Home Virtual Visits for Outpatient Follow-Up Stroke Care: Cross-Sectional Study

Abstract

BackgroundTimely, in-person access to health care is a challenge for people living with conditions such as stroke that result in frailty, loss of independence, restrictions in driving and mobility, and physical and cognitive decline. In Southeastern Ontario, access is further complicated by rurality and the long travel distances to visit physician clinics. There is a need to make health care more accessible and convenient. Home virtual visits (electronic visits, eVisits) can conveniently connect physicians to patients. Physicians use a secure personal videoconferencing tool to connect to patients in their homes. Patients use their device of choice (smartphone, tablet, laptop, or desktop) for the visit.ObjectiveThis study aimed to assess the feasibility and logistics of implementing eVisits in a stroke prevention clinic for seniors.MethodsA 6-month eVisit pilot study was initiated in the Kingston Health Sciences Centre stroke prevention clinic in August 2018. eVisits were used only for follow-up patient encounters. An integrated evaluation was used to test the impact of the program on clinic workflow and patient satisfaction. Patient satisfaction was evaluated by telephone interviews, using a brief questionnaire. Access and patient satisfaction metrics were compared with concurrent standard of care (patients’ prior personal experience with in-person visits). Values are presented as median (interquartile range).ResultsThere were 75 subjects in the pilot. The patients were aged 65 (56-73.5) years, and 39% (29/75) resided in rural areas. There was a shorter wait for an appointment by eVisit versus in-person (mean 59.98 [SD 48.36] days vs mean 78.36 [SD 50.54] days; P<.001). The eVisit was also shorter, taking on an average of only 10 min to deliver follow-up care with a high degree of patient satisfaction versus 90 (60-112) min for in-person care. The total time saved by patients per eVisit was 80 (50-102) min, 44 (21-69) min of which was travel time. Travel distance avoided by the patients was 30.1 km (11.2-82.2). The estimated total out-of-pocket cost savings for patients per eVisit was Can $52.83 (31.26-94.53). The estimated savings (opportunity cost for in-person outpatient care) for our eVisit pilot project was Can $23,832-$28,584. The patient satisfaction with eVisits was very good compared with their prior personal experience with in-person outpatient care.ConclusionsThe eVisit program was well received by patients, deemed to be safe by physicians, and avoided unnecessary patient travel and expense. It also has the potential to reduce health care costs. We plan to scale the project within the department and the institution.

Accelerated launch of video visits in ambulatory neurology during COVID-19

“…In fact, it was robustly reported that video visits were way better than a phone call. This aligns with other studies that have noted the value of assessing patients in their own homes 6,23,24 by, for example, helping identify safety issues, verifying patients' medications, 25 and involving family members on the call. 26 Providers also expressed that there is huge potential for video visits, given the increased ability to monitor health data remotely, such as gait sensors and applications for commercially available smart devices to track movement.…”

“…This could result in further barriers to appropriate and timely care. 1,25 Video visits, however, have the potential for saving patients and/or their caregivers travel time and associated outof-pocket and health care costs. 1,5,8,23,25 Providers also reported innovating on physical examination techniques.…”

“…1,25 Video visits, however, have the potential for saving patients and/or their caregivers travel time and associated outof-pocket and health care costs. 1,5,8,23,25 Providers also reported innovating on physical examination techniques. For example, Stanford neuro-ophthalmologists have demonstrated that performing an eye examination online is possible in their educational videos teaching others how to do eye examinations online (med.stanford.edu/ophthalmology/patient_care/tele-eyecare.html#virtual_care).…”

Tackling the Burden of Neurological Diseases in Canada with Virtual Care During the COVID-19 Pandemic and Beyond

“…The results of our pilot study demonstrated a very high degree of patient satisfaction, reduction in per capita health care costs, out of pocket expenses [mean(SD): $74.92(57.99) CND; median(IQR): $52.83(31.26-94.53) CND], health system costs (range between $23,832 to $28,584 dollars, just from the pilot), and statistically significant reduction in wait times for an eVisit follow-up compared to in-person follow-up. 11 Physicians were able to assess patients more quickly via eVisit than via an in-person encounter, thus increasing the timely availability of health care. 12 Adopting virtual care solutions can also result in a significant reduction in costs.…”

Providing care for the 99.9% during the COVID-19 pandemic: How ethics, equity, epidemiology, and cost per QALY inform healthcare policy

“…To meet our ethical responsibilities to provide equitable care for all people, innovations have occurred. While we continue to see patients requiring nondeferrable care in person in our clinics, we have expanded our use of video visits 14 and other e-health tools. However, most procedures and many critical patient-doctor interactions must occur in person, and these have been delayed.…”