Integration of virtual physician visits into a provincial 8-1-1 health information telephone service during the COVID-19 pandemic: a descriptive study of HealthLink BC Emergency iDoctor-in-assistance (HEiDi)

Ho, Kendall; Lauscher, Helