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Guan Q, Garg R, McCormack D, Lunsky Y, Tadrous M, Campbell T, Gomes T. Impact of COVID-19 on psychoactive medication use among individuals with intellectual and developmental disabilities in Ontario, Canada: A repeated cross-sectional study. Disabil Health J 2024:101649. [PMID: 38876963 DOI: 10.1016/j.dhjo.2024.101649] [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: 02/16/2024] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Evidence for worsening mental health among individuals with intellectual and developmental disabilities (IDD) during COVID-19 sparked concerns for increased use of psychoactive medications. OBJECTIVE To examine the impact of COVID-19 on psychoactive medication use and clinical monitoring among individuals with IDD in Ontario, Canada. METHODS We conducted a repeated cross-sectional study among individuals with IDD and examined weekly trends for psychoactive medication dispensing and outpatient physician visits among those prescribed psychoactive medications between April 7, 2019, and March 25, 2023. We used interventional autoregressive integrated moving average models to determine the impact of the declaration of emergency for COVID-19 (March 17, 2020) on the aforementioned trends. RESULTS The declaration of emergency for COVID-19 did not significantly impact psychoactive medication use among individuals with IDD. Provision of clinical monitoring remained relatively stable, apart from a short-term decline in the weekly rate of outpatient physician visits following the declaration of emergency for COVID-19 (step estimate: 21.26 per 1000 individuals [p < 0.01]; ramp estimate: 0.88 per 1000 individuals [p = 0.01]). When stratified by mode of delivery, there was a significant shift towards virtual care (step estimate: 78.80 per 1000 individuals; p < 0.01). The weekly rate of in-person physician visits gradually increased, returning to rates observed prior to the COVID-19 pandemic in January 2023. CONCLUSION Although access to clinical care remained relatively stable, the shift towards virtual care may have negatively impacted those who encounter challenges communicating via virtual mediums. Future research is required to identify the support systems necessary for individuals with IDD during virtual health care interactions.
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Affiliation(s)
- Qi Guan
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. 4th floor, Toronto, Ontario, M5T 3M6, Canada; ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, Ontario, M5B 1T8, Canada
| | - Ria Garg
- ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, Ontario, M5B 1T8, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario, M5S 3M2, Canada
| | | | - Yona Lunsky
- ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada; Department of Psychiatry, University of Toronto, 250 College St. 8th floor, Toronto, Ontario, M5T 1R8, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen St. W, Toronto, Ontario, M6J 1H4, Canada
| | - Mina Tadrous
- ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario, M5S 3M2, Canada; Women's College Research Institute, 76 Grenville St., Toronto, Ontario, M5S 1B2, Canada
| | - Tonya Campbell
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, Ontario, M5B 1T8, Canada
| | - Tara Gomes
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. 4th floor, Toronto, Ontario, M5T 3M6, Canada; ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, Ontario, M5B 1T8, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario, M5S 3M2, Canada.
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Balitsky AK, Cantor N, Zhang K, Pond G, Levine MN. Oncologists' Satisfaction with Virtual Care: A Questionnaire. Curr Oncol 2024; 31:3269-3277. [PMID: 38920731 DOI: 10.3390/curroncol31060248] [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: 04/14/2024] [Revised: 05/17/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Although virtual care (VC) has become an integral part of oncology care and healthcare delivery, clinicians' perspectives on and satisfaction with this modality are not well understood. METHODS Using a National Network Forum framework and expert panel review, we developed a questionnaire to measure oncologists' satisfaction with VC. The questionnaire was distributed to Canadian oncologists through medical society email lists (n = 1541). We used a 5-point Likert scale to capture their responses, which included strongly disagree (1), disagree (2), undecided (3), agree (4), and strongly agree (5). RESULTS A total of 61 oncologists and/or oncology trainees, of 768 (7.9%) who opened their email, completed questionnaires between October 2022 and January 2023. Every questionnaire item had a response rate greater than 98%. Seventy-two percent of the respondents were satisfied with VC. Oncologists who were less comfortable with technology were more likely to report lower levels of satisfaction (p < 0.001, Wilcoxon rank-sum). The questionnaire items that received the highest levels of agreement were related to VC reducing costs and improving access for patients and concerns about missing a diagnosis and assessing patients' functional status. The questionnaire items that received the greatest disagreement were related to VC improving access for patients with language barriers, VC being associated with time-savings for clinicians, improvements in clinical efficacy, and more readily available lab tests. CONCLUSIONS Most of the oncologists surveyed are satisfied with VC; however, there are some concerns with VC that need to be addressed. Future research on optimizing VC should address clinicians' concerns, in addition to addressing the patient experience.
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Affiliation(s)
- Amaris Karin Balitsky
- Hamilton Health Sciences, Juravinski Cancer Center, Hamilton, ON L8V 5C2, Canada
- Escarpment Cancer Research Institute, Hamilton, ON L8V 5C2, Canada
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Nathan Cantor
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Karen Zhang
- Hamilton Health Sciences, Juravinski Cancer Center, Hamilton, ON L8V 5C2, Canada
- Escarpment Cancer Research Institute, Hamilton, ON L8V 5C2, Canada
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Greg Pond
- Escarpment Cancer Research Institute, Hamilton, ON L8V 5C2, Canada
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Mark Norman Levine
- Hamilton Health Sciences, Juravinski Cancer Center, Hamilton, ON L8V 5C2, Canada
- Escarpment Cancer Research Institute, Hamilton, ON L8V 5C2, Canada
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada
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Hall JN, Vijayakumar A, Reis L, Alamgir A, Kokorelias KM, Hemphill J, Pattni N, Legere L, Halperin IJ, Di Prospero L, Elman D, Domb S, Arafeh D, Ledwos C, Sheppard CL, Hitzig SL. A qualitative study on the Virtual Emergency Department care experiences of equity-deserving populations. PLoS One 2024; 19:e0304618. [PMID: 38833484 PMCID: PMC11149852 DOI: 10.1371/journal.pone.0304618] [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: 12/20/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024] Open
Abstract
Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQI+ community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing virtual models of care. The objective of this qualitative study was to describe the experiences of patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada. Forty-three participants (36 patients and 7 family caregivers) with different and intersecting identities who used the Virtual ED participated in the study. Semi-structured interviews were conducted to explore reasons for accessing the Virtual ED, barriers to access, and how the Virtual ED met their care needs and expectations, including ways their experience could have been improved. Thematic analysis was used to identify themes from the data. Patients from equity-deserving populations described negative past experiences with ED in-person care, which included recounts of discrimination or culturally insensitive care while waiting to see the ED physician or nurse. Conversely, participants found the Virtual ED to be a socially and culturally safe space since they could now by-pass the waiting room experience. However, virtual care could not replace in-person care for certain issues (e.g., physical exam), and there was a need for greater promotion of the service to specific communities that might benefit from having access to the Virtual ED. Targeted outreach to help raise awareness of the service to equity-deserving communities is an important future direction.
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Affiliation(s)
- Justin N. Hall
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Logan Reis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Akm Alamgir
- Access Alliance Multicultural Health and Community Services, Toronto, Ontario, Canada
| | - Kristina M. Kokorelias
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sinai Health, University Health Network, Toronto, Ontario, Canada
| | | | - Noorin Pattni
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Laurie Legere
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ilana J. Halperin
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Debbie Elman
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Domb
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Arafeh
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Cliff Ledwos
- Access Alliance Multicultural Health and Community Services, Toronto, Ontario, Canada
| | - Christine L. Sheppard
- Wellesley Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
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Lindsay S, Ragunathan S, Kingsnorth S, Zhou C, Kakonge L, Cermak C, Hickling A, Wright FV. Understanding the benefits and challenges of outpatient virtual care during the COVID-19 pandemic in a Canadian pediatric rehabilitation hospital. Disabil Rehabil 2024; 46:2396-2404. [PMID: 37306595 DOI: 10.1080/09638288.2023.2221902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/01/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE The evolving virtual health care experience highlights the potential of technology to serve as a way to enhance care. Having virtual options for assessment, consultation and intervention were essential during the coronavirus (COVID-19) pandemic, especially for children with disabilities and their families. The purpose of our study was to describe the benefits and challenges of outpatient virtual care during the pandemic within pediatric rehabilitation. METHODS This qualitative study, part of a larger mixed methods project, involved in-depth interviews with 17 participants (10 parents, 2 youth, 5 clinicians) from a Canadian pediatric rehabilitation hospital. We analyzed the data using a thematic approach. RESULTS Our findings demonstrated three main themes: (1) benefits of virtual care (e.g., continuity of care, convenience, stress reduction and flexibility, and comfort within the home environment and enhanced rapport); (2) challenges related to virtual care (e.g., technical difficulties and lack of technology, environmental distractions and constraints, communication difficulty, and health impacts); and (3) advice for the future of virtual care (i.e., offering choice to families, enhanced communication and addressing health equity issues). CONCLUSIONS Clinicians and hospital leaders should consider addressing the modifiable barriers in accessing and delivering virtual care to optimize its effectiveness.
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Affiliation(s)
- Sally Lindsay
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Shauna Kingsnorth
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Chuanlin Zhou
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lisa Kakonge
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- School of Rehabilitation Science, McMaster University, Toronto, Canada
| | - Carly Cermak
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Andrea Hickling
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - F Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
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MacKenzie NE, Marbil MG, Soltani S, Lorenzetti DL, Birnie KA. A systematic review of in-person versus remotely delivered interventions for youth with chronic pain. PAEDIATRIC & NEONATAL PAIN 2024; 6:35-43. [PMID: 38863459 PMCID: PMC11163229 DOI: 10.1002/pne2.12119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 06/13/2024]
Abstract
The COVID-19 pandemic prompted a rapid shift from in-person to virtually-delivered care. Many youth with chronic pain have the ability to access care virtually; however, little is known about the efficacy of pain care for youth with chronic pain delivered virtually when compared to in-person. Such evidence is essential to guide youth in making decisions about their care, but also to inform what options health professionals present to youth. The purpose of this systematic review and meta-analysis was to examine the efficacy of interventions that are delivered in-person versus virtually for youth with chronic pain. Five databases (i.e., CINAHL, EMBASE, MEDLINE, APA PsycINFO, and Web of Science) were searched in October 2022 to identify randomized controlled trials that compare single/multimodal interventions for pediatric chronic pain delivered in-person versus virtually. A total 3638 unique studies were identified through database and other searching, two of which satisfied established criteria for inclusion in this review. Both studies compared psychological interventions delivered virtually versus in-person for youth with chronic pain and showed comparable efficacy across modalities. The planned meta-analyses could not be conducted due to different outcomes within each study that could not be combined. This systematic review highlights a critical gap in the evidence regarding the efficacy of virtually delivered interventions for youth with chronic pain. This evidence is necessary to inform treatment decisions for youth, and further research is required to develop the evidence to inform clinical interventions, especially as virtual treatments continue to be offered.
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Affiliation(s)
- Nicole E. MacKenzie
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
- Centre for Pediatric Pain ResearchIWK HealthHalifaxNova ScotiaCanada
| | | | - Sabine Soltani
- Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Diane L. Lorenzetti
- Health Sciences Library and Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Kathryn A. Birnie
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Anesthesiology, Perioperative and Pain Medicine, and Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
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Albright L, Ko W, Buvanesh M, Haraldsson H, Polubriaginof F, Kuperman GJ, Levy M, Sterling MR, Dell N, Estrin D. Opportunities and Challenges for Augmented Reality in Family Caregiving: Qualitative Video Elicitation Study. JMIR Form Res 2024; 8:e56916. [PMID: 38814705 PMCID: PMC11176885 DOI: 10.2196/56916] [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: 01/31/2024] [Revised: 03/27/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers' unmet needs is via the design of digital technologies that support caregivers' complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home. OBJECTIVE This study explored how AR might assist family caregivers with the delivery of home-based cancer care. The specific objectives were to shed light on challenges caregivers face where AR might help, investigate opportunities for AR to support caregivers, and understand the risks of AR exacerbating caregiver burdens. METHODS We conducted a qualitative video elicitation study with clinicians and caregivers. We created 3 video elicitations that offer ways in which AR might support caregivers as they perform often high-stakes, unfamiliar, and anxiety-inducing tasks in postsurgical cancer care: wound care, drain care, and rehabilitative exercise. The elicitations show functional AR applications built using Unity Technologies software and Microsoft Hololens2. Using elicitations enabled us to avoid rediscovering known usability issues with current AR technologies, allowing us to focus on high-level, substantive feedback on potential future roles for AR in caregiving. Moreover, it enabled nonintrusive exploration of the inherently sensitive in-home cancer care context. RESULTS We recruited 22 participants for our study: 15 clinicians (eg, oncologists and nurses) and 7 family caregivers. Our findings shed light on clinicians' and caregivers' perceptions of current information and communication challenges caregivers face as they perform important physical care tasks as part of cancer treatment plans. Most significant was the need to provide better and ongoing support for execution of caregiving tasks in situ, when and where the tasks need to be performed. Such support needs to be tailored to the specific needs of the patient, to the stress-impaired capacities of the caregiver, and to the time-constrained communication availability of clinicians. We uncover opportunities for AR technologies to potentially increase caregiver confidence and reduce anxiety by supporting the capture and review of images and videos and by improving communication with clinicians. However, our findings also suggest ways in which, if not deployed carefully, AR technologies might exacerbate caregivers' already significant burdens. CONCLUSIONS These findings can inform both the design of future AR devices, software, and applications and the design of caregiver support interventions based on already available technology and processes. Our study suggests that AR technologies and the affordances they provide (eg, tailored support, enhanced monitoring and task accuracy, and improved communications) should be considered as a part of an integrated care journey involving multiple stakeholders, changing information needs, and different communication channels that blend in-person and internet-based synchronous and asynchronous care, illness, and recovery.
