Exploring the use and challenges of implementing virtual visits during COVID-19 in primary care and lessons for sustained use

Abstract

Background The COVID-19 pandemic has rapidly transformed how healthcare is delivered to limit the transmission of the virus. This descriptive cross-sectional study explored the current use of virtual visits in providing care among primary care providers in southwestern Ontario during the first wave of the COVID-19 pandemic and the anticipated level of utilization post-pandemic. It also explored clinicians’ perceptions of the available support tools and resources and challenges to incorporating virtual visits within primary care practices. Methods Primary care physicians and nurse practitioners currently practicing in the southwestern part of Ontario were invited to participate in an online survey. The survey invite was distributed via email, different social media platforms, and newsletters. The survey questions gathered clinicians’ demographic information and assessed their experience with virtual visits, including the proportion of visits conducted virtually (before, during the pandemic, and expected volume post-pandemic), overall satisfaction and comfort level with offering virtual visits using modalities, challenges experienced, as well as useful resources and tools to support them in using virtual visits in their practice. Results We received 207 responses, with 96.6% of respondents offering virtual visits in their practice. Participants used different modalities to conduct virtual visits, with the vast majority offering visits via phone calls (99.5%). Since the COVID-19 pandemic, clinicians who offered virtual visits have conducted an average of 66.4% of their visits virtually, compared to an average of 6.5% pre-pandemic. Participants anticipated continuing use of virtual visits with an average of 43.9% post-pandemic. Overall, 74.5% of participants were satisfied with their experience using virtual visits, and 88% believed they could incorporate virtual visits well within the usual workflow. Participants highlighted some challenges in offering virtual care. For example, 58% were concerned about patients’ limited access to technology, 55% about patients’ knowledge of technology, and 41% about the lack of integration with their current EMR, the increase in demand over time, and the connectivity issues such as inconsistent Wi-Fi/Internet connection. There were significant differences in perception of some challenges between clinicians in urban vs, rural areas. Clinicians in rural areas were more likely to consider the inconsistent Wi-Fi and limited connectivity as barriers to incorporating virtual visits within the practice setting (58.8% vs. 40.2%, P = 0.030). In comparison, clinicians in urban areas were significantly more concerned about patients overusing virtual care services (39.4% vs. 21.6%, P = 0.024). As for support tools, 47% of clinicians advocated for virtual care standards outlined by their profession’s college. About 32% identified change management support and technical training as supportive tools. Moreover, 39% and 28% thought local colleagues and in-house organizational support are helpful resources, respectively. Conclusion Our study shows that the adoption of virtual visits has exponentially increased during the pandemic, with a significant interest in continuing to use virtual care options in the delivery of primary care post-pandemic. The study sheds light on tools and resources that could enhance operational efficiencies in adopting virtual visits in primary care settings and highlights challenges that, when addressed, can expand the health system capacity and sustained use of virtual care.

Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review

“…Nomenclatures regarding remote care strategies varied considerably among studies, with the terms “telehealth” [ 30 , 33 , 36 , 44 , 45 , 47 , 54 , 55 , 60 , 63 , 64 , 67 - 69 , 72 ] and “telemedicine” [ 29 , 31 , 32 , 38 , 39 , 46 , 47 , 51 , 59 , 61 , 63 , 69 , 71 ] being the most frequent. The following terms were also mentioned: teleconsultation [ 40 , 58 , 71 ], virtual visit [ 41 , 48 , 58 ], virtual health/eHealth [ 35 , 51 ], remote consultation [ 37 , 50 , 56 , 65 ], electronic consultation [ 35 , 62 ], telephone follow-up [ 35 , 66 ], video visit [ 35 , 70 ], video consultation [ 34 , 49 ], online consultation [ 69 ], virtual care [ 53 ], web-based video consultation [ 69 ], digital monitoring [ 72 ], nonpresential consultation [ 52 ], and remote self-monitoring [ 43 ].…”

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“…This finding is in line with Brant et al [ 37 ], who found that the majority of practices in 5 areas of the United Kingdom conducted telephone consultation, while none provided video consultation. In addition, Heba and colleagues [ 38 ] reported that during COVID-19, 96.6% of general practitioners in southwestern Ontario used teleconsultation, but 99.5% of this was conducted via telephone consultation. A study looking at telehealth implementation in Australia showed that even with a change in reimbursement policy in the country, Australian health care providers, especially primary care providers, still preferred telephone consultation over video consultation [ 39 ].…”