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Ritchie O, Koptyra E, Marquis LB, Kadri R, Laurie A, Vydiswaran VGV, Li J, Brown LK, Veinot TC, Buis LR, Guetterman TC. Virtual Care: Perspectives From Family Physicians. Fam Med 2024; 56:321-324. [PMID: 38652849 PMCID: PMC11216767 DOI: 10.22454/fammed.2024.592756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, virtual care expanded rapidly at Michigan Medicine and other health systems. From family physicians' perspectives, this shift to virtual care has the potential to affect workflow, job satisfaction, and patient communication. As clinics reopened and care delivery models shifted to a combination of in-person and virtual care, the need to understand physician experiences with virtual care arose in order to improve both patient and provider experiences. This study investigated Michigan Medicine family medicine physicians' perceptions of virtual care through qualitative interviews to better understand how to improve the quality and effectiveness of virtual care for both patients and physicians. METHODS We employed a qualitative descriptive design to examine physician perspectives through semistructured interviews. We coded and analyzed transcripts using thematic analysis, facilitated by MAXQDA (VERBI) software. RESULTS The results of the analysis identified four major themes: (a) chief concerns that are appropriate for virtual evaluation, (b) physician perceptions of patient benefits, (c) focused but contextually enriched patient-physician communication, and (d) structural support needed for high-quality virtual care. CONCLUSIONS These findings can help further direct the discussion of how to make use of resources to improve the quality and effectiveness of virtual care.
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Affiliation(s)
- Olivia Ritchie
- Department of Family Medicine, University of MichiganAnn Arbor, MI
| | - Emily Koptyra
- Department of Family Medicine, University of MichiganAnn Arbor, MI
- School of Information, University of MichiganAnn Arbor, MI
- Department of Learning Health Sciences, University of Michigan Medical SchoolAnn Arbor, MI
- Department of Health Behavior and Health Education, School of Public Health, University of MichiganAnn Arbor, MI
| | - Liz B. Marquis
- School of Information, University of MichiganAnn Arbor, MI
| | - Reema Kadri
- Department of Family Medicine, University of MichiganAnn Arbor, MI
| | - Anna Laurie
- Department of Family Medicine, University of MichiganAnn Arbor, MI
| | - V. G. Vinod Vydiswaran
- School of Information, University of MichiganAnn Arbor, MI
- Department of Learning Health Sciences, University of Michigan Medical SchoolAnn Arbor, MI
| | - Jiazhao Li
- School of Information, University of MichiganAnn Arbor, MI
| | | | - Tiffany C. Veinot
- School of Information, University of MichiganAnn Arbor, MI
- Department of Learning Health Sciences, University of Michigan Medical SchoolAnn Arbor, MI
- Department of Health Behavior and Health Education, School of Public Health, University of MichiganAnn Arbor, MI
| | - Lorraine R. Buis
- Department of Family Medicine, University of MichiganAnn Arbor, MI
- School of Information, University of MichiganAnn Arbor, MI
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Campbell LA, Clark SE, Chorney J, Emberly D, Carrey NJ, Bagnell A, Blenus J, Daneff M, Campbell JC. Understanding the uptake of virtual care for first and return outpatient appointments in child and adolescent mental health services: a mixed-methods study. BMJ Open 2023; 13:e074803. [PMID: 38110381 DOI: 10.1136/bmjopen-2023-074803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To describe patterns of virtual and in-person outpatient mental health service use and factors that may influence the choice of modality in a child and adolescent service. DESIGN A pragmatic mixed-methods approach using routinely collected administrative data between 1 April 2020 and 31 March 2022 and semi-structured interviews with clients, caregivers, clinicians and staff. Interview data were coded according to the Consolidated Framework for Implementation Research (CFIR) and examined for patterns of similarity or divergence across data sources, respondents or other relevant characteristics. SETTING Child and adolescent outpatient mental health service, Nova Scotia, Canada. PARTICIPANTS IWK Health clinicians and staff who had participated in virtual mental healthcare following its implementation in March 2020 and clients (aged 12-18 years) and caregivers of clients (aged 3-18 years) who had received treatment from an IWK outpatient clinic between 1 April 2020 and 31 March 2022 (n=1300). Participants (n=48) in semi-structured interviews included nine clients aged 13-18 years (mean 15.7 years), 10 caregivers of clients aged 5-17 years (mean 12.7 years), eight Community Mental Health and Addictions booking and registration or administrative staff and 21 clinicians. RESULTS During peak pandemic activity, upwards of 90% of visits (first or return) were conducted virtually. Between waves, return appointments were more likely to be virtual than first appointments. Interview participants (n=48) reported facilitators and barriers to virtual care within the CFIR domains of 'outer setting' (eg, external policies, client needs and resources), 'inner setting' (eg, communications within the service), 'individual characteristics' (eg, personal attributes, knowledge and beliefs about virtual care) and 'intervention characteristics' (eg, relative advantage of virtual or in-person care). CONCLUSIONS Shared decision-making regarding treatment modality (virtual vs in-person) requires consideration of client, caregiver, clinician, appointment, health system and public health factors across episodes of care to ensure accessible, safe and high-quality mental healthcare.
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Affiliation(s)
- Leslie Anne Campbell
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Debbie Emberly
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - N J Carrey
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexa Bagnell
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jaime Blenus
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Miriam Daneff
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
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Neumann A, König HH, Bokermann J, Hajek A. Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review. JMIR Ment Health 2023; 10:e46148. [PMID: 37594785 PMCID: PMC10474517 DOI: 10.2196/46148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/03/2023] [Accepted: 05/31/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. OBJECTIVE The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. METHODS This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. RESULTS Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). CONCLUSIONS The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. TRIAL REGISTRATION PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5.
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Affiliation(s)
- Ariana Neumann
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josephine Bokermann
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Honey A, Hines M, Barton R, Berry B, Gilroy J, Glover H, Hancock N, Waks S, Wells K. Preferences for telehealth: A qualitative study with people accessing a new mental health service. Digit Health 2023; 9:20552076231211083. [PMID: 37928331 PMCID: PMC10621303 DOI: 10.1177/20552076231211083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Objectives To examine preferences for telehealth versus in-person services for people who sought mental health support from an unfamiliar service during the COVID-19 pandemic and to identify the factors that influenced these preferences. Methods Data are drawn from semi-structured interviews with 45 participants (32 people who accessed mental health services, 7 informal support people, and 6 people who accessed services themselves as well as identifying as informal supports). Data relating to experiences of telehealth, comparisons with in-person services and preferences were coded inductively and analysed using qualitative content analysis. Results Just over half of the participants in our sample preferred telehealth or at least regarded it as a suitable option. Those who preferred telehealth were more likely to have had direct experience, particularly via videoconferencing, as part of their access to this new mental health service. Reasons for preferring in-person services included belief in the superiority of interpersonal communication in these settings, compatibility with personal communication style and discomfort with technology. Those preferring telehealth cited its convenience, elimination of the need to travel for services, the comfort and safety afforded by accessing services at home and the ability to communicate more openly. Conclusions Hybrid models of care which harness the unique benefits of both in-person and remote service modalities appear to have a legitimate place in models of mental health care outside of pandemic situations. These results illuminate the potential of telehealth services when engaging with people seeking mental health help for the first time and in situations where existing relationships with service providers have not yet been established.
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Affiliation(s)
- Anne Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Monique Hines
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rebecca Barton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bridget Berry
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - John Gilroy
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Helen Glover
- Enlightened Consultants, Brisbane, Qld, Australia
| | - Nicola Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Shifra Waks
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karen Wells
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Remote Consultations for Mental Health: Patient Experiences. J Community Health 2022; 48:347-352. [PMID: 36454479 PMCID: PMC9713736 DOI: 10.1007/s10900-022-01175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE An exponential implementation of remote mental health care has been observed, but little data is available on experiences and barriers of remote health from a patient's perspective. This study investigated experiences associated with several forms of remote consultations (both telephone and online video) for mental health care during the COVID-19 coronavirus pandemic with a particular focus on patients' experiences. METHODS This study includes results of an online web-based survey filled in by 512 patients on the use and experiences of remote mental health consultations and circulating between March and October 2021. RESULTS Psychiatric consultations were initiated by the health care provider in 47.0% of cases, while psychological consultations were most often initiated in shared decision with the patient (54.9%). Only 28.8% of participants mentioned advantages regarding teleconsultations over face-to-face, compared to 39.3% for online video consultations. Moreover, 49.3% saw clear disadvantages for teleconsultations and 32.7% for video consultations. Positive factors associated with remote mental health care included when faced with transportation problems, followed by consultations primarily focusing on medication (for telephone consultations) or on more practical aspects (for video consultations). 25.0% of patients deemed conversations when being angry or sad to be feasible by telephone, and 33.0% considered these feasibly using video consultations. CONCLUSION Remote consultations were deemed feasible, but the positive factors did not seem to outweigh the face-to-face contacts from a patient's perspective. Remote consultations will probably remain present in the following decades, although care must be taken when providing the possibility of remote mental health care.
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