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Affiliation(s)
- Liam Albright
- Department of Information Science, Cornell University, New York, NY, United States
| | - Woojin Ko
- Department of Computer Science, Cornell Tech, New York, NY, United States
| | - Meyhaa Buvanesh
- Department of Information Science, Jacobs Technion-Cornell Institute, Cornell Tech, New York, NY, United States
| | | | - Fernanda Polubriaginof
- Digital Informatics and Technology Solutions (DigITS), Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gilad J Kuperman
- Digital Informatics and Technology Solutions (DigITS), Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Michelle Levy
- Digital Informatics and Technology Solutions (DigITS), Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Nicola Dell
- Department of Information Science, Jacobs Technion-Cornell Institute, Cornell Tech, New York, NY, United States
| | - Deborah Estrin
- Department of Computer Science, Cornell Tech, New York, NY, United States
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Hafid S, Freeman K, Aubrey-Bassler K, Queenan J, Drummond N, Lawson J, Vanstone M, Nicholson K, Lussier MT, Mangin D, Howard M. Describing primary care patterns before and during the COVID-19 pandemic across Canada: a quasi-experimental pre-post design cohort study using national practice-based research network data. BMJ Open 2024; 14:e084608. [PMID: 38772895 PMCID: PMC11110591 DOI: 10.1136/bmjopen-2024-084608] [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] [Received: 01/23/2024] [Accepted: 04/18/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE The objective was to analyse how the pandemic affected primary care access and comprehensiveness in chronic disease management by comparing primary care patterns before and during the early COVID-19 pandemic. DESIGN We conducted a quasi-experimental pre-post design cohort study and reported indicators for the 21 months before and after the onset of the COVID-19 pandemic. SETTING We used electronic medical record data from primary care clinics enrolled in the Canadian Primary Care Sentinel Surveillance Network from 1 January 2018 to 31 December 2021. POPULATION The study population included patients (n=919 928) aged 18 years or older with at least one primary care contact from 12 March 2018 to 12 March 2020, in Canada. OUTCOME MEASURES The study indicators included three indicators measuring access to primary care (encounters, blood pressure measurements and lab tests) and three for comprehensiveness (diagnoses, non-COVID-19 vaccines administered and referrals). RESULTS 67.3% of the cohort was aged ≥40 years, 56.4% were female and 53.5% were from Ontario, Canada. Fewer patients received an encounter during the pandemic (91.5% to 81.5%), while the median (IQR) number of encounters remained the same (5 (2-1)) for those with access. Fewer patients received a blood pressure measurement (47.9% to 31.8%), and patients received fewer measurements during the pandemic (2 (1-4) to 1 (0-2)). CONCLUSIONS Encounters with primary care remained consistent during the pandemic, but in-person care, such as lab tests and blood pressure measurements, decreased. In-person care indicators followed temporally to national COVID-19 case counts during the pandemic.
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Affiliation(s)
- Shuaib Hafid
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Karla Freeman
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - John Queenan
- Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Neil Drummond
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Lawson
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn Nicholson
- Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Marie-Thérèse Lussier
- Médecine de famille et de médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| | - Dee Mangin
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Howard
- Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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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 DOI: 10.1371/journal.pone.0299005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Abdelmutti N, Powis M, Macedo A, Liu Z, Bender JL, Papadakos J, Hack S, Rajnish N, Rana P, Kittuppanantharajah S, Lovas M, Melwani S, Moody L, Elliot M, Ashfaq I, Avery L, Mohammed H, Berlin A, Krzyzanowska MK. Virtual Cancer Care Beyond the COVID-19 Pandemic: Patient and Staff Perspectives and Recommendations. JCO Oncol Pract 2024; 20:643-656. [PMID: 38266201 DOI: 10.1200/op.23.00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 01/26/2024] Open
Abstract
PURPOSE COVID-19 catalyzed rapid implementation of virtual cancer care (VC); however, work is needed to inform long-term adoption. We evaluated patient and staff experiences with VC at a large urban, tertiary cancer center to inform recommendations for postpandemic sustainment. METHODS All physicians who had provided VC during the pandemic and all patients who had a valid e-mail address on file and at least one visit to the Princess Margaret Cancer Centre in Toronto, Canada, in the preceding year were invited to complete a survey. Interviews and focus groups with patients and staff across the cancer center were analyzed using qualitative descriptive analysis and triangulated with survey findings. RESULTS Response rates for patients and physicians were 15% (2,343 of 15,169) and 41% (100 of 246), respectively. A greater proportion of patients than physicians were satisfied with VC (80.1 v 53.4%; P < .01). In addition, fewer patients than physicians felt that virtual visits were worse than those conducted in person (28.0 v 43.4%; P < .01) and that telephone and video visits negatively affected the human interaction that they valued (59.8% v 82.0%; P < .01). Major barriers to VC for patients were respect for care preferences and personal boundaries, accessibility, and equitable access. For staff, major barriers included a lack of role clarity, dedicated resources (space and technology), integration of nursing and allied health, support (administrative, clinical, and technical), and guidance on appropriateness of use. CONCLUSION Patient and staff perceptions and barriers to virtual care are different. Moving forward, we need to pay attention to both staff and patient experiences with virtual care since this will have major implications for long-term adoption into clinical practice.
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Affiliation(s)
- Nazek Abdelmutti
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Cancer Digital Intelligence, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Melanie Powis
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Alyssa Macedo
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Radiation Oncology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Jackie L Bender
- Department of Supportive Care, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Janet Papadakos
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Cancer Education, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Saidah Hack
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Nikki Rajnish
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Palwasha Rana
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Shay Kittuppanantharajah
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Mike Lovas
- Cancer Digital Intelligence, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Sheena Melwani
- Cancer Digital Intelligence, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Lesley Moody
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Mary Elliot
- Department of Supportive Care, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Iqra Ashfaq
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Lisa Avery
- Biostatistics Research Unit, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Hiba Mohammed
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Cancer Digital Intelligence, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
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10
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Leggett B, Eliason P, Sick S, Burma JS, Wong SK, Laperrière D, Goulet C, Fremont P, Russell K, Schneider KJ, Emery CA. Youth Preseason Performance on the Sport Concussion Assessment Tool 5 Across Multiple Sports. Clin J Sport Med 2024; 34:288-296. [PMID: 38149828 DOI: 10.1097/jsm.0000000000001201] [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] [Received: 05/09/2023] [Accepted: 11/07/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To examine preseason Sport Concussion Assessment Tool 5 (SCAT5) performance of adolescent sport participants by environment (in-person/virtual), sex, age, concussion history, collision/noncollision sport participation, and self-reported medical diagnoses. DESIGN Cross-sectional. SETTING Canadian community and high-school sport settings. PARTICIPANTS Three thousand eight hundred five adolescent (2493 male, 1275 female, and 37 did not disclose; 11- to 19-year-old) sport participants. ASSESSMENT OF RISK FACTORS Sport Concussion Assessment Tool 5 administration method (in-person/virtual), sex (male/female/unreported), age (years), concussion history (0/1/2/3+), collision/noncollision sport participant, and self-reported medical diagnoses [attention deficit disorder or attention-deficit/hyperactivity disorder, headache/migraine, learning disability, and psychiatric disorder (ie, anxiety/depression/other)]. OUTCOME MEASURES Preseason SCAT5 outcomes including total number of symptoms (TNS; /22), symptom severity score (SSS; /132), Standardized Assessment of Concussion (SAC; /50), and modified Balance Error Scoring System (mBESS; /30). RESULTS Multiple multilevel linear or Poisson regression complete case analyses adjusting for clustering and robust standard errors, with β-coefficients (95% CI) back-transformed to indicate an increase/decrease in SCAT5 subdomains when relevant for clinical interpretation. Virtual (V) performance was associated with fewer symptoms reported [TNS Difference V-IP = -1.53 (95% CI, -2.22 to -0.85)], lower SSS [-2.49 (95% CI, -4.41 to -0.58)], and fewer mBESS errors (IP) [-0.52 (95% CI, -0.77 to -0.27)] compared with in-person. For every one-year increase in age, more symptoms [TNS = 0.22 (95% CI, 0.01-0.44)], higher SSS [0.52 (95% CI, 0.01-1.06)], higher SAC [0.27 (95% CI, 0.15-0.38), and poorer balance [mBESS = -0.19 (-0.28 to -0.09)] were observed. Differences between males and females were also seen across all SCAT5 outcomes. Individuals reporting any medical diagnosis or 3+ concussion history also reported more symptoms (TNS) and higher SSS than those who did not. CONCLUSIONS Administration environment, sex, age, concussion history, and medical diagnoses were associated with SCAT5 subdomains and are important considerations when interpreting the SCAT5 results.
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Affiliation(s)
- Benjamin Leggett
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Paul Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Stacy Sick
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Joel S Burma
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Sophie K Wong
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - David Laperrière
- Pavillon de l'Éducation physique et des sports, Université Laval, Québec City, QC, Canada
- Pediatrics and Child Health, University of Manitoba, Winnipeg, MN, Canada
- Department of Physical Education, Faculty of Education, Université Laval, Québec City, QC, Canada
| | - Claude Goulet
- Department of Physical Education, Faculty of Education, Université Laval, Québec City, QC, Canada
| | - Pierre Fremont
- Pavillon de l'Éducation physique et des sports, Université Laval, Québec City, QC, Canada
| | - Kelly Russell
- Pediatrics and Child Health, University of Manitoba, Winnipeg, MN, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Evidence Sport and Spine, Calgary, AB, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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11
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Fu R, Sutradhar R, Li Q, Eskander A. Virtual and in-person visits by Ontario physicians in the COVID-19 era. J Telemed Telecare 2024; 30:706-714. [PMID: 35296163 PMCID: PMC11027436 DOI: 10.1177/1357633x221086447] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We examined the coronavirus disease 2019 (COVID-19) pandemic impact on weekly trends in the billing of virtual and in-person physician visits in Ontario, Canada. METHODS In this retrospective cohort study, physician billing records from Ontario were aggregated on a weekly basis for in-person and virtual visits from 3 January 2016 to 27 March 2021. For each type of visit, a segmented negative binomial regression analysis was performed to estimate the weekly pre-pandemic trend in billing volume per thousand adults (3 January 2016 to 14 March 2020), the immediate change in mean volume at the start of the pandemic, and additional change in weekly volume in the pandemic era (15 March 2020 to 27 March 2021). RESULTS Before the start of the pandemic, the weekly volume of virtual visits per thousand adults was low with a 0.5% increase per week (rate ratio [RR]: 1.0053, 95% confidence interval [CI]: 1.0050-1.0056). A dramatic 65% reduction in in-person visits (RR: 0.35, 95% CI: 0.32-0.39) occurred at the start of the pandemic while virtual visits grew by 21-fold (RR: 21.3, 95% CI: 19.6-23.0). In the pandemic era, in-person visits rose by 1.4% per week (RR: 1.014, 95% CI: 1.011-1.017) but no change was observed for virtual visits (p-value = 0.31). Overall, we noted a 57.6% increase in total weekly physician visits volume after the start of the pandemic. DISCUSSION These results are meaningful for virtual care reimbursement models. Future study needs to assess the quality of care and whether the increase in virtual care volume is cost-effective to society.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology – Head and Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology – Head and Neck Surgery, Michael Garron Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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12
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Hetherington E, Darling E, Harper S, Nguyen F, Schummers L, Norman WV. Inequalities in access to prenatal care during the COVID-19 pandemic: Analysis of a population-based cohort. Paediatr Perinat Epidemiol 2024; 38:291-301. [PMID: 38339962 DOI: 10.1111/ppe.13050] [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] [Received: 07/27/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Before the COVID-19 pandemic, access to prenatal care was lower among some socio-demographic groups. This pandemic caused disruptions to routine preventative care, which could have increased inequalities. OBJECTIVES To investigate if the COVID-19 pandemic increased inequalities in access to prenatal care among those who are younger, live in rural areas, have a lower socio-economic situation (SES) and are recent immigrants. METHODS We used linked administrative datasets from ICES to identify a population-based cohort of 455,245 deliveries in Ontario from January 2018 to December 2021. Our outcomes were first-trimester prenatal visits, first-trimester ultrasound and adequacy of prenatal care. We used joinpoint analysis to examine outcome time trends and identify trend change points. We stratified analyses by age, rural residence, SES and recent immigration, and examined risk differences (RD) with 95% confidence intervals (CI) between groups at the beginning and end of the study period. RESULTS For all outcomes, we noted disruptions to care beginning in March or April 2020 and returning to previous trends by November 2020. Inequalities were stable across groups, except recent immigrants. In July 2017, 65.0% and 69.8% of recent immigrants and non-immigrants, respectively, received ultrasounds in the first trimester (RD -4.8%, 95% CI -8.0, -1.5). By October 2020, this had increased to 75.4%, with no difference with non-immigrants (RD 0.4%, 95% CI -2.4, 3.2). Adequacy of prenatal care showed more intensive care as of November 2020, reflecting a higher number of visits. CONCLUSIONS We found no evidence that inequalities between socio-economic groups that existed prior to the pandemic worsened after March 2020. The pandemic may be associated with increased access to care for recent immigrants. The introduction of virtual visits may have resulted in a higher number of prenatal care visits.
