“Healthcare at its finest”: Patient perspectives on virtual care appointments in primary care

Abstract

Context: COVID-19 led to a rapid uptake of virtual care appointments (telephone and video) in primary care (PC). Decisions on the future of virtual care need to consider patients' experiences. Objective: To understand patients' experience with virtual care appointments. Study Design: Mixed methods study, presentation focus on qualitative data. A semi-structured interview guide was co-created with patient advisors. A broad recruitment strategy included emailing patient and community organizations, research team network, and social media. Data analyzed using thematic analysis. Participant Eligibility: At least one synchronous virtual encounter in PC since March 2020. Setting: Ontario (Canada) offers universal coverage for PC visits with no co-payment. Results: N=55 interviews were conducted between January 2021 and March 2021. Technology: Telephone was preferred modality. Access: Virtual care was convenient and saved patients' time and money. Appointment scheduling & booking processes were barriers. Privacy and Confidentiality: No concerns about privacy & confidentiality in patients' environment, yet participants wanted assurance about privacy & confidentiality in providers' environment. Communication: Providers' detailed explanations, patients' health literacy levels, and asynchronous methods of sharing information and documents before and/or after appointments facilitated good experiences. Lack of body-language was a barrier. Therapeutic Relationship: Strong preexisting relationships facilitated good virtual care experiences. Participants expressed concerns about long-term erosion of relationship when using virtual care. Whole-Person Care: Virtual care facilitated easy inclusion of family members in appointments. However, virtual care appointments were more problem-focused and included less conversation topics outside of specific problem than in-person appointments. Quality of Care: Most participants reported quality of virtual care was similar to in-person appointments; although, a few participants reported it was worse. Conclusions: Virtual care was

Understanding the uptake of virtual care for first and return outpatient appointments in child and adolescent mental health services: a mixed-methods study

“…As in previous studies, our findings support a hybrid model of virtual and in-person care6 21 and identify additional considerations regarding visit types and client needs. The higher proportion of in-person Choice appointments compared with Partnership appointments is in keeping with a previously published survey of child and adolescent mental health clinicians, who reported a preference for initial in-person meetings to establish rapport and develop a therapeutic relationship before transferring to virtual care 22–24. However, our results demonstrate a role for virtual care in first contact with clinicians.…”

“…The higher proportion of in-person Choice appointments compared with Partnership appointments is in keeping with a previously published survey of child and adolescent mental health clinicians, who reported a preference for initial in-person meetings to establish rapport and develop a therapeutic relationship before transferring to virtual care. 22–24 However, our results demonstrate a role for virtual care in first contact with clinicians. Participants in the present study noted the relative advantage of virtual care for initial appointments to establish rapport with clients who would otherwise not attend in-person appointments due to reluctance to come to the clinic related to the clinical presenting concern (eg, social anxiety) or logistical barriers (such as caregivers having to take a day off of work, access transport or find childcare).…”

“There’s nothing like a good crisis for innovation”: a qualitative study of family physicians’ experiences with virtual care during the COVID-19 pandemic

“…Additionally, FPs highlighted the importance of longitudinal patient-FP relationships and continuity of care in the delivery of care through virtual modalities. These unique qualities of family medicine have been previously identified as important supports in mitigating the negative impacts of rapid shifts in the availability and delivery of care during the pandemic [49][50][51]. Notably, recent updates in Ontario to the 2021-2024 Physician Services Agreement have introduced permanent virtual care billing codes to the Ontario Health Insurance Plan, replacing the temporary codes introduced during the pandemic.…”

“…While virtual care was not the primary focus of our study, discussions of virtual care emerged organically during interviews in the context of pandemic roles and responsibilities. Further research is needed to understand the use of virtual care and its facilitators and barriers outside the context of the pandemic [51]. Interviews were conducted between October 2020 and June 2021 and may not reflect experiences related to the use of virtual care later in the pandemic.…”

Quality measures of virtual care in ambulatory healthcare environments: a scoping review

“…The COVID-19 pandemic changed the global healthcare landscape and accelerated the implementation and access to virtual care for many patients 2. Although utilisation of virtual care decreased after pandemic restrictions eased, the demands for the option of virtual care persist with many patients and/or caregivers appreciating the convenience that virtual care affords 3 4. Healthcare providers also see the value of virtual care in specific situations due to its potential to improve patient access to care especially for those with mobility issues or living in rural/remote areas, and for maintaining connections with patients in between in-person visits 5.…”