal registration was associated with an increase in the number of certain traditional encounters over the time period surrounding portal registration. Following the index year, there was a significant jump in annual number of visits to physicians in the portal arm (0.42 more visits/year vs control, P<.001) but not for visits to nurse practitioners and physician assistants. The annual number of calls to the practice triage nurses also showed a greater increase in the portal arm compared to the control arm after the index year (an additional 0.10 calls, P=.006). The average provider time spent on portal-related work was 5.7 minutes per patient per year. CONCLUSIONS We found that portal registration was associated with a subsequent increase in the number of some traditional encounters and an increase in clerical workload for providers. Portals have enormous potential to truly engage patients as partners in their own health care, but their impact on use of traditional health care services and clerical burden must also be considered when they are incorporated into primary care.
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Affiliation(s)
| | - Mark Fraser
- West Carleton Family Health Team, Carp, ON, Canada
| | - Meltem Tuna
- ICES, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Simone Dahrouge
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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18
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Kukafka R, Salahub C, Bird C, Bhatia RS, Desveaux L, Glazier RH, Hedden L, Ivers NM, Martin D, Na Y, Spithoff S, Tadrous M, Kiran T. Characteristics and Health Care Use of Patients Attending Virtual Walk-in Clinics in Ontario, Canada: Cross-sectional Analysis. J Med Internet Res 2023; 25:e40267. [PMID: 36633894 PMCID: PMC9880810 DOI: 10.2196/40267] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/31/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Funding changes in response to the COVID-19 pandemic supported the growth of direct-to-consumer virtual walk-in clinics in several countries. Little is known about patients who attend virtual walk-in clinics or how these clinics contribute to care continuity and subsequent health care use. OBJECTIVE The objective of the present study was to describe the characteristics and measure the health care use of patients who attended virtual walk-in clinics compared to the general population and a subset that received any virtual family physician visit. METHODS This was a retrospective, cross-sectional study in Ontario, Canada. Patients who had received a family physician visit at 1 of 13 selected virtual walk-in clinics from April 1 to December 31, 2020, were compared to Ontario residents who had any virtual family physician visit. The main outcome was postvisit health care use. RESULTS Virtual walk-in patients (n=132,168) had fewer comorbidities and lower previous health care use than Ontarians with any virtual family physician visit. Virtual walk-in patients were also less likely to have a subsequent in-person visit with the same physician (309/132,168, 0.2% vs 704,759/6,412,304, 11%; standardized mean difference [SMD] 0.48), more likely to have a subsequent virtual visit (40,030/132,168, 30.3% vs 1,403,778/6,412,304, 21.9%; SMD 0.19), and twice as likely to have an emergency department visit within 30 days (11,003/132,168, 8.3% vs 262,509/6,412,304, 4.1%; SMD 0.18), an effect that persisted after adjustment and across urban/rural resident groups. CONCLUSIONS Compared to Ontarians attending any family physician virtual visit, virtual walk-in patients were less likely to have a subsequent in-person physician visit and were more likely to visit the emergency department. These findings will inform policy makers aiming to ensure the integration of virtual visits with longitudinal primary care.
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Affiliation(s)
| | - Christine Salahub
- Support, Systems, and Outcomes Department, University Health Network, Toronto, ON, Canada
| | | | - R Sacha Bhatia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Laura Desveaux
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Better Health, Ontario Trillium Health Partners, Mississauga, ON, Canada
| | - Richard H Glazier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Noah M Ivers
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Danielle Martin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family Medicine, Women's College Hospital, Toronto, ON, Canada
| | | | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family Medicine, Women's College Hospital, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Mina Tadrous
- Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Tara Kiran
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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19
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Singer A, Kosowan L, LaBine L, Shenoda D, Katz A, Abrams EM, Halas G, Wong ST, Talpade S, Kirby S, Baldwin A, Francois J. Characterizing the use of virtual care in primary care settings during the COVID-19 pandemic: a retrospective cohort study. BMC PRIMARY CARE 2022; 23:320. [PMID: 36496379 PMCID: PMC9736717 DOI: 10.1186/s12875-022-01890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. METHODS: Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescriptions) and provider (sex, age, clinic location, provider type, remuneration, country of graduation, return visit rate) characteristics describe the study population by visit type. Generalized estimating equation models describe factors associated with virtual care. RESULTS: There were 146,372 visits provided by 154 primary care providers between 03/14/20 and 06/30/20, of which 33.6% were virtual care. Female patients (OR 1.16, CI 1.09-1.22), patients with ≥ 3 comorbidities (OR 1.71, CI 1.44-2.02), and patients with ≥ 10 prescriptions (OR 2.71, 2.2-1.53) had higher odds of receiving at least one virtual care visit compared to male patients, patients with no comorbidities and patients with no prescriptions. There was no significant difference between the number of follow-up visits that were provided as a clinic visit compared to a virtual care visit (8.7% vs. 5.8%) (p = 0.6496). CONCLUSION Early in the pandemic restrictions, approximately one-third of visits were virtual. Virtual care was utilized by patients with more comorbidities and prescriptions, suggesting that patients with chronic disease requiring ongoing care utilized virtual care. Virtual care as a primary care visit type continues to evolve. Ongoing provision of virtual care can enhance quality, patient-centered care moving forward.
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Affiliation(s)
- Alexander Singer
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Leanne Kosowan
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Lisa LaBine
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Daniel Shenoda
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Alan Katz
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Departments of Community Health Science and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Manitoba Centre for Health Policy, Winnipeg, MB Canada
| | - Elissa M Abrams
- grid.21613.370000 0004 1936 9609Department of Pediatrics, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC Canada
| | - Gayle Halas
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Sabrina T. Wong
- grid.17091.3e0000 0001 2288 9830School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC Canada
| | - Siddhesh Talpade
- grid.416388.00000 0001 1245 5369Planning and Knowledge Management, Manitoba Health and Seniors Care, Winnipeg, MB Canada
| | - Sarah Kirby
- grid.21613.370000 0004 1936 9609George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB Winnipeg, Canada
| | - Alanna Baldwin
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Jose Francois
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
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20
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Selick A, Durbin J, Hamdani Y, Rayner J, Lunsky Y. Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res 2022; 6:e38916. [PMID: 35951444 PMCID: PMC9400841 DOI: 10.2196/38916] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. Objective The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. Methods We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. Results We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that “one size does not fit all,” and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients’ abilities to access necessary health care. Conclusions This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models.
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Affiliation(s)
- Avra Selick
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janet Durbin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yani Hamdani
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Rayner
- Alliance for Healthier Communities, Toronto, ON, Canada
- Centre for Studies in Family Medicine, Western University, London, ON, Canada
| | - Yona Lunsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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21
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Examining virtual visit use during a pandemic and perspectives of primary care providers, patients and caregivers: a mixed-methods research protocol. BMJ Open 2022. [PMCID: PMC9361746 DOI: 10.1136/bmjopen-2022-062807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction COVID-19 prompted rapid shifts to virtual primary care; however, the secondary implications and ideal applications of this change require further consideration. Patient and public stakeholder input has been bypassed. To integrate virtual care (VC) in what currently appears to be a lengthier battle against COVID-19 and related sequelae, further investigation is needed to support ideal implementation and use. This study aims to describe factors associated with the use of virtual visits in primary care practices, along with more in-depth description of users’ experiences and perspectives. Methods and analysis This study will be conducted in three phases, using a mixed-methods approach and in consultation with community advisors. Phase 1 will analyse data from electronic medical records (EMRs) to characterise the use and users of VC in primary care during the early phase of the COVID-19 pandemic. Analysis will be primarily descriptive; regression modelling will assess associations between patient and provider factors with a virtual visit. In phase 2, we will use an EMR-facilitated process to automate the distribution of patient surveys within an estimated 10 clinics. These surveys aim to describe care experiences, transactional use and perspectives of VC. In phase 3, focus groups with patients, caregivers and primary care clinicians will seek more in-depth exploration of VC regarding accessibility of care, acceptability and perceptions of quality care. Interpretive phenomenological analysis will be used for thematic analysis. The framework method will employ a matrix structure to organise the data and to facilitate comparison, integration and further interpretation. Ethics and dissemination This study has been approved by the University of Manitoba’s Health Research Ethics Board (HS24197). A co-designed dissemination strategy will include reports and infographics to policymakers and the public, manuscripts and presentations to academic and clinician audiences, and contributions to a learning plan for professional development.
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22
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Patterson PB, Roddick J, Pollack CA, Dutton DJ. Virtual care and the influence of a pandemic: Necessary policy shifts to drive digital innovation in healthcare. Healthc Manage Forum 2022; 35:272-278. [PMID: 35775144 PMCID: PMC9253722 DOI: 10.1177/08404704221110084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The potential for virtual healthcare to improve access to primary care services in Canada has long been a topic of discussion; however, implementation has been slow despite growing interest among the public. Non-essential service lockdowns implemented in 2020 in response to the COVID-19 pandemic catalyzed rapid and widespread uptake of virtual healthcare delivery. It is important to consider how to maintain equitable access to virtual care following the pandemic. We conducted a narrative scoping review to understand barriers related to the sustained adoption of virtual primary care delivery in Canada. Barriers at the system, healthcare provider, and patient levels were related to digital health infrastructure, and the regulatory environment governing virtual care provision and remuneration for healthcare professionals. The article identifies areas where policy shifts by health system leaders could sustain the longer-term availability of Canadian virtual care services.
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23
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McCrady E, Strychowsky JE, Woolfson JP. Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study. JMIR Pediatr Parent 2022; 5:e34115. [PMID: 35666938 PMCID: PMC9202653 DOI: 10.2196/34115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. OBJECTIVE This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. METHODS This study took place at the Children's Hospital at London Health Sciences Centre, a children's hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. RESULTS Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. CONCLUSIONS Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care.
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Affiliation(s)
- Emma McCrady
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, ON, Canada
| | - Julie E Strychowsky
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Jessica P Woolfson
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, ON, Canada.,Division of Pediatric Gastroenterology, London Health Sciences Centre Children's Hospital, London, ON, Canada
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24
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Li E, Tsopra R, Jimenez G, Serafini A, Gusso G, Lingner H, Fernandez MJ, Irving G, Petek D, Hoffman R, Lazic V, Memarian E, Koskela T, Collins C, Espitia SM, Clavería A, Nessler K, O’Neill BG, Hoedebecke K, Ungan M, Laranjo L, Ghafur S, Fontana G, Majeed A, Car J, Darzi A, Neves AL. General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study. PLOS DIGITAL HEALTH 2022; 1:e0000029. [PMID: 36812543 PMCID: PMC9931239 DOI: 10.1371/journal.pdig.0000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs' perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June-September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients' preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.
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Affiliation(s)
- Edmond Li
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (EL); (ALN)
| | - Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006 Paris, France
- Inria Paris, Paris, France
- Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Geronimo Jimenez
- Center for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Heidrun Lingner
- Hannover Medical School, Center for Public, Health and Healthcare, German Center for Lung Research (DZL) / BREATH Hannover, Germany
| | - Maria Jose Fernandez
- Leiro Health Center, Leiro, Spain
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
| | - Greg Irving
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ensieh Memarian
- Department of Clinical Sciences in Malmö, Lund University, Internal Medicine- Epidemiology Research Group, Skane University Hospital, Malmö, Sweden
| | - Tuomas Koskela
- General Practice, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Finland
| | | | | | - Ana Clavería
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
- Primary Care Research Unit. Vigo Health Area, Vigo, Spain
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Braden Gregory O’Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Kyle Hoedebecke
- Department of Utilization Management, Oscar Health, Dallas, United States of America
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Saira Ghafur
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gianluca Fontana
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Center for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Leiro Health Center, Leiro, Spain
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
| | - Ara Darzi
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (EL); (ALN)
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25
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Agarwal P, Wang R, Meaney C, Walji S, Damji A, Gill N, Yip G, Elman D, Florindo T, Fung S, Witty M, Pham TN, Ramji N, Kiran T. Sociodemographic differences in patient experience with primary care during COVID-19: results from a cross-sectional survey in Ontario, Canada. BMJ Open 2022; 12:e056868. [PMID: 35534055 PMCID: PMC9086266 DOI: 10.1136/bmjopen-2021-056868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We sought to understand patients' care-seeking behaviours early in the pandemic, their use and views of different virtual care modalities, and whether these differed by sociodemographic factors. METHODS We conducted a multisite cross-sectional patient experience survey at 13 academic primary care teaching practices between May and June 2020. An anonymised link to an electronic survey was sent to a subset of patients with a valid email address on file; sampling was based on birth month. For each question, the proportion of respondents who selected each response was calculated, followed by a comparison by sociodemographic characteristics using χ2 tests. RESULTS In total, 7532 participants responded to the survey. Most received care from their primary care clinic during the pandemic (67.7%, 5068/7482), the majority via phone (82.5%, 4195/5086). Among those who received care, 30.53% (1509/4943) stated that they delayed seeking care because of the pandemic. Most participants reported a high degree of comfort with phone (92.4%, 3824/4139), video (95.2%, 238/250) and email or messaging (91.3%, 794/870). However, those reporting difficulty making ends meet, poor or fair health and arriving in Canada in the last 10 years reported lower levels of comfort with virtual care and fewer wanted their practice to continue offering virtual options after the pandemic. CONCLUSIONS Our study suggests that newcomers, people living with a lower income and those reporting poor or fair health have a stronger preference and comfort for in-person primary care. Further research should explore potential barriers to virtual care and how these could be addressed.
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Affiliation(s)
- Payal Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sakina Walji
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Academic Family Health Team, Toronto, Ontario, Canada
| | - Ali Damji
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Credit Valley Family Health Team, Mississauga, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Navsheer Gill
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Gina Yip
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Oak Valley Health Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Debbie Elman
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tiffany Florindo
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Susanna Fung
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Scarborough Health Network, Scarborough, Ontario, Canada
| | - Melissa Witty
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Barrie and Community Family Health Team, Barrie, Ontario, Canada
| | - Thuy-Nga Pham
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- South East Toronto Family Health Team, Toronto, Ontario, Canada
| | - Noor Ramji
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Institue of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Kursīte M, Stars I, Strēle I, Gobiņa I, Ķīvīte-Urtāne A, Behmane D, Dūdele A, Villeruša A. A mixed-method study on the provision of remote consultations for non-communicable disease patients during the first wave of the COVID-19 pandemic in Latvia: lessons for the future. BMC Health Serv Res 2022; 22:263. [PMID: 35219328 PMCID: PMC8881750 DOI: 10.1186/s12913-022-07634-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/10/2022] [Indexed: 01/31/2023] Open
Abstract
Background The COVID-19 pandemic has challenged the ability of healthcare systems to ensure the continuity of health services for patients with non-communicable diseases (NCDs). The issue of remote consultations has emerged. Before the COVID-19 pandemic, remote consultations were not routinely provided or covered by public health funding in Latvia. This study aimed to describe the dynamics of consultations and the volume of remote consultations provided for patients with particular NCD and explore clinicians’ experiences of providing remote consultations during the first wave of the COVID-19 pandemic in Latvia. Methods A mixed-method study focusing on the first wave of the COVID-19 pandemic in Latvia in Spring 2020 was conducted. Quantitative data from the National Health Services were analysed to assess the dynamics of consultations for patients with selected NCDs. Qualitative data were collected through 34 semi-structured interviews with general practitioners (GPs) and specialists and were analysed using an inductive thematic analysis. Purposive maximum variation sampling was used for participant selection. Results During the period with the strongest restrictions of scheduled on-site consultations, a decrease in the total number of consultations was observed for a variety of NCDs. A significant proportion of consultations in this period were provided remotely. GPs provided approximately one-third of cancer-related consultations and almost half of consultations for the other selected conditions remotely. Among specialists, endocrinologists had the highest proportion of remote consultations (up to 72.0%), while urologists had the lowest (16.4%). Thematic analysis of the semi-structured interviews revealed five themes: 1) Adjusting in a time of confusion and fear, 2) Remote consultations: safety versus availability, 3) Sacrifice and loss of privacy, 4) Advantages and disadvantages of communication technologies, and 5) Different form of communication and a health literacy challenge. Conclusions During the first wave of the COVID-19 pandemic in Latvia, disruptions to health care services decreased the total number of consultations for patients with NCDs provided by both GPs and specialists. In this period, remote consultations proved to be an important instrument for ensuring the continuity of health care for patients with NCDs, and the necessity to develop a well-designed system for telemedicine in Latvia was highlighted.
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Pendrith C, Nayyar D, Chu C, O'Brien T, Lyons OD, Agarwal P, Martin D, Bhatia RS, Mukerji G. Outpatient visit trends for internal medicine ambulatory care sensitive conditions after the COVID-19 pandemic: a time-series analysis. BMC Health Serv Res 2022; 22:198. [PMID: 35164751 PMCID: PMC8845247 DOI: 10.1186/s12913-022-07566-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/31/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to a dramatic shift in the delivery of outpatient medicine with reduced in-person visits and a transition to predominantly virtual visits. We sought to understand trends in visit patterns for ambulatory care sensitive conditions (ACSCs) commonly seen in internal medicine clinics. METHODS We included adult outpatients seen for an ACSC between March 15th, 2017 and March 14th, 2021 at a single-centre in Ontario, Canada. Monthly visits were assessed by visit type (new consultation, follow-up), diagnosis, and clinic. Time series analyses compared visit volumes pre- and post-pandemic. Proportion of virtual visits were compared before and during the pandemic. Patient and visit factors were compared between in-person and virtual visits. RESULTS 8274 patients with 34,021 visits were included. Monthly visits increased by 15% during the pandemic (p < 0.0001). New consultations decreased by 10% (p = 0.0053) but follow-up visits increased by 21% (p < 0.0001). Monthly heart failure visits increased by 43% (p < 0.0001) whereas atrial fibrillation visits decreased. Pre- pandemic, < 1% of visits were virtual compared to 82% during the pandemic (p < 0.0001). Less than half of heart failure visits were virtual whereas > 95% of diabetes visits were virtual. CONCLUSIONS We found a significant increase in overall visits to internal medicine clinics driven by increased volumes of follow-up visits, which more than offset decreased new consultations. There was variability in visit trends and uptake of virtual care by visit diagnosis, which may indicate challenges with delivery of virtual care for certain conditions.
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Affiliation(s)
- Ciara Pendrith
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
| | - Dhruv Nayyar
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Cherry Chu
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
| | - Tara O'Brien
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Owen D Lyons
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Payal Agarwal
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
- Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Danielle Martin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Geetha Mukerji
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario, M5S 1B3, Canada.
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Women's College Hospital, Toronto, ON, Canada.
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Yang R, Zeng K, Jiang Y. Prevalence, Factors, and Association of Electronic Communication Use With Patient-Perceived Quality of Care From the 2019 Health Information National Trends Survey 5-Cycle 3: Exploratory Study. J Med Internet Res 2022; 24:e27167. [PMID: 35119369 PMCID: PMC8857700 DOI: 10.2196/27167] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/25/2021] [Accepted: 11/10/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Electronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients' use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level. OBJECTIVE The aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. METHODS Data from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders' personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method. RESULTS The overall prevalence of e-communication use was 60.3%, with a significantly lower prevalence in older adults (16.6%) than that in <45-year-old adults (41%) and 45-65-year-old adults (42.4%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95% CI 1.18-1.82; P=.001), with a household income ≥US $50,000 (OR 1.63, 95% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care (β=.12, 95% CI 0.02-0.22; P=.02). CONCLUSIONS This study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults.
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Affiliation(s)
- Rumei Yang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Kai Zeng
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
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Men F, Urquia ML, Tarasuk V. Pain-driven emergency department visits and food insecurity: a cross-sectional study linking Canadian survey and health administrative data. CMAJ Open 2022; 10:E8-E18. [PMID: 35017172 PMCID: PMC8758177 DOI: 10.9778/cmajo.20210056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As the leading cause of emergency department visits in Canada, pain disproportionately affects socioeconomically disadvantaged populations. We examine the association between household food insecurity and individuals' pain-driven emergency department visits. METHODS We designed a cross-sectional study linking the Canadian Community Health Survey 2005-2017 to the National Ambulatory Care Reporting System 2003-2017. Food insecurity was measured using a validated questionnaire. We excluded individuals with missing food insecurity status, individuals younger than 12 years and jurisdiction-years with partial emergency department records. We assessed emergency department visits driven by pain at different sites (migraine, other headaches, chest-throat pain, abdomen-pelvis pain, dorsalgia, joint pain, limb pain, other pain) and their characteristics (frequency, cause, acuity and time of emergency department visit) in Ontario and Alberta. We adjusted for sociodemographic characteristics, lifestyle and prior non-pain-driven emergency department visits in the models. RESULTS The sample contained 212 300 individuals aged 12 years and older. Compared with food-secure individuals, marginally, moderately and severely food-insecure people had 1.42 (95% confidence interval [CI] 1.20-1.68), 1.64 (95% CI 1.37-1.96) and 1.99 (95% CI 1.61-2.46) times higher adjusted incidence rates of pain-driven emergency department visits, respectively. The association was similar across sexes and significant among adults but not adolescents. Food insecurity was further associated with site-specific pain, with severely food-insecure individuals having significantly higher pain incidence than food-secure individuals. Severe food insecurity predicted more frequent, multicause, high-acuity and after-hours emergency department visits. INTERPRETATION Household food insecurity status is significantly associated with pain-driven emergency department visits in the Canadian population. Policies targeting food insecurity may reduce pain and emergency department utilization.
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Affiliation(s)
- Fei Men
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Consumer Sciences (Men), The University of Alabama, Tuscaloosa, Ala.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto; Li Ka Shing Knowledge Institute (Urquia), St. Michael's Hospital, Toronto, Ont.
| | - Marcelo L Urquia
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Consumer Sciences (Men), The University of Alabama, Tuscaloosa, Ala.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto; Li Ka Shing Knowledge Institute (Urquia), St. Michael's Hospital, Toronto, Ont
| | - Valerie Tarasuk
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Consumer Sciences (Men), The University of Alabama, Tuscaloosa, Ala.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto; Li Ka Shing Knowledge Institute (Urquia), St. Michael's Hospital, Toronto, Ont
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Pecina JL, Nigon LM, Penza KS, Murray MA, Kronebusch BJ, Miller NE, Jensen TB. Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study. J Med Internet Res 2021; 23:e25899. [PMID: 34932016 PMCID: PMC8726036 DOI: 10.2196/25899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/04/2021] [Accepted: 10/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.
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Affiliation(s)
- Jennifer L Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Leah M Nigon
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Kristine S Penza
- Mayo Clinic Express Care, Mayo Clinic, Rochester, MN, United States
| | - Martha A Murray
- Mayo Clinic Express Care, Mayo Clinic, Rochester, MN, United States
| | | | - Nathaniel E Miller
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Teresa B Jensen
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
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Rezahi S, Mathers A, Patel P, Tilli T, Dolovich L. Telehealth in community pharmacy: A new "place" for the appointment-based model given COVID-19 and the future of health care. Can Pharm J (Ott) 2021; 154:363-367. [PMID: 34777643 PMCID: PMC8581807 DOI: 10.1177/17151635211014922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sara Rezahi
- Leslie L. Dan Faculty of Pharmacy, University of Toronto, Toronto
- School of Pharmacy, University of Waterloo, Waterloo
| | - Annalise Mathers
- Leslie L. Dan Faculty of Pharmacy, University of Toronto, Toronto
| | - Pooja Patel
- Leslie L. Dan Faculty of Pharmacy, University of Toronto, Toronto
| | - Tiana Tilli
- Whole Health Pharmacy Partners, Markham, Ontario
| | - Lisa Dolovich
- Leslie L. Dan Faculty of Pharmacy, University of Toronto, Toronto
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Gujral K, Scott JY, Ambady L, Dismuke-Greer CE, Jacobs J, Chow A, Oh A, Yoon J. A Primary Care Telehealth Pilot Program to Improve Access: Associations with Patients' Health Care Utilization and Costs. Telemed J E Health 2021; 28:643-653. [PMID: 34559017 DOI: 10.1089/tmj.2021.0284] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The Veterans Health Administration (VHA) piloted an innovative video telehealth program called Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) in fiscal year (FY) 2014. V-IMPACT set up one regional "hub" site where primary care (PC) teams provided regular PC through telehealth services to patients in outlying "spoke" sites that experienced gaps in provider coverage. We evaluated associations between clinic-level adoption of V-IMPACT and patients' utilization and VHA's costs for primary, emergency, and inpatient care. Materials and Methods: This observational study used repeated cross-sections of 208,612 unique veteran patients assigned to a PC team in 22 V-IMPACT spoke sites from FY2013 to FY2018. V-IMPACT adoption in a spoke site was indicated if more than 1% of patients assigned to PC in a site used V-IMPACT services during the year. Association between V-IMPACT adoption and outcomes were assessed using mixed-effects models. Results: V-IMPACT adoption was associated with increased telehealth visits for PC (incidence rate ratio [IRR] = 2.42 [1.29 to 4.55]) and for primary care mental health integration (IRR = 7.25 [2.69 to 19.54]). V-IMPACT adoption was not associated with in-person visits, or with total visits (in-person plus video telehealth). V-IMPACT adoption was also not associated with acute hospital stays, emergency department visits, or VHA costs. Conclusions: Programs such as VHA's V-IMPACT can increase telehealth visits for PC, allowing successful transition across modalities and facilitating continuity of care without impacting total care. Programs should track substitution of in-person visits with telehealth visits and examine its effects on patients' health outcomes, satisfaction, and travel costs.
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Affiliation(s)
- Kritee Gujral
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Leena Ambady
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Clara E Dismuke-Greer
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Josephine Jacobs
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Adam Chow
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Anna Oh
- Division of Geriatrics, Department of Medicine, UCSF, San Francisco, California, USA.,San Francisco VA Health Care System, San Francisco, California, USA
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of General Internal Medicine, UCSF School of Medicine, San Francisco, California, USA
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Desveaux L, Budhwani S, Stamenova V, Bhattacharyya O, Shaw J, Bhatia RS. Closing the Virtual Gap in Health Care: A Series of Case Studies Illustrating the Impact of Embedding Evaluation Alongside System Initiatives. J Med Internet Res 2021; 23:e25797. [PMID: 34477560 PMCID: PMC8449303 DOI: 10.2196/25797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/20/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Early decisions relating to the implementation of virtual care relied on necessity and clinical judgement, but there is a growing need for the generation of evidence to inform policy and practice designs. The need for stronger partnerships between researchers and decision-makers is well recognized, but how these partnerships can be structured and how research can be embedded alongside existing virtual care initiatives remain unclear. We present a series of case studies that illustrate how embedded research can inform policy decisions related to the implementation of virtual care, where decisions are either to (1) discontinue (red light), (2) redesign (yellow light), or (3) scale up existing initiatives (green light). Data were collected through document review and informal interviews with key study personnel. Case 1 involved an evaluation of a mobile diabetes platform that demonstrated a mismatch between the setting and the technology (decision outcome: discontinue). Case 2 involved an evaluation of a mental health support platform that suggested evidence-based modifications to the delivery model (decision outcome: redesign). Case 3 involved an evaluation of video visits that generated evidence to inform the ideal model of implementation at scale (decision outcome: scale up). In this paper, we highlight the characteristics of the partnership and the process that enabled success and use the cases to illustrate how these characteristics were operationalized. Structured communication included monthly check-ins and iterative report development. We also outline key characteristics of the partnership (ie, trust and shared purpose) and the process (ie, timeliness, tailored reporting, and adaptability) that drove the uptake of evidence in decision-making. Across each case, the evaluation was designed to address policy questions articulated by our partners. Furthermore, structured communication provided opportunities for knowledge mobilization. Structured communication was operationalized through monthly meetings as well as the delivery of interim and final reports. These case studies demonstrate the importance of partnering with health system decision-makers to generate and mobilize scientific evidence. Embedded research partnerships founded on a shared purpose of system service provided an effective strategy to bridge the oft-cited gap between science and policy. Structured communication provided a mechanism for collaborative problem-solving and real-time feedback, and it helped contextualize emerging insights.
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Affiliation(s)
- Laura Desveaux
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Suman Budhwani
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Vess Stamenova
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - James Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
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Mohammed HT, Hyseni L, Bui V, Gerritsen B, Fuller K, Sung J, Alarakhia M. Exploring the use and challenges of implementing virtual visits during COVID-19 in primary care and lessons for sustained use. PLoS One 2021; 16:e0253665. [PMID: 34166441 PMCID: PMC8224904 DOI: 10.1371/journal.pone.0253665] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic has rapidly transformed how healthcare is delivered to limit the transmission of the virus. This descriptive cross-sectional study explored the current use of virtual visits in providing care among primary care providers in southwestern Ontario during the first wave of the COVID-19 pandemic and the anticipated level of utilization post-pandemic. It also explored clinicians’ perceptions of the available support tools and resources and challenges to incorporating virtual visits within primary care practices. Methods Primary care physicians and nurse practitioners currently practicing in the southwestern part of Ontario were invited to participate in an online survey. The survey invite was distributed via email, different social media platforms, and newsletters. The survey questions gathered clinicians’ demographic information and assessed their experience with virtual visits, including the proportion of visits conducted virtually (before, during the pandemic, and expected volume post-pandemic), overall satisfaction and comfort level with offering virtual visits using modalities, challenges experienced, as well as useful resources and tools to support them in using virtual visits in their practice. Results We received 207 responses, with 96.6% of respondents offering virtual visits in their practice. Participants used different modalities to conduct virtual visits, with the vast majority offering visits via phone calls (99.5%). Since the COVID-19 pandemic, clinicians who offered virtual visits have conducted an average of 66.4% of their visits virtually, compared to an average of 6.5% pre-pandemic. Participants anticipated continuing use of virtual visits with an average of 43.9% post-pandemic. Overall, 74.5% of participants were satisfied with their experience using virtual visits, and 88% believed they could incorporate virtual visits well within the usual workflow. Participants highlighted some challenges in offering virtual care. For example, 58% were concerned about patients’ limited access to technology, 55% about patients’ knowledge of technology, and 41% about the lack of integration with their current EMR, the increase in demand over time, and the connectivity issues such as inconsistent Wi-Fi/Internet connection. There were significant differences in perception of some challenges between clinicians in urban vs, rural areas. Clinicians in rural areas were more likely to consider the inconsistent Wi-Fi and limited connectivity as barriers to incorporating virtual visits within the practice setting (58.8% vs. 40.2%, P = 0.030). In comparison, clinicians in urban areas were significantly more concerned about patients overusing virtual care services (39.4% vs. 21.6%, P = 0.024). As for support tools, 47% of clinicians advocated for virtual care standards outlined by their profession’s college. About 32% identified change management support and technical training as supportive tools. Moreover, 39% and 28% thought local colleagues and in-house organizational support are helpful resources, respectively. Conclusion Our study shows that the adoption of virtual visits has exponentially increased during the pandemic, with a significant interest in continuing to use virtual care options in the delivery of primary care post-pandemic. The study sheds light on tools and resources that could enhance operational efficiencies in adopting virtual visits in primary care settings and highlights challenges that, when addressed, can expand the health system capacity and sustained use of virtual care.
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Affiliation(s)
| | - Lirije Hyseni
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
| | - Victoria Bui
- Hamilton Family Health Team, Hamilton, Ontario, Canada
| | - Beth Gerritsen
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
- Hamilton Family Health Team, Hamilton, Ontario, Canada
| | - Katherine Fuller
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jihyun Sung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mohamed Alarakhia
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Selick A, Bobbette N, Lunsky Y, Hamdani Y, Rayner J, Durbin J. Virtual health care for adult patients with intellectual and developmental disabilities: A scoping review. Disabil Health J 2021; 14:101132. [PMID: 34127406 PMCID: PMC9619129 DOI: 10.1016/j.dhjo.2021.101132] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
Background The COVID-19 pandemic led to an abrupt shift to virtual health care for many patients, including adults with intellectual and developmental disabilities (IDD). Approaches to virtual care that are successful for people without IDD may need to be adapted for adults with IDD. Objective The aim of this scoping review was to examine what is known about virtual health care for adults with IDD and in particular, the impact of virtual delivery on access to care for this population. Methods A comprehensive search was conducted of the academic and grey literature. A two-stage screening process was conducted by two independent reviewers and a structured data extraction template was populated for each included study. Findings were analyzed thematically using Access to Care Framework domains. Results In total, 22 studies met inclusion criteria. The majority were published in the past three years and focused on specialized IDD services. A subset of 12 studies reported findings on access to care for adults with IDD. Participants generally reported high acceptability of virtual care, though some preferred face-to-face encounters. Initial results on effectiveness were positive, though limited by small sample sizes. Challenges included internet quality and technical skill or comfort. Conclusions This review suggests that it is possible to deliver accessible, high quality virtual care for adults with IDD, however, relatively little research has been conducted on this topic. Due to COVID-19 there is currently a unique opportunity and urgency to learn when and for whom virtual care can be successful and how it can be supported.
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Affiliation(s)
- Avra Selick
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada.
| | - Nicole Bobbette
- Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada; Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Yona Lunsky
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada
| | - Yani Hamdani
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada
| | - Jennifer Rayner
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada
| | - Janet Durbin
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada
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Bhatia RS, Chu C, Pang A, Tadrous M, Stamenova V, Cram P. Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study. CMAJ Open 2021; 9:E107-E114. [PMID: 33597307 PMCID: PMC8034297 DOI: 10.9778/cmajo.20200311] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is thought to have increased use of virtual care, but population-based studies are lacking. We aimed to assess the uptake of virtual care during the COVID-19 pandemic using comprehensive population-based data from Ontario. METHODS This was a repeated cross-sectional study design. We used administrative data to evaluate changes in in-person and virtual visits among all residents of Ontario before (2012-2019) and during (January-August 2020) the COVID-19 pandemic. We included all patients who had an ambulatory care visit in Ontario. We excluded claims for patients who were not Ontario residents or had an invalid or missing health card number. We compared monthly or quarterly virtual care use across age groups, neighbourhood income quintiles and chronic disease subgroups. We also examined physician characteristics that may have been associated with virtual care use. RESULTS Among all residents of Ontario (population 14.6 million), virtual care increased from 1.6% of total ambulatory visits in the second quarter of 2019 to 70.6% in the second quarter of 2020. The proportion of physicians who provided 1 or more virtual visits per year increased from 7.0% in the second quarter of 2019 to 85.9% in the second quarter of 2020. The proportion of Ontarians who had a virtual visit increased from 1.3% in 2019 to 29.2% in 2020. Older patients were the highest users of virtual care. The proportion of total virtual visits that were provided to patients residing in rural areas (v. urban areas) declined significantly between 2012 and 2020, reflecting a shift in virtual care to a service increasingly used in urban centres. The rates of virtual care use increased similarly across all conditions and across all income quintiles. INTERPRETATION Our findings show that Ontario's approach to virtual care led to broad adoption across all provider groups, patient age, types of chronic diseases and neighborhood income. These findings have policy implications, including use of virtual care billing codes, for the ongoing use of virtual care during the second wave of the pandemic and beyond.
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Affiliation(s)
- R Sacha Bhatia
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia, Chu, Tadrous, Stamenova), Women's College Hospital; ICES Central (Bhatia, Pang); Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network; Department of Medicine (Cram), University of Toronto, Toronto, Ont.
| | - Cherry Chu
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia, Chu, Tadrous, Stamenova), Women's College Hospital; ICES Central (Bhatia, Pang); Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network; Department of Medicine (Cram), University of Toronto, Toronto, Ont
| | - Andrea Pang
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia, Chu, Tadrous, Stamenova), Women's College Hospital; ICES Central (Bhatia, Pang); Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network; Department of Medicine (Cram), University of Toronto, Toronto, Ont
| | - Mina Tadrous
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia, Chu, Tadrous, Stamenova), Women's College Hospital; ICES Central (Bhatia, Pang); Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network; Department of Medicine (Cram), University of Toronto, Toronto, Ont
| | - Vess Stamenova
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia, Chu, Tadrous, Stamenova), Women's College Hospital; ICES Central (Bhatia, Pang); Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network; Department of Medicine (Cram), University of Toronto, Toronto, Ont
| | - Peter Cram
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia, Chu, Tadrous, Stamenova), Women's College Hospital; ICES Central (Bhatia, Pang); Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network; Department of Medicine (Cram), University of Toronto, Toronto, Ont
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Leis JA, Born KB, Theriault G, Ostrow O, Grill A, Johnston KB. Using antibiotics wisely for respiratory tract infection in the era of covid-19. BMJ 2020; 371:m4125. [PMID: 33187951 DOI: 10.1136/bmj.m4125] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jerome A Leis
- Division of Infectious Diseases and General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Karen B Born
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guylene Theriault
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Olivia Ostrow
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Allan Grill
- Department of Family Medicine, Markham Stouffville Hospital, Markham, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - K Brian Johnston
- Quality of Care NL/Choosing Wisely NL, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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