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Affiliation(s)
- Erin Hetherington
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- ICES McMaster, Hamilton, Ontario, Canada
| | - Elizabeth Darling
- ICES McMaster, Hamilton, Ontario, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Laura Schummers
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Thanh NX, Waye A, Stewart D, Weatherald J, Lam GY, Stickland MK, Hill MD, Choy J, Chuck AW, Wasylak T. Increased Virtual Visits to Physicians During the COVID-19 Pandemic and Estimated Impact on Physician Compensation: The Case of Lung and Colorectal Cancers, Chronic Obstructive Pulmonary Diseases, and Heart Failure in Alberta, Canada. Telemed J E Health 2024. [PMID: 38656126 DOI: 10.1089/tmj.2023.0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Introduction: The COVID-19 pandemic started in Alberta in March 2020 and significantly increased telehealth service use and provision reducing the risk of virus transmission. We examined the change in the number and proportion of virtual visits by physician specialty and condition (chronic obstructive pulmonary diseases [COPD], heart failure [HF], colorectal and lung cancers), as well as associated changes in physician compensation. Methods: A population-based design was used to analyze all processed physician claims comparing the number and proportion of virtual visits and associated physician billings relative to in-person between pre- (2019/2020) and intra-pandemic (2020/2021). Physician compensations were the claim amounts paid by the health insurance. Results: Pre-pandemic (intra-), there were 8,981 (8,897) lung cancer, 9,245 (9,029) colorectal, 37,558 (36,292) HF, and 68,270 (52,308) COPD patients. Each patient had totally 2.3-4.7 (of which 0.4-0.6% were virtual) general practitioner (GP) visits and 0.9-2.3 (0.2-0.7% were virtual) specialist visits per year pre-pandemic. The average number and proportion of per-patient virtual visits to GPs and specialists grew significantly pre- to intra-pandemic by 2,138-4,567%, and 2,201-7,104%, respectively. Given the lower fees of virtual compared with in-person visits, the reduction in physician compensation associated with the increased use of virtual care was estimated at $3.85 million, with $2.44 million attributed to specialist and $1.41 million to GP. Discussion: Utilization of telehealth increased significantly, while the physician billings per patient and physician compensation declined early in the pandemic in Alberta for the four chronic diseases considered. This study forms the basis for future study in understanding the impact of virtual care, now part of the fabric of health care delivery, on quality of care and patient safety, overall health service utilization (such as diagnostic imaging and other investigations), as well as economic impacts to patients, health care systems, and society.
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Affiliation(s)
- Nguyen Xuan Thanh
- Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arianna Waye
- Health Evidence & Innovation, Alberta Health Services, Calgary, Alberta, Canada
| | - Douglas Stewart
- Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Jason Weatherald
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Y Lam
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Medicine Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Medicine Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael D Hill
- Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jonathan Choy
- Virtual Care Access and Navigation, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anderson W Chuck
- Strategic Finance, Alberta Health Services, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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14
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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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15
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Lau K, Escudero C, Lee I, Yu C. Experiences of Motivational Interviewing in Virtual Health-care Visits for Adults With Type 2 Diabetes Mellitus: A Qualitative Analysis. Can J Diabetes 2024:S1499-2671(24)00087-X. [PMID: 38641003 DOI: 10.1016/j.jcjd.2024.04.008] [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: 11/09/2023] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES The purpose of this qualitative study is to identify barriers minimizing the effectiveness of motivational interviewing during virtual clinic encounters for individuals with type 2 diabetes based on the capability, opportunity, motivation, and behaviour (COM-B) model. METHODS One-on-one semistructured interviews were conducted from March to June 2023, with 17 adults with type 2 diabetes (64.7% female; median age 69 years, range 47 to 83 years) followed at St. Michael's Hospital (Toronto, Canada). Themes from transcribed interviews were identified through descriptive analysis using a grounded theory approach. RESULTS The following main themes were identified: 1) face-to-face appointments strengthen provider-patient rapport and collaboration; 2) virtual encounters reduce patient accountability and hinder health-seeking behaviour; and 3) individuals with physical disabilities and/or low technological proficiency experience decreased provider accessibility. Protective factors that can mitigate these negative impacts include establishing rapport during in-person appointments before transitioning to virtual appointments and incorporating a video component during virtual encounters. CONCLUSIONS Several barriers of virtual appointments currently limit the effectiveness of motivational interviewing for individuals with type 2 diabetes and make it difficult to provide person-centred care, especially by phone. However, there are protective factors that help to maintain healthy lifestyle behaviours, even after transitioning to virtual settings, and are areas for optimization moving forward.
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Affiliation(s)
- Kimberley Lau
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Escudero
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Irene Lee
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine Yu
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
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16
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Walsh R, Telner D, Butt DA, Krueger P, Fleming K, MacDonald S, Pyakurel A, Greiver M, Jaakkimainen L. Factors associated with plans for early retirement among Ontario family physicians during the COVID-19 pandemic: a cross-sectional study. BMC PRIMARY CARE 2024; 25:118. [PMID: 38637731 PMCID: PMC11025226 DOI: 10.1186/s12875-024-02374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Higher numbers of family physicians (FPs) stopped practicing or retired during the COVID-19 pandemic, worsening the family doctor shortage in Canada. Our study objective was to determine which factors were associated with FPs' plans to retire earlier during the COVID-19 pandemic. METHODS We administered two cross-sectional online surveys to Ontario FPs asking whether they were "planning to retire earlier" as a result of the pandemic during the first and third COVID-19 pandemic waves (Apr-Jun 2020 and Mar-Jul 2021). We used logistic regression to determine which factors were associated with early retirement planning, adjusting for age. RESULTS The age-adjusted proportion of FP respondents planning to retire earlier was 8.2% (of 393) in the first-wave and 20.5% (of 454) in the third-wave. Planning for earlier retirement during the third-wave was associated with age over 50 years (50-59 years odds ratio (OR) 5.37 (95% confidence interval (CI):2.33-12.31), 60 years and above OR 4.18 (95% CI: 1.90-10.23)), having difficulty handling increased non-clinical responsibilities (OR 2.95 (95% CI: 1.79-4.94)), feeling unsupported to work virtually (OR 1.96 (95% CI: 1.19-3.23)) or in-person (OR 2.70 (95% CI: 1.67-4.55)), feeling unable to provide good care (OR 1.82 (95% CI: 1.10-3.03)), feeling work was not valued (OR 1.92 (95% CI: 1.15-3.23)), feeling frightened of dealing with COVID-19 (OR 2.01 (95% CI: 1.19-3.38)), caring for an elderly relative (OR 2.36 (95% CI: 1.69-3.97)), having difficulty obtaining personal protective equipment (OR 2.00 (95% CI: 1.16-3.43)) or difficulty implementing infection control practices in clinic (OR 2.10 (95% CI: 1.12-3.89)). CONCLUSIONS Over 20% of Ontario FP respondents were considering retiring earlier by the third-wave of the COVID-19 pandemic. Supporting FPs in their clinical and non-clinical roles, such that they feel able to provide good care and that their work is valued, reducing non-clinical (e.g., administrative) responsibilities, dealing with pandemic-related fears, and supporting infection control practices and personal protective equipment acquisition in clinic, particularly in those aged 50 years or older may help increase family physician retention during future pandemics.
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Affiliation(s)
- Rachel Walsh
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Deanna Telner
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Michael Garron Hospital, Toronto, ON, Canada
| | - Debra A Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Scarborough Health Network, Scarborough, ON, Canada
| | - Paul Krueger
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen Fleming
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Aakriti Pyakurel
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, North York General Hospital, Toronto, ON, Canada
| | - Liisa Jaakkimainen
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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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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18
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Petrie S, Laur C, Rios P, Suarez A, Makanjuola O, Burke E, Bhattacharyya O, Mukerji G. Quality measures of virtual care in ambulatory healthcare environments: a scoping review. BMJ Open 2024; 14:e078214. [PMID: 38569716 PMCID: PMC10989112 DOI: 10.1136/bmjopen-2023-078214] [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] [Received: 07/27/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES Delivery of virtual care increased throughout the COVID-19 pandemic and persisted after physical distancing measures ended. However, little is known about how to measure the quality of virtual care, as current measures focus on in-person care and may not apply to a virtual context. This scoping review aims to understand the connections between virtual care modalities used with ambulatory patient populations and quality measures across the Quintuple Aim (provider experience, patient experience, per capita cost, population health and health equity). DESIGN Virtual care was considered any interaction between patients and/or their circle of care occurring remotely using any form of information technology. Five databases (MEDLINE, Embase, PsycInfo, Cochrane Library, JBI) and grey literature sources (11 websites, 3 search engines) were searched from 2015 to June 2021 and again in August 2022 for publications that analysed virtual care in ambulatory settings. Indicators were extracted, double-coded into the Quintuple Aim framework; patient and provider experience indicators were further categorised based on the National Academy of Medicine quality framework (safety, effectiveness, patient-centredness, timeliness, efficiency and equity). Sustainability was added to capture the potential for continued use of virtual care. RESULTS 13 504 citations were double-screened resulting in 631 full-text articles, 66 of which were included. Common modalities included video or audio visits (n=43), remote monitoring (n=11) and mobile applications (n=11). The most common quality indicators were related to patient experience (n=58 articles), followed by provider experience (n=25 articles), population health outcomes (n=23 articles) and health system costs (n=19 articles). CONCLUSIONS The connections between virtual care modalities and quality domains identified here can inform clinicians, administrators and other decision-makers how to monitor the quality of virtual care and provide insights into gaps in current quality measures. The next steps include the development of a balanced scorecard of virtual care quality indicators for ambulatory settings to inform quality improvement.
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Affiliation(s)
- Samuel Petrie
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Celia Laur
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Patricia Rios
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Ally Suarez
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Oluwatoni Makanjuola
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Emeralda Burke
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Onil Bhattacharyya
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Sikka V, King C, Klinker S, Mont T, Sommers-Olson B, Hunt BE, Davis S, Fonseca J. Telemedicine for veterans in the setting of the COVID-19 pandemic: Lessons learned from a virtual urgent care center. J Telemed Telecare 2024; 30:514-518. [PMID: 34970932 DOI: 10.1177/1357633x211069018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Although telemedicine was predominantly adopted during the COVID-19 pandemic, its impact on healthcare outcomes in the veteran population in achieving first contact resolution, or the ability to safely manage patient care at home from an urgent care perspective, is yet to be determined. METHODS This study included 13,090 veteran patient episodes who presented to the Department of Veteran's Affairs Veterans Integrated Services Network 8's Clinical Contact Center, a virtual urgent care organization covering South Georgia, Florida, and U.S. Virgin Islands in providing episodic care, between March 2020 and February 2021. Multivariate logistic regression estimated the probability that veterans with COVID-19-related symptoms stayed at home compared to presenting to the emergency department (ED) or their primary care provider. RESULTS Patients with COVID-related symptoms were 33% less likely to present to the ED compared to patients who presented with non-COVID-related symptoms. DISCUSSION The virtual urgent care center enabled veterans to receive timely care and avoid public places that could potentially lead to a COVID-19 infection or infecting others.
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Affiliation(s)
- Veronica Sikka
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Christian King
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
- Orlando VA Healthcare System, Orlando, FL, USA
| | - Suzanne Klinker
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | - Theresa Mont
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | | | - Bruce E Hunt
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Stacey Davis
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | - Jennifer Fonseca
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
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20
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Verweel L, Packham T, Goldstein R, Brooks D, MacKay C. Implementation of virtual pulmonary rehabilitation during the COVID-19 pandemic: Experiences and perceptions of patients and healthcare providers. Respir Med 2024; 225:107588. [PMID: 38460709 DOI: 10.1016/j.rmed.2024.107588] [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] [Received: 11/29/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Pulmonary rehabilitation (PR) plays an important role in the management of symptomatic patients with chronic respiratory diseases (CRD). While studies have investigated the feasibility and efficacy of virtual PR (VPR), it is important to understand the experiences of patients and healthcare providers (HCPs) during the rapid digital health transformation that occurred in the COVID-19 pandemic. OBJECTIVES To explore the experiences and perspectives of patients and HCPs who participated in VPR during the pandemic. METHODS Semi-structured interviews were conducted with CRD patients and HCPs. This study used a qualitative descriptive approach and a team-based inductive thematic analysis. RESULTS Participants included 11 HCPs (7 female; 29-55 years) and 19 CRD patients (11 male; 62-83 years; 15 COPD, 4 COPD/ILD). Three major themes and 10 subthemes were identified: i) the pandemic response: a 'trial by fire' (navigating uncertainty, emotional impact of change, shifting practice amid complexity); ii) beyond the emergency: navigating a 'new normal' (eligibility and assessment for VPR, virtual exercise, virtual education and resources, clinical supervision and patient safety); and iii) care beyond boundaries: the implications of using technology for PR (benefits and limitations of technology, psychosocial implications, VPR in the future). CONCLUSION The pivot to VPR was acknowledged as positive by both patients and HCPs although both groups were mindful of the implementation challenges. These findings provide insight into the experience of HCPs and patients in introducing VPR in response to the pandemic and will inform future implementation of VPR for individuals with CRD.
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Affiliation(s)
- L Verweel
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada.
| | - T Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - R Goldstein
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada; Departments of Medicine and Physical Therapy, University of Toronto, Toronto, Canada
| | - D Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada
| | - C MacKay
- West Park Healthcare Centre, Toronto, Canada; Departments of Medicine and Physical Therapy, University of Toronto, Toronto, Canada
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Shaw J, Glover W. The Political Economy of Digital Health Equity: Structural Analysis. J Med Internet Res 2024; 26:e46971. [PMID: 38530341 PMCID: PMC11005444 DOI: 10.2196/46971] [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: 03/03/2023] [Revised: 06/30/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wiljeana Glover
- Technology, Operations, and Information Management Division, Babson College, Wellesley, MA, United States
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22
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De La Torre A, Diaz P, Perdomo R. Analysis of the virtual healthcare model in Latin America: a systematic review of current challenges and barriers. Mhealth 2024; 10:20. [PMID: 38689618 PMCID: PMC11058594 DOI: 10.21037/mhealth-23-47] [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: 08/19/2023] [Accepted: 12/03/2023] [Indexed: 05/02/2024] Open
Abstract
Background The virtual care model can be used in all aspects of healthcare, such as prevention, diagnosis, treatment, and follow-up of most medical and surgical conditions. The objective of this study was to identify the current barriers to implementing and consolidating the virtual healthcare model, of "telemedicine", in Latin American countries. Methods A systematic review was conducted through four databases: PubMed, Scopus, Web of Science, and Virtual Health, including articles in Spanish, Portuguese, and English. A combination of Boolean operators was used with the terms "telemedicine", "telehealth", "telecare", "home care services", "remote care" and the name of each Latin American country. Articles published from January 2020 to January 2023 that reported on the barriers and challenges of using the virtual care model were included. Results Nineteen articles were included. Brazil (n=5) and Argentina (n=4) were the countries where there was the greatest interest to explore barriers to virtual care. The barriers identified were categorized into five main themes: (I) technological and technical issues; (II) absence of a physical examination; (III) patient's negative perceptions; (IV) negative perceptions among healthcare professionals; and (V) structural obstacles and those associated with the healthcare system. The main obstacles reported were connectivity problems, lack of a complete physical examination, issues of privacy, high risk of medical malpractice, and absence of local regulation. Conclusions The virtual care model is a safe and cost-effective alternative for the delivery of health services, with multiple benefits for patients and their families. The indication for the use of virtual care should be based on a risk model for patient prioritization. Likewise, the analysis of the main barriers and benefits is fundamental to consolidating this model of care and ensuring its expansion in the region.
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23
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Santosh R, Mohammed YN, Rahaman Z, Khurana S. The Role of Telemedicine in Enhancing Chronic Kidney Disease (CKD) Management and Dialysis Care. Cureus 2024; 16:e55816. [PMID: 38590481 PMCID: PMC10999887 DOI: 10.7759/cureus.55816] [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: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
Telemedicine has emerged as a transformative solution in the realm of healthcare, particularly in addressing the complexities and challenges associated with chronic kidney disease (CKD) and dialysis care. This editorial explores the potential of telemedicine in revolutionizing the management and treatment of kidney diseases, highlighting its role in mitigating the burdens faced by healthcare systems worldwide. With the advent of high-quality audio and visual platforms, telemedicine has facilitated remote healthcare delivery, enabling healthcare professionals to provide exceptional care from a distance. This is particularly relevant in the context of CKD and end-stage kidney disease (ESKD) patients, where the need for continuous care and monitoring is critical. This editorial underscored the escalating incidence of ESKD, driven by prevalent risk factors, such as diabetes, hypertension, and obesity, and the disparities in access to treatments among different populations. The integration of telemedicine in CKD and dialysis care presents a pathway toward a more accessible, efficient, and cost-effective healthcare delivery. It offers numerous benefits, including the convenience of remote monitoring, enhanced patient compliance, reduced healthcare costs, and improved patient satisfaction and quality of life. Telemedicine facilitates a multidisciplinary approach to care, allowing for timely intervention and follow-ups, which are crucial for patients undergoing dialysis. Moreover, the COVID-19 pandemic has accelerated the adoption of telemedicine, showcasing its effectiveness in maintaining continuity of care amid restrictions on patient contact. Despite its promising potential, its implementation of telemedicine faces several challenges, including regulatory hurdles, concerns about the security of medical information, and the adequacy of virtual platforms to capture crucial health indicators. In addition, the financial implications of telemedicine and its long-term sustainability remain areas requiring further investigation. In conclusion, telemedicine holds significant promise in enhancing the care and management of CKD and dialysis patients. It offers a vital solution to overcome the geographical barrier, improve access to care, and alleviate the strain on healthcare systems. However, further research is needed to fully understand its benefits compared to traditional care models and to address the challenges associated with implementation. The expansion of telemedicine in kidney care signifies a step toward a more inclusive, efficient, and patient-centered healthcare future.
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Affiliation(s)
| | - Yaqub Nadeem Mohammed
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Zubair Rahaman
- Internal Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Sakshi Khurana
- Radiology, New York Presbyterian/Columbia University Irving Medical Center, New York, USA
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24
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Babaei N, Zamanzadeh V, Valizadeh L, Lotfi M, Kousha A, Samad-Soltani T, Avazeh M. Virtual care in the health care system: A concept analysis. Scand J Caring Sci 2024; 38:35-46. [PMID: 38009448 DOI: 10.1111/scs.13227] [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: 08/05/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Health care providers need a better understanding of virtual care to recognise and use it for service delivery. AIM To provide a more comprehensive definition of the concept of virtual care. METHOD This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases. RESULTS The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services. CONCLUSION Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.
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Affiliation(s)
- Nasib Babaei
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Kousha
- Department of Health Education and Health Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marziyeh Avazeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Hedden L, Spencer S, Mathews M, Gard Marshall E, Lukewich J, Asghari S, Gill P, McCracken RK, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, Schacter G. "Technology has allowed us to do a lot more but it's not necessarily the panacea for everybody": Family physician perspectives on virtual care during the COVID-19 pandemic and beyond. PLoS One 2024; 19:e0296768. [PMID: 38422067 PMCID: PMC10903916 DOI: 10.1371/journal.pone.0296768] [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: 07/05/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Early in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments. Our objective was to explore Canadian family physicians' perspectives on the strengths and limitations of virtual care implementation for their patient populations during the COVID-19 pandemic and implications for the integration of virtual care into broader primary care practice. METHODS We conducted semi-structured qualitative interviews with family physicians working in four Canadian jurisdictions (Vancouver Coastal health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region, Newfoundland and Labrador). We analyzed interview data using a structured applied thematic approach. RESULTS We interviewed 68 family physicians and identified four distinct themes during our analysis related to experiences with and perspectives on virtual care: (1) changes in access to primary care; (2) quality and efficacy of care provided virtually; (3) patient and provider comfort with virtual modalities; and (4) necessary supports for virtual care moving forward. CONCLUSIONS The move to virtual care enhanced access to care for select patients and was helpful for family physicians to better manage their panels. However, virtual care also created access challenges for some patients (e.g., people who are underhoused or living in areas without good phone or internet access) and for some types of care (e.g., care that required access to medical devices). Family physicians are optimistic about the ongoing integration of virtual care into broader primary care delivery, but guidance, regulations, and infrastructure investments are needed to ensure equitable access and to maximize quality of care.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Paul Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rita K. McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Devlin MK, McIntyre NJ, Ramer MD, Kwon YH, Nicholson JM, Mrkobrada M, Kronick J, Calvin JE, Spicer E. Applying the lessons of design thinking: a unique programme of care for acutely unwell, community-dwelling COVID-19 patients. BMJ Open Qual 2024; 13:e002500. [PMID: 38413092 PMCID: PMC10900416 DOI: 10.1136/bmjoq-2023-002500] [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: 07/15/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic limited access to primary care and in-person assessments requiring healthcare providers to re-envision care delivery for acutely unwell outpatients. Design thinking methodology has the potential to support the robust evolution of a new clinical model. AIM To demonstrate how design thinking methodology can rapidly and rigorously create and evolve a safe, timely, equitable and patient-centred programme of care, and to share valuable lessons for effective implementation of design thinking solutions to address complex problems. METHOD We describe how design thinking methodology was employed to create a new clinical model of care. Using the example of a novel telemedicine programme to support acutely unwell, community-dwelling COVID-19-positive patients called the London Urgent COVID-19 Care Clinic (LUC3), we show how continuous quality outcomes (safety, timeliness, equity and patient-centredness), as well as patient experience survey responses, can drive iterative changes in programme delivery. RESULTS The inspiration phase identified four key needs for this patient population: monitoring COVID-19 signs and symptoms; self-managing COVID-19 symptoms; managing other comorbidities in the setting of COVID-19; and escalating care as needed. Guided by these needs, a cross-disciplinary stakeholder group was engaged in the ideation and implementation phases to create a unique and comprehensive telemedicine programme (LUC3). During the implementation phase, LUC3 assessed 2202 community-based patients diagnosed with acute COVID-19; the collected quality outcomes and end-user feedback led to evolution of programme delivery. CONCLUSION Design thinking methodology provided an essential framework and valuable lessons for the development of a safe, equitable, timely and patient-centred telemedicine care programme. The lessons learnt here-the importance of inclusive collaboration, using empathy to guide equity-focused interventions, leveraging continuous metrics to drive iteration and aiming for good-if-not-perfect plans-can serve as a road map for using design thinking for targeted healthcare problems.
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Affiliation(s)
- Megan K Devlin
- Division of Infectious Diseases, Department of Medicine, Western University, London, Ontario, Canada
- Infectious Diseases Care Program, St Joseph's Health Care London, London, Ontario, Canada
| | - Natasha J McIntyre
- Centre for Quality, Innovation and Safety, Western University, London, Ontario, Canada
| | - Matthew D Ramer
- Faculty of Health Sciences and Wellness, Humber College Institute of Technology and Advanced Learning, Toronto, Ontario, Canada
| | - Young Han Kwon
- Centre for Quality, Innovation and Safety, Western University, London, Ontario, Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - Marko Mrkobrada
- Division of General Internal Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Jami Kronick
- Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - James E Calvin
- Centre for Quality, Innovation and Safety, Western University, London, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
| | - Erin Spicer
- Centre for Quality, Innovation and Safety, Western University, London, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, Western University, London, Ontario, Canada
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Zhao QJ, Rozenberg D, Nourouzpour S, Orchanian-Cheff A, Flannery J, Kaul R, Agbeyaka S, Barber M, dePeiza P, Maria Doumouras A, Draper H, Gebara N, Lau J, Liberman D, Luther RA, Sanh M, Furlan AD. Positive impact of a telemedicine education program on practicing health care workers during the COVID-19 pandemic in Ontario, Canada: A mixed methods study of an Extension for Community Healthcare Outcomes (ECHO) program. J Telemed Telecare 2024; 30:365-380. [PMID: 34962167 DOI: 10.1177/1357633x211059688] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In addition to shifting and expanding clinical responsibilities, rapidly evolving information and guidelines during the COVID-19 pandemic has made it difficult for health care workers (HCW) to synthesise and translate COVID-19 information into practice. This study evaluated whether a COVID-19-specific telemedicine education program (ECHO COVID) would impact health care workers' self-efficacy and satisfaction in the management of patients with COVID-19. METHODS A prospective mixed methods parallel-design study was conducted among ECHO COVID participants using pre-post questionnaires and a focus group discussion. Questionnaire results were examined for changes in health care workers' self-efficacy and satisfaction. Focus group discussion data were analysed to explore health care workers' experience in ECHO COVID and the context of their practice during the COVID-19 pandemic. RESULTS 239 health care workers registered in ECHO COVID and 114 (47.7%) completed questionnaires and attended at least one ECHO COVID session. Median self-efficacy scores increased from 5 (IQR 4-6) to 6 (IQR 6-6) (p < 0.0001), independent of profession, years in practice, age group, or practice environment. Participants were highly satisfied with ECHO COVID sessions with a median score of 4 (IQR 4-5). Focus group discussion data indicated that health care workers gained knowledge through ECHO COVID and revealed facilitators for ECHO COVID program success, including the transition to virtual care, the practicability of knowledge provided, and a 'perspective from the trenches.' DISCUSSION This study demonstrated that a telemedicine education program aimed to support health care workers in managing patients with COVID-19 had a positive impact on health care workers' self-efficacy and satisfaction. This impact was specifically mediated by the ECHO COVID program.
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Affiliation(s)
- Q Jane Zhao
- ECHO at UHN, University Health Network, Toronto, Canada
| | - Dmitry Rozenberg
- ECHO at UHN, University Health Network, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
| | | | - Ani Orchanian-Cheff
- ECHO at UHN, University Health Network, Toronto, Canada
- Library and Information Services, University Health Network, Toronto, Canada
| | - John Flannery
- ECHO at UHN, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
| | - Rupert Kaul
- ECHO at UHN, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
| | | | - Mary Barber
- ECHO at UHN, University Health Network, Toronto, Canada
| | | | | | - Haley Draper
- ECHO at UHN, University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Nadine Gebara
- ECHO at UHN, University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Jenny Lau
- ECHO at UHN, University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Dan Liberman
- Department of Medicine, McGill University
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Ryan A Luther
- ECHO at UHN, University Health Network, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
| | - Monica Sanh
- ECHO at UHN, University Health Network, Toronto, Canada
- Library and Information Services, University Health Network, Toronto, Canada
| | - Andrea D Furlan
- ECHO at UHN, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canda
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Russell JA. Innocent bystanders: effects of the COVID-19 pandemic on non-COVID-19 critical illness outcomes. Thorax 2024; 79:101-103. [PMID: 38050148 DOI: 10.1136/thorax-2023-220431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 12/06/2023]
Affiliation(s)
- James A Russell
- Division of Critical Care Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Halas G, Baldwin A, Mackay K, Cardenas E, LaBine L, Cherrett P, Abraham L, Fogarty V, Singer A, Katz A, Kirby S. Patients' and caregivers' experiences of virtual care in a primary care setting during the COVID-19 pandemic: A patient-oriented research study. Digit Health 2024; 10:20552076241232949. [PMID: 38410792 PMCID: PMC10896066 DOI: 10.1177/20552076241232949] [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] [Received: 09/01/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
Objective This study explored patient and caregiver expectations and experiences of virtual primary care in Manitoba, Canada. This study focused on accessibility of care, acceptability and perceptions of quality from 'users' of primary healthcare services. Due to the rapid implementation of virtual primary care during the COVID-19 pandemic in Canada, patient/public input was largely bypassed. Methods A mixed method was conducted in collaboration with Patient and Caregiver Community Advisors. Data was obtained from 696 surveys and 9 focus groups (n = 41 patients and caregivers). Results Data suggest good acceptance of virtual visits, although considered a new experience despite almost exclusive use of the telephone. Participants preferred more input for choosing the type of visit but experienced less stress, time and inconvenience by using virtual care. There were mixed opinions of quality. More complex visits were associated with incomplete consultations and serve as one exemplar of the limitations due to lack of physical presence or contact. Unique communication skills were required to convey health concerns adequately and accurately. A more transactional approach was perceived from the lack of visual cues and the awkwardness associated with pauses during the phone conversation. Virtual care may be better used for certain circumstances but should encompass patient-centred decision making for when and how. Many expressed interests in video options; technology access and user ability are additional considerations for advancing virtual care. Conclusions The experiences and recommendations from patients and caregivers provide an important contribution to decision-making and integrating and sustaining quality virtual care for patient-centered healthcare service delivery. Keywords: Virtual care experiences, primary care, patient-oriented research, mixed methods, COVID-19.
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Affiliation(s)
- Gayle Halas
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alanna Baldwin
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Ernesto Cardenas
- Rady Faculty of Health Sciences, Dept of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Lisa LaBine
- Rady Faculty of Health Sciences, Dept of Family Medicine, University of Manitoba, Winnipeg, Canada
| | | | | | | | - Alexander Singer
- Rady Faculty of Health Sciences, Dept of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Rady Faculty of Health Sciences, Dept of Family Medicine, University of Manitoba, Winnipeg, Canada
- Rady Faculty of Health Sciences, Dept of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarah Kirby
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada
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Rouleau G, Wu K, Parry M, Richard L, Desveaux L. Providing compassionate care in a virtual context: Qualitative exploration of Canadian primary care nurses' experiences. Digit Health 2024; 10:20552076231224072. [PMID: 38205037 PMCID: PMC10777765 DOI: 10.1177/20552076231224072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Objective Virtual care presents a promising opportunity to create new communication channels and increase access to healthcare. However, concerns have been raised around the potential for unintended emotional distances created through virtual care environments that could strain patient-provider relationships. While compassionate care is an enabler of emotional connectivity and a core tenant of nursing, little is known about whether or how nurses have adapted their compassion skills into virtual interactions. These concerns are particularly relevant in primary care, where there is a focus on relational continuity (i.e. relationship-based, longitudinal care) and a broad uptake of virtual care. The aim of this study was to explore the meaning of compassionate virtual care and to uncover how nurses operationalized compassionate care through virtual interactions in primary care. Methods We used a qualitative interpretive descriptive lens to conduct semistructured interviews with primary care nurses (Ontario, Canada) who had provided virtual care (i.e. video visits, remote patient monitoring, or asynchronous messaging). We used a thematic approach to analyze the data. Results We interviewed 18 nurse practitioners and two registered nurses. Participants described how: (1) compassionate care was central to nursing practice, (2) compassionate care was evolving through virtual nurse-patient interaction, and (3) nurses balanced practice with patients' expectations while providing virtual compassionate care. Conclusions There is an opportunity to better align nurses' understanding and operationalization of compassionate care in virtual primary care contexts. Exploring how compassionate care is operationalized in primary care settings is a necessary first step to building compassionate competencies across the nursing profession to support the continued virtual evolution of health service delivery.
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Affiliation(s)
- Geneviève Rouleau
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
- Nursing Department, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Kelly Wu
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | - Monica Parry
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lauralie Richard
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Laura Desveaux
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Kidholm K, Jensen LK, Johansson M, Montori VM. Telemedicine and the assessment of clinician time: a scoping review. Int J Technol Assess Health Care 2023; 40:e3. [PMID: 38099431 PMCID: PMC10859839 DOI: 10.1017/s0266462323002830] [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] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Telemedicine may improve healthcare access and efficiency if it demands less clinician time than usual care. We sought to describe the degree to which telemedicine trials assess the effect of telemedicine on clinicians' time and to discuss how including the time needed to treat (TNT) in health technology assessment (HTA) could affect the design of telemedicine services and studies. METHODS We conducted a scoping review by searching clinicaltrials.gov using the search term "telemedicine" and limiting results to randomized trials or observational studies registered between January 2012 and October 2023. We then reviewed trial registration data to determine if any of the outcomes assessed in the trials measured effect on clinicians' time. RESULTS We found 113 studies and of these 78 studies of telemedicine met the inclusion criteria and were included. Nine (12 percent) of the 78 studies had some measure of clinician time as a primary outcome, and 11 (14 percent) as a secondary outcome. Four studies compared direct measures of TNT with telemedicine versus usual care, but no statistically significant difference was found. Of the sixteen studies including indirect measures of clinician time, thirteen found no significant effects, two found a statistically significant reduction, and one found a statistically significant increase. CONCLUSIONS This scoping review found that clinician time is not commonly measured in studies of telemedicine interventions. Attention to telemedicine's TNT in clinical studies and HTAs of telemedicine in practice may bring attention to the organization of clinical workflows and increase the value of telemedicine.
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Affiliation(s)
- Kristian Kidholm
- Center for Innovative Medical Technology, Odense University Hospital and University of Southern Denmark, Denmark
| | - Lise Kvistgaard Jensen
- Center for Innovative Medical Technology, Odense University Hospital and University of Southern Denmark, Denmark
| | - Minna Johansson
- Global Center for Sustainable Healthcare, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Victor M Montori
- Department of Medicine, Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, MN, USA
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Wong H, Razvi Y, Hamid MA, Mistry N, Filler G. Age and sex-related comparison of referral-based telemedicine service utilization during the COVID-19 pandemic in Ontario: a retrospective analysis. BMC Health Serv Res 2023; 23:1374. [PMID: 38062437 PMCID: PMC10704790 DOI: 10.1186/s12913-023-10373-2] [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: 02/06/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to increased utilization of telemedicine services. METHODS A retrospective analysis of all referral-based ambulatory telemedicine services in Ontario from November 2019 to June 2021 was collected from the Ontario Health Insurance Plan (OHIP) billing database. Only fee-for-service billings were included in the present analysis. Coincident COVID-19 cases were obtained from Public Health Ontario. Comparisons were made based on age bracket, sex, telemedicine and in-person care. RESULTS Billings for telemedicine services in Ontario increased from $1.7 million CAD in November 2019 to $64 million CAD in April 2020 and the proportions reached a mean peak of 72% in April 2020 and declined to 46% in June 2021. A positive correlation was found between the use of telemedicine and COVID-19 cases (p = 0.05). The age group with the highest proportion of telemedicine use was the 10-20-year-olds, followed by the 20-50-year-olds (61 ± 9.0%, 55 ± 7.3%, p = 0.01). Both age groups remained above 50% telemedicine services at the end of the study period. There seemed to be higher utilization by females (females 54.2 ± 8.0%, males 47.9 ± 7.7%, ANCOVA p = 0.05) for all specialties, however, after adjusting for male to female ratio m:f of 0.952:1.0 according to the 2016 census, this was no longer significant. CONCLUSIONS The use of telemedicine services remained at a high level across groups, particularly the 10-50-year-olds. There were clear age preferences for using telemedicine. Studying these differences may provide insights into how the delivery of non-hospital-based medicine has changed during the COVID-19 pandemic.
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Affiliation(s)
- Hubert Wong
- Department of Pediatrics, Scarborough Health Network, 2867 Ellesmere Rd, Scarborough, Toronto, ON, M1E 4B9, Canada.
| | - Yasmeen Razvi
- University of Toronto Temerty School of Medicine, Toronto, ON, Canada
| | | | - Niraj Mistry
- Department of Pediatrics, Scarborough Health Network, 2867 Ellesmere Rd, Scarborough, Toronto, ON, M1E 4B9, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Guido Filler
- Department of Paediatrics, Western University, London, ON, Canada
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Shuldiner J, Srinivasan D, Desveaux L, Hall JN. The Implementation of a Virtual Emergency Department: Multimethods Study Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework. JMIR Form Res 2023; 7:e49786. [PMID: 38051562 PMCID: PMC10731546 DOI: 10.2196/49786] [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: 06/09/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND While the COVID-19 pandemic dramatically increased virtual care uptake across many health settings, it remains significantly underused in urgent care. OBJECTIVE This study evaluated the implementation of a pilot virtual emergency department (VED) at an Ontario hospital that connected patients to emergency physicians through a web-based portal. We sought to (1) assess the acceptability of the VED model, (2) evaluate whether the VED was implemented as intended, and (3) explore the impact on quality of care, access to care, and continuity of care. METHODS This evaluation used a multimethods approach informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included semistructured interviews with patients and physicians as well as postvisit surveys from patients. Interviews were transcribed and analyzed using thematic analysis. Data from the surveys were described using summary statistics. RESULTS From December 2020 to December 2021, the VED had a mean of 153 (SD 25) visits per month. Among them, 67% (n=677) were female, and 75% (n=758) had a family physician. Patients reported that the VED provided high-quality, timely access to care and praised the convenience, shorter appointments, and benefit of the calm, safe space afforded through virtual appointments. In instances where patients were directed to come into the emergency department (ED), physicians were able to provide a "warm handoff" to improve efficiency. This helped manage patient expectations, and the direct advice of the ED physician reassured them that the visit was warranted. There was broad initial uptake of VED shifts among ED physicians with 60% (n=22) completing shifts in the first 2 months and 42% (n=15) completing 1 or more shifts per month over the course of the pilot. There were no difficulties finding sufficient ED physicians for shifts. Most physicians enjoyed working in the VED, saw value for patients, and were motivated by patient satisfaction. However, some physicians were hesitant as they felt their expertise and skills as ED physicians were underused. The VED was implemented using an iterative staged approach with increased service capabilities over time, including access to ultrasounds, virtual follow-ups after a recent ED visit, and access to blood work, urine tests, and x-rays (at the hospital or a local community laboratory). Physicians recognized the value in supporting patients by advising on the need for an in-person visit, booking a diagnostic test, or referring them to a specialist. CONCLUSIONS The VED had the support of physicians and facilitated care for low-acuity presentations with immediate benefits for patients. It has the potential to benefit the health care system by seeing patients through the web and guiding patients to in-person care only when necessary. Long-term sustainability requires a focus on understanding digital equity and enhanced access to rapid testing or investigations.
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Affiliation(s)
- Jennifer Shuldiner
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Diya Srinivasan
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - Justin N Hall
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Lapointe-Shaw L, Salahub C, Austin PC, Bai L, Bhatia RS, Bird C, Glazier RH, Hedden L, Ivers NM, Martin D, Shuldiner J, Spithoff S, Tadrous M, Kiran T. Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use. JAMA Netw Open 2023; 6:e2349452. [PMID: 38150254 PMCID: PMC10753397 DOI: 10.1001/jamanetworkopen.2023.49452] [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] [Received: 08/23/2023] [Accepted: 11/13/2023] [Indexed: 12/28/2023] Open
Abstract
Importance Virtual visits became more common after the COVID-19 pandemic, but it is unclear in what context they are best used. Objective To investigate whether there was a difference in subsequent emergency department use between patients who had a virtual visit with their own family physician vs those who had virtual visits with an outside physician. Design, Setting, and Participants This propensity score-matched cohort study was conducted among all Ontario residents attached to a family physician as of April 1, 2021, who had a virtual family physician visit in the subsequent year (to March 31, 2022). Exposure The type of virtual family physician visit, with own or outside physician, was determined. In a secondary analysis, own physician visits were compared with visits with a physician working in direct-to-consumer telemedicine. Main Outcome and Measure The primary outcome was an emergency department visit within 7 days after the virtual visit. Results Among 5 229 240 Ontario residents with a family physician and virtual visit, 4 173 869 patients (79.8%) had a virtual encounter with their own physician (mean [SD] age, 49.3 [21.5] years; 2 420 712 females [58.0%]) and 1 055 371 patients (20.2%) had an encounter with an outside physician (mean [SD] age, 41.8 [20.9] years; 605 614 females [57.4%]). In the matched cohort of 1 885 966 patients, those who saw an outside physician were 66% more likely to visit an emergency department within 7 days than those who had a virtual visit with their own physician (30 748 of 942 983 patients [3.3%] vs 18 519 of 942 983 patients [2.0%]; risk difference, 1.3% [95% CI, 1.2%-1.3%]; relative risk, 1.66 [95% CI, 1.63-1.69]). The increase in the risk of emergency department visits was greater when comparing 30 216 patients with definite direct-to-consumer telemedicine visits with 30 216 patients with own physician visits (risk difference, 4.1% [95% CI, 3.8%-4.5%]; relative risk, 2.99 [95% CI, 2.74-3.27]). Conclusions and Relevance In this study, patients whose virtual visit was with an outside physician were more likely to visit an emergency department in the next 7 days than those whose virtual visit was with their own family physician. These findings suggest that primary care virtual visits may be best used within an existing clinical relationship.
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Affiliation(s)
- Lauren Lapointe-Shaw
- University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | | | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Li Bai
- ICES, Toronto, Ontario, Canada
| | - R. Sacha Bhatia
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Cardiology, University Health Network, Toronto, Ontario, Canada
| | | | - Richard H. Glazier
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Noah M. Ivers
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Danielle Martin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Jennifer Shuldiner
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Mina Tadrous
- ICES, Toronto, Ontario, Canada
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tara Kiran
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community 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, Unity Health Toronto, Toronto, Ontario, Canada
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Madrazo L, Zhang G, Bishop KA, Appleton A, Joneja M, Goldszmidt M. "It's What We Can Do Right Now": Professional Identity Formation Among Internal Medicine Residents During the COVID-19 Pandemic. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1428-1433. [PMID: 37683270 DOI: 10.1097/acm.0000000000005452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
PURPOSE The COVID-19 pandemic represents a consequential moment of disruption for medical training that has far-reaching implications for professional identity formation (PIF). To date, this has not been studied. As medical education grapples with a postpandemic era, it is essential to gain insight into how the pandemic has influenced PIF to better support its positive influences and mitigate its more detrimental effects. This study examined how PIF occurred during the COVID-19 pandemic to better adapt future medical training. METHOD Constructivist grounded theory guided the iterative data collection and analyses. The authors conducted semistructured group interviews with 24 Ontario internal medicine residents in postgraduate years (PGYs) 1 to 3 between November 2020 and July 2021. Participants were asked to reflect on their day-to-day clinical and learning experiences during the pandemic. RESULTS Twenty-four internal medicine residents were interviewed (12 PGY-1 [50.0%], 9 PGY-2 [37.5%], and 3 PGY-3 [12.5%]). Participants described how navigating patient care and residency training through the pandemic consistently drew their attention to various system problems. How participants responded to these problems was shaped by an interplay among their personal values, their level of personal wellness or burnout, self-efficacy, institutional values, and the values of their supervisors and work community. As they were influenced by these factors, some were led toward acting on the problem(s) they identified, whereas others had a sense of resignation and deferred action. These interactions were evident in participants' experiences with communication, advocacy, and learning. CONCLUSIONS Residents' professional identities are continuously shaped by how they perceive, reconcile, and address various challenges. As residents navigate tensions between personally held values and apparent system values, individuals in supervisory positions should be mindful of their influence as role models who empower values and practices that are recognized by participants to be important aspects of physician identity.
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Braund H, Dalgarno N, Chan-Nguyen S, Digby G, Haji F, O'Riordan A, Appireddy R. Exploring Patient Advisors' Perceptions of Virtual Care Across Canada: Qualitative Phenomenological Study. J Med Internet Res 2023; 25:e45215. [PMID: 37995127 PMCID: PMC10704306 DOI: 10.2196/45215] [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: 12/21/2022] [Revised: 06/19/2023] [Accepted: 07/31/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND While virtual care services existed prior to the emergence of COVID-19, the pandemic catalyzed a rapid transition from in-person to virtual care service delivery across the Canadian health care system. Virtual care includes synchronous or asynchronous delivery of health care services through video visits, telephone visits, or secure messaging. Patient advisors are people with patient and caregiving experiences who collaborate within the health care system to share insights and experiences in order to improve health care. OBJECTIVE This study aimed to understand patient advisors' perceptions related to virtual care and potential impacts on health care quality. METHODS We adopted a phenomenological approach, whereby we interviewed 20 participants who were patient advisors across Canada using a semistructured interview protocol. The protocol was developed by content experts and medical education researchers. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data collection stopped once thematic saturation was reached. The study was conducted at Queen's University, Kingston, Ontario. We recruited 20 participants from 5 Canadian provinces (17 female participants and 3 male participants). RESULTS Six themes were identified: (1) characteristics of effective health care, (2) experiences with virtual care, (3) modality preferences, (4) involvement of others, (5) risks associated with virtual care encounters, and (6) vulnerable populations. Participants reported that high-quality health care included building relationships and treating patients holistically. In general, participants described positive experiences with virtual care during the pandemic, including greater efficiency, increased accessibility, and that virtual care was less stressful and more patient centered. Participants comparing virtual care with in-person care reported that time, scheduling, and content of interactions were similar across modalities. However, participants also shared the perception that certain modalities were more appropriate for specific clinical encounters (eg, prescription renewals and follow-up appointments). Perspectives related to the involvement of family members and medical trainees were positive. Potential risks included miscommunication, privacy concerns, and inaccurate patient assessments. All participants agreed that stakeholders should be proactive in applying strategies to support vulnerable patients. Participants also recommended education for patients and providers to improve virtual care delivery. CONCLUSIONS Participant-reported experiences of virtual care encounters were relatively positive. Future work could focus on delivering training and resources for providers and patients. While initial experiences are positive, there is a need for ongoing stakeholder engagement and evaluation to improve patient and caregiver experiences with virtual care.
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Affiliation(s)
- Heather Braund
- Office of Professional Development and Educational Scholarship, Health Sciences, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sophy Chan-Nguyen
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Geneviève Digby
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Faizal Haji
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne O'Riordan
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Mao L, Mohan G, Normand C. Use of information communication technologies by older people and telemedicine adoption during COVID-19: a longitudinal study. J Am Med Inform Assoc 2023; 30:2012-2020. [PMID: 37572310 PMCID: PMC10654849 DOI: 10.1093/jamia/ocad165] [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: 01/14/2023] [Revised: 07/15/2023] [Accepted: 08/11/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES To investigate how information communication technology (ICT) factors relate to the use of telemedicine by older people in Ireland during the pandemic in 2020. Furthermore, the paper tested whether the supply of primary care, measured by General Practitioner's (GP) accessibility, influenced people's telemedicine options. METHOD Based on 2 waves from The Irish Longitudinal Study on Ageing, a nationally representative sample, multivariate logistic models were applied to examine the association between pre-pandemic use of ICTs and telemedicine usage (GP, pharmacist, hospital doctor), controlling for a series of demographic, health, and socioeconomic characteristics. RESULTS Previously reported having Internet access was a statistically positive predictor for telemedicine usage. The availability of high-speed broadband Internet did not exhibit a statistical association. The association was more prominent among those under 70 years old and non-Dublin urban areas. People with more chronic conditions, poorer mental health, and private health insurance had higher odds of using telemedicine during the period of study. No clear pattern between telemedicine use and differential geographic access to GP was found. DISCUSSION The important role of ICT access and frequent engagement with the Internet in encouraging telemedicine usage among older adults was evidenced. CONCLUSION Internet access was a strong predictor for telemedicine usage. We found no evidence of a substitution or complementary relationship between telemedicine and in-person primary care access.
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Affiliation(s)
- Likun Mao
- Department of Economics, University of Aberdeen, King’s College, Aberdeen AB24 3FX, United Kingdom
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Trinity Central, Dublin D02 R590, Republic of Ireland
| | - Gretta Mohan
- Economic and Social Research Institute, Dublin 2 D02 K138, Republic of Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Republic of Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Kings College London, London SE5 9PJ, United Kingdom
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Livingston N, Lindahl A, McConnell J, Chouman A, Day CS. Do Orthopaedic Virtual Clinic Visits Demonstrate Cost and Time Efficiencies Compared With In-person Visits? Clin Orthop Relat Res 2023; 481:2080-2090. [PMID: 37624757 PMCID: PMC10566797 DOI: 10.1097/corr.0000000000002813] [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] [Received: 03/22/2023] [Accepted: 07/14/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND There are numerous reasons for the increased use of telemedicine in orthopaedic surgery, one of which is the perception that virtual visits are more cost-effective than in-person visits. However, to our knowledge, no studies have compared the cost and time investment of virtual versus in-person visits using the time-driven activity-based costing (TDABC) method. Unlike methods that estimate cost based on charges for services rendered, TDABC provides a more precise measurement of costs, which is essential for assessing cost-effective innovations and moving to value-based healthcare. QUESTIONS/PURPOSES (1) Are virtual visits less costly than analogous in-person visits, as measured by TDABC? (2) Does TDABC yield cost estimates that are lower or higher than the ratio of costs to charges (RCC), which is a simple, frequently used costing method? (3) Do the total time commitments of healthcare personnel, and that of the surgeon specifically, vary between the virtual and in-person settings? METHODS Patients for this prospective, observational study were recruited from the practices of the highest-volume virtual-visit surgeons of three subspecialties (joints, hand, and sports) in a multihospital, tertiary-care academic institution in a metropolitan area in the Midwestern United States. Each surgeon had at least 10 years of clinical practice. Between June 2021 and September 2021, we analyzed both in-person and virtual return visits with patients who had an established relationship with the surgeon, because this represented the most frequent type of virtual visits and enabled a direct comparison between the two settings. New patients were not included in the study because of the limited availability of new-patient virtual visits; such patients often benefit from in-person physical examinations and on-site imaging. Additionally, patients seen for routine postoperative care were excluded because they were primarily seen in person by a physician assistant. Data were acquired during this period until 90 in-person and 90 virtual visits were collected according to selection criteria; no patients were lost to follow-up. Distinct process maps, which represent the steps involved in a clinic visit used to measure healthcare personnel time invested, were constructed for in-person and virtual clinic visits and used to compare total personnel and surgeon time spent. To calculate TDABC-derived costs, time allocated by personnel to complete each step was measured and used to calculate cost based on each personnel member's yearly salary. From the accounting department of our hospital, we acquired RCC cost data according to the level of service for a return visit. RESULTS The total median cost, as measured by TDABC, was USD 127 (IQR USD 111 to 163) for an in-person visit and USD 140 (IQR USD 113 to 205) for a virtual visit (median difference USD 13; p = 0.16). RCC overestimated TDABC-calculated direct variable cost in five of six service levels (in-person levels 3, 4, and 5 and virtual levels 3 and 5) by a range of USD 25 to 88. Additionally, we found that virtual visits consumed 4 minutes less of total personnel time (in-person: 17 minutes [IQR 13.5 to 23.5 minutes], virtual: 13 minutes [IQR 11 to 19 minutes]; p < 0.001); however, this difference in personnel time did not equate to cost savings because surgeons spent 2 minutes longer on virtual visit activities than they did on in-person activities (in-person: 6 minutes [IQR 4.5 to 9.5 minutes], virtual: 8 minutes [IQR 5.5 to 13 minutes]; p = 0.003). CONCLUSION Orthopaedic virtual visits did not deliver cost savings compared with in-person visits because surgeons spent more time on virtual visits and participated in virtual visits at the clinical site. Additionally, as anticipated, RCC overestimated costs as calculated by TDABC. These findings suggest that cost is not a primary advantage of transitioning to virtual visits, and that factors such as patient preference and satisfaction should be considered instead. LEVEL OF EVIDENCE Level II, economic and decision analysis.
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Affiliation(s)
| | - Alex Lindahl
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Jack McConnell
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Ahmad Chouman
- Wayne State University School of Medicine, Detroit, MI, USA
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Chandrasekaran R, Bapat P, Jeripity Venkata P, Moustakas E. Do Patients Assess Physicians Differently in Video Visits as Compared with In-Person Visits? Insights from Text-Mining Online Physician Reviews. Telemed J E Health 2023; 29:1557-1565. [PMID: 36847352 DOI: 10.1089/tmj.2022.0507] [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] [Indexed: 03/01/2023] Open
Abstract
Introduction: Use of both in-person and video visits have become a common norm in health care delivery, especially after the COVID-19 pandemic. It is imperative to understand how patients feel about their providers and their experiences during in-person and video visits. This study examines the important factors that patients use in their reviews and differences in the relative importance. Methods: We performed sentiment analysis and topic modeling on online physician reviews from April 2020 to April 2022. Our dataset comprised 34,824 reviews posted by patients after completing in-person or video visits. Results: Sentiment analysis yielded 27,507 (92.69%) positive and 2,168 (7.31%) negative reviews for in-person visits, and 4,610 (89.53%) positive and 539 (10.47%) negative reviews for video visits. Topic modeling identified seven factors patients used in their reviews: Bedside manners, Medical Expertise, Communication, Visit Environment, Scheduling and Follow-up, Wait times, and Costs and insurance. Patients who gave positive reviews after in-person consultations more frequently mentioned communication, office environment and staff, and bedside manners. Those who gave negative reviews after in-person visits mentioned longer wait times, providers' office and staff, medical expertise, and costs and insurance problems. Patients with positive reviews after video visits emphasized communication, bedside manners, and medical expertise. However, patients posting negative reviews after video visits frequently mentioned problems with appointment scheduling and follow-up, medical expertise, wait times, costs and insurance, and technical problems in video visits. Conclusions: This study identified key factors that influence patients' assessment of their providers in in-person and video visits. Paying attention to these factors can help improve the overall patient experience.
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Affiliation(s)
- Ranganathan Chandrasekaran
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Biomedical and Health Information Systems, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Prathamesh Bapat
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Evangelos Moustakas
- Center for Innovation and Entrepreneurship, Middlesex University at Dubai, Dubai, United Arab Emirates
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Senthinathan A, Tadrous M, Hussain S, Craven BC, Jaglal SB, Moineddin R, Shepherd J, Cadel L, Noonan VK, McKay S, Tu K, Guilcher SJT. Examining the impact of COVID-19 on health care utilization among persons with chronic spinal cord injury/dysfunction: a population study. Spinal Cord 2023; 61:562-569. [PMID: 37660208 DOI: 10.1038/s41393-023-00930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
STUDY DESIGN A retrospective longitudinal cohort time-series analysis study. OBJECTIVES To examine healthcare utilization and delivery during the COVID-19 pandemic in individuals with spinal cord injury/dysfunction (SCI/D). SETTING Health administrative database in Ontario, Canada. METHODS In 5754 individuals with SCI/D diagnosed from 2004-2014 and living in the community, healthcare utilization (physician visits, primary care visits, specialist visits, urologist visits, physiatrist visits, emergency department (ED) visits, and hospital admissions) and delivery (total, in-person, virtual) were determined at the (1) pre-pandemic period (March 2015 to February 2020), (2) initial pandemic onset period (March 2020-May 2020), and (3) pandemic period (June 2020 to March 2022). Autoregressive integrated moving average (ARIMA) modelling was conducted to determine the impact of the pandemic on monthly healthcare utilization and delivery. RESULTS The initial pandemic onset period had a significant reduction of 24% in physicians (p = 0.0081), 35% in specialists (p < 0.0001), and 30% in urologist (p < 0.0001) visits, compared to pre-pandemic levels, with a partial recovery as the pandemic progressed. In April 2020, compared to the pre-pandemic period, a significant increase (p < 0.0001) in virtual visits for physicians, specialists, urologists, and primary care was found. The initial pandemic onset period had a 58% decrease in hospital admissions (p = 0.0011), compared to the pre-pandemic period. CONCLUSION Healthcare utilization dropped in the initial pandemic onset period as physicians, specialists, and urologists, as well as hospitalization visits decreased significantly (p < 0.05) versus pre-pandemic levels. Virtual visit increases compensated for in-person visit decreases as the pandemic progressed to allow for total visits to partially recover.
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Affiliation(s)
- Arrani Senthinathan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Mina Tadrous
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Swaleh Hussain
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - B Catharine Craven
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Susan B Jaglal
- ICES, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - John Shepherd
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | | | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Lee T, Walley KR, Boyd JH, Cawcutt KA, Kalil A, Russell JA. Impact of the COVID-19 pandemic on non-COVID-19 community-acquired pneumonia: a retrospective cohort study. BMJ Open Respir Res 2023; 10:e001810. [PMID: 37865420 PMCID: PMC10603472 DOI: 10.1136/bmjresp-2023-001810] [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: 05/06/2023] [Accepted: 09/22/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic could impact frequency and mortality of non-COVID-19 community-acquired pneumonia (CAP). Changes in frequency, patient mix, treatment and organ dysfunction could cascade together to increase mortality of CAP during compared with pre-COVID-19. METHODS Hospitalised CAP patients at St. Paul's Hospital, Vancouver, Canada pre-COVID-19 (fiscal years 2018/2019 and 2019/2020) and during COVID-19 pandemic (2020/2021 and 2021/2022) were evaluated. RESULTS In 5219 CAP patients, there was no significant difference prepandemic versus during pandemic in mean age, gender and Charlson Comorbidity Score. However, hospital mortality increased significantly from pre-COVID-19 versus during COVID-19 (7.5% vs 12.1% respectively, (95% CI for difference: 3.0% to 6.3%), p<0.001), a 61% relative increase, coincident with increases in ICU admission (18.3% vs 25.5%, respectively, (95% CI for difference: 5.0% to 9.5%) p<0.001, 39% relative increase) and ventilation (12.7% vs 17.5%, respectively, (95% CI for difference: 2.8% to 6.7%) p<0.001, 38% relative increase). Results remained the same after regression adjustment for age, sex and Charlson score. CAP hospital admissions decreased 27% from pre-COVID-19 (n=1349 and 1433, 2018/2019 and 2019/2020, respectively) versus the first COVID-19 pandemic year (n=1047 in 2020/2021) then rose to prepandemic number (n=1390 in 2021/2022). During prepandemic years, CAP admissions peaked in winter; during COVID-19, the CAP admissions peaked every 6 months. CONCLUSIONS AND RELEVANCE This is the first study to show that the COVID-19 pandemic was associated with increases in hospital mortality, ICU admission and invasive mechanical ventilation rates of non-COVID-19 CAP and a transient, 1-year frequency decrease. There was no winter seasonality of CAP during the COVID-19 pandemic era. These novel findings could be used to guide future pandemic planning for CAP hospital care.
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Affiliation(s)
- Terry Lee
- Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith R Walley
- Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John H Boyd
- Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly A Cawcutt
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andre Kalil
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - James A Russell
- Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Regragui S, Abou Malham S, Gaboury I, Bois C, Deville-Stoetzel N, Maillet L, Savoie A, Breton M. Nursing practice and teleconsultations in a pandemic context: A mixed-methods study. J Clin Nurs 2023; 32:6339-6353. [PMID: 37202866 DOI: 10.1111/jocn.16756] [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: 12/07/2022] [Revised: 03/03/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
AIM To explore the use and implementation of teleconsultations by primary care nurses in the context of the COVID-19 pandemic. BACKGROUND Teleconsultation use increased rapidly during the COVID-19 pandemic. Its implementation has been documented for physicians and specialists, but knowledge is still limited in nursing practice. DESIGN A sequential mixed-methods study. METHODS Phase 1: A cross-sectional e-survey with 98 nurses (64 nurse clinicians [NCs] and 34 nurse practitioners [NPs]) was conducted in 2020 in 48 teaching primary care clinics in Quebec (Canada). Phase 2: Semi-structured interviews with four NCs and six NPs were conducted in 2021 in three primary care clinics. This study adheres to STROBE and COREQ guidelines. RESULTS During the pandemic, telephone was the principal teleconsultation modality used by NPs and NCs compared to other teleconsultation modalities (text messages, email and video). The only variable associated with a higher likelihood of using teleconsultations was type of professional (NCs). Video consultation was almost absent from the modalities used. The majority of participants reported several facilitators to using teleconsultations in their work (e.g. web platforms and work-family balance) and for patients (e.g. rapid access). Some barriers to utilisation were identified (e.g. lack of physical resources) for successful integration of teleconsultations at the organisational, technological and systemic levels. Participants also reported positive (e.g. assessment of cognitive deficiency) and negative (e.g. rural population) impacts of using teleconsultations during a pandemic that made the use of teleconsultations complex. CONCLUSION This study highlights the potential for nurses to use teleconsultations in primary care practice and suggests concrete solutions to encourage their implementation after the pandemic. RELEVANCE TO CLINICAL PRACTICE Findings emphasize the need for updated nursing education, easy-to-use technology and the strengthening of policies for the sustainable use of teleconsultations in primary health care. IMPLICATIONS FOR THE PROFESSION This study could promote the sustainable use of teleconsultations in nursing practice. REPORTING METHOD The study adhered to relevant EQUATOR guidelines; the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as the study focused on the use of teleconsultation among health professionals, specifically primary care nurses.
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Affiliation(s)
- Safa Regragui
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sabina Abou Malham
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Isabelle Gaboury
- Département de médecine de famille, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Caroline Bois
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Nadia Deville-Stoetzel
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Lara Maillet
- École nationale d'administration publique, Montréal, Québec, Canada
| | - Annie Savoie
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mylaine Breton
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Spithoff S, Mogic L. Enterprise Healthcare Physician Services in Canada: An Environmental Scan. Healthc Policy 2023; 19:71-80. [PMID: 37695709 PMCID: PMC10519332 DOI: 10.12927/hcpol.2023.27155] [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: 09/13/2023] Open
Abstract
Employers in Canada are increasingly offering physician services to their employees through third-party "enterprise" virtual care platforms. In our environmental scan, we identified nine enterprise healthcare companies offering physician services to millions of Canadian employees via enterprise platforms. All platforms offered rapid access to virtual physician services. Some offered in-person visits, access to specialists, health system navigation and sharing of information with an employee's regular care provider. Almost half shared aggregate or de-identified health data with employers. These platforms provide rapid and convenient access to physician services but also disrupt the continuity of care, pose risks to employee privacy and expand two-tiered healthcare.
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Affiliation(s)
- Sheryl Spithoff
- Assistant Professor Department of Family and Community Medicine University of Toronto Scientist Women's College Hospital Research Institute Women's College Hospital, Toronto, ON
| | - Lana Mogic
- Research Assistant Department of Family and Community Medicine Women's College Hospital Toronto, ON
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Okpara C, Ioannidis G, Thabane L, Adachi JD, Rabinovich A, Hewston P, Lee J, McArthur C, Kennedy C, Woo T, Boulos P, Bobba R, Wang M, Thrall S, Mangin D, Marr S, Armstrong D, Patterson C, Bray S, de Wit K, Maharaj S, Misiaszek B, Sookhoo JB, Thompson K, Papaioannou A. The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial. Pilot Feasibility Stud 2023; 9:124. [PMID: 37461117 PMCID: PMC10351184 DOI: 10.1186/s40814-023-01346-7] [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: 02/24/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic. METHODS Participants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component. RESULTS The program enrolled 33% (n = 72) of referrals to the study (n = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant's adherence levels included virtual exercise sessions 81% (95% CI: 75-88%), home-based exercise 50% (95% CI: 38-62%), protein supplements consumption 68% (95% CI: 55-80%), and medication optimization 38% (95% CI: 21-59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms. CONCLUSION The GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant's intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change. TRIAL REGISTRATION ClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366.
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Affiliation(s)
- Chinenye Okpara
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - George Ioannidis
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- The Research Institute of St Joseph’s Healthcare, Hamilton, ON Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | | | | | - Patricia Hewston
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Justin Lee
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Caitlin McArthur
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS Canada
| | - Courtney Kennedy
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Tricia Woo
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Pauline Boulos
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Raja Bobba
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Mimi Wang
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Samuel Thrall
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Derelie Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Sharon Marr
- Department of Medicine, University of Toronto, Hamilton, ON Canada
| | - David Armstrong
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Steven Bray
- Department of Kinesiology, McMaster University, Hamilton, ON Canada
| | - Kerstin de Wit
- Department of Emergency Medicine, Queen’s University, Kingston, ON Canada
| | - Shyam Maharaj
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Brian Misiaszek
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Karen Thompson
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
| | - Alexandra Papaioannou
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
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Smith JM, Pearson KK, Roberson AE. Interface of Clinical Nurse Specialist Practice and Healthcare Technology. CLIN NURSE SPEC 2023; 37:169-176. [PMID: 37410561 DOI: 10.1097/nur.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
PURPOSE This article demonstrates the leadership role of the clinical nurse specialist in developing and implementing healthcare technology across the continuum of care. DESCRIPTION Three virtual nursing practices-facilitated self-care, remote patient monitoring, and virtual acute care nursing-illustrate how the clinical nurse specialist is well suited to transform traditional practice models to ones that use healthcare technology effectively. These 3 practices use interactive healthcare technology to gather patient data and allow communication and coordination with the healthcare team to meet patient-specific needs. OUTCOME Use of healthcare technology in virtual nursing practices led to early care team intervention, optimized care team processes, proactive patient outreach, timely access to care, and reduction in healthcare-associated errors and near-miss events. CONCLUSION Clinical nurse specialists are well positioned to develop innovative, effective, accessible, and high-quality virtual nursing practices. Integrating healthcare technology with nursing practice augments care for various patients, ranging from those with low illness severity in the outpatient setting to acutely ill patients in the inpatient hospital environment.
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Affiliation(s)
- Justin M Smith
- Author Affiliations: Department of Nursing, Mayo Clinic, Rochester, Minnesota
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Murase K, Lyons OD. Impact of the COVID-19 pandemic on diagnosis of sleep apnea: an observational study of a hybrid virtual care clinical pathway. Sleep Biol Rhythms 2023; 21:309–317. [PMID: 36713036 PMCID: PMC9867549 DOI: 10.1007/s41105-023-00447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023]
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, there has been a reduction in patient uptake of in-person care, likely in part, due to patients' fear of contracting COVID infection. We aimed to examine changes in the proportion of patients assessed in a sleep clinic who subsequently underwent in-lab polysomnography before and during the pandemic. A retrospective study was conducted, comparing the periods September 2018-April 2019 (pre-pandemic) and September 2020-April 2021 (pandemic). Among the patients who were referred to an ambulatory sleep clinic in Toronto, Ontario for assessment of possible sleep apnea, the number of patients who underwent diagnostic PSG within 90 days from the first consultation with a physician was analyzed. Significantly lower number of patients underwent PSG in the pandemic than the pre-pandemic period [122/229 patients (53.3%) vs. 169/208 patients (81.3%), p < 0.001]. Older age and having a consultation in the months of full-blown pandemic, which was defined as month with its average of newly confirmed COVID-19 positive cases in Ontario > 1000 cases/day, were associated with declining PSG in the pandemic period. Among patients who underwent PSG, sleep apnea was found in 114/169 (67.5%) and 85/122 (69.7%) patients in the pre-pandemic and the pandemic period, respectively (p = 0.69). During the pandemic, there was a dramatic reduction in uptake of in-lab PSG. It is very likely that a significant proportion of patients in this cohort had sleep apnea that went undiagnosed with significant implications for health outcomes.
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Affiliation(s)
- Kimihiko Murase
- Department of Medicine, Women’s College Hospital, 76 Grenville St, Toronto, ON M5S 1B2 Canada
- Women’s College Research Institute, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Owen D. Lyons
- Department of Medicine, Women’s College Hospital, 76 Grenville St, Toronto, ON M5S 1B2 Canada
- Women’s College Research Institute, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Chuen VL, Dholakia S, Kalra S, Watt J, Wong C, Ho JMW. Geriatric Specialists' Perspectives on Telemedicine during the COVID-19 Pandemic: a Concurrent Triangulation Mixed-Methods Study . Can Geriatr J 2023; 26:283-289. [PMID: 37265985 PMCID: PMC10198678 DOI: 10.5770/cgj.26.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
During the COVID-19 pandemic, physicians provided virtual care to minimize viral transmission. This concurrent triangulation mixed-methods study assesses the use of synchronous telephone and video visits with patients and asynchronous eConsults by geriatric providers, and explores their perspectives on telemedicine use during the pandemic. Participants included physicians practicing in Ontario, Canada who were certified in Geriatric Medicine, or Care of the Elderly, or who were the most responsible physician in a long-term care for at least 10 patients. Participants' perspectives were solicited using an online survey and themes were generated through a reflexive thematic analysis of survey responses. We assessed the current use of each telemedicine tool and compared the proportion of participants using telemedicine before the pandemic with self-predicted use after the pandemic. We received 29 surveys from eligible respondents (87.9% completion rate), with 75.9% being geriatricians. The telephone was most used (96.6%), followed by video (86.2%) and eConsults (64%). Most participants using telephone and video visits had newly implemented them during the pandemic and intend to continue using these tools post-pandemic. Our thematic analysis revealed that telemedicine plays an important role in the continuity of care during the pandemic, with increased self-reported positive perspectives and openness towards use of virtual care tools, although limited by inadequate physical exams or cognitive testing. Its ongoing use depends on the availability of continued remuneration.
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Affiliation(s)
- Victoria L Chuen
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto
| | - Saumil Dholakia
- Department of Psychiatry, University of Ottawa, Ottawa
- GeriMedRisk, Waterloo
| | - Saurabh Kalra
- Department of Family Medicine, McMaster University, Kitchener
| | - Jennifer Watt
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto
- St. Michael's Hospital, Toronto
| | - Camilla Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto
- St. Michael's Hospital, Toronto
| | - Joanne M-W Ho
- GeriMedRisk, Waterloo
- Divison of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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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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Tao X, Zhu W, Chu M, Zhang Y. Nurse-led virtual interventions in managing chronic diseases: a protocol for a systematic review of randomised controlled trials. BMJ Open 2023; 13:e070583. [PMID: 37188471 DOI: 10.1136/bmjopen-2022-070583] [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] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Technological advances are changing nursing practice; however, nurse-led virtual care for chronic disease management has not yet been adequately explored and described. This study will review and analyse the effects of nurse-led virtual services and describe the virtual intervention characteristics relevant to the scope of nursing practice in chronic disease management. METHODS AND ANALYSIS This study will systematically review randomised controlled trials evaluating the effects of nurse-led virtual care interventions on patients with chronic conditions. Databases including PubMed, Embase, Web of Science, CINAHL, Chinese National Knowledge Infrastructure, Wanfang (Chinese) and VIP Chinese Science and Technology Periodicals will be searched. All studies will be screened and selected using the criteria described in 'population, intervention, comparison, outcome and study design' format. Relevant studies will be searched using the reference lists of eligible studies and review articles. The risk of bias will be assessed using the Joanna Briggs Institute Quality Appraisal Form. Two reviewers will independently extract data from all the included studies using a standardised data extraction form on the Covidence platform. RevMan V.5.3 software will be used to perform the meta-analysis. Data synthesis will be conducted with descriptive synthesis by summarising and tabulating the data and presenting them according to the research questions. ETHICS AND DISSEMINATION Formal ethical approval is not required as the data used in this systematic review are abstracted from the pre-existing literature. The results of this study will be disseminated through peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022361260.
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Affiliation(s)
- Xingjuan Tao
- Shanghai JiaoTong University School of Nursing, Shanghai, China
| | - Weishan Zhu
- Shanghai JiaoTong University School of Nursing, Shanghai, China
| | - Mingzi Chu
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuanyuan Zhang
- Shanghai JiaoTong University School of Nursing, Shanghai, China
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Dmochowski RR, Rovner ES, Kennelly MJ, Newman DK, Abedinzadeh L, Snyder D, Thomas E, Haag-Molkenteller C, Rosenberg MT. Study design of a phase 4, real-world study (COMPOSUR) to evaluate vibegron in patients with overactive bladder. BMC Urol 2023; 23:64. [PMID: 37095473 PMCID: PMC10124676 DOI: 10.1186/s12894-023-01240-7] [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: 09/21/2022] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Overactive bladder (OAB) is defined as urinary urgency accompanied by frequency and nocturia, with or without urge urinary incontinence (UUI). Vibegron, a selective β3-adrenergic receptor agonist approved in the US in December 2020, demonstrated efficacy in reducing symptoms of OAB and was safe and well tolerated in the 12-week EMPOWUR trial and its 40-week, double-blind extension trial. The goal of the COMPOSUR study is to evaluate vibegron in a real-world setting to assess patient treatment satisfaction, tolerability, safety, duration of treatment, and persistence. METHODS This is a 12-month, prospective, observational, real-world study, with an optional 12-month extension to 24 months, in the US assessing adults ≥ 18 years old starting a new course of vibegron. Patients must be previously diagnosed with OAB with or without UUI, symptomatic for ≥ 3 months before enrollment, and receive prior treatment with an anticholinergic, with mirabegron, or with a combination of an anticholinergic and mirabegron. Enrollment is performed by the investigator following exclusion and inclusion criteria guided by US product labeling, reinforcing a real-world approach. Patients complete the OAB Satisfaction with Treatment Questionnaire (OAB-SAT-q) monthly and the OAB Questionnaire short form (OAB-q-SF) and Work Productivity and Activity Impairment Questionnaire (WPAI:US) at baseline and monthly for 12 months. Patients are followed up via phone call, in-person visits, or telehealth (ie, virtual) visits. The primary endpoint is patient treatment satisfaction as determined by the OAB-SAT-q satisfaction domain score. Secondary endpoints include percent positive responses to individual OAB-SAT-q questions, additional OAB-SAT-q domain scores, and safety. Exploratory endpoints include adherence and persistence. DISCUSSION OAB leads to a significant decrease in quality of life, as well as impairment of work activities and productivity. Persistence with OAB treatments can be challenging, often due to lack of efficacy and adverse effects. COMPOSUR is the first study to provide long-term, prospective, pragmatic treatment data for vibegron in the US and the resultant effect on quality of life among patients with OAB in a real-world clinical setting. Trial registration ClinicalTrials.gov identifier: NCT05067478; registered: October 5, 2021.
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Affiliation(s)
- Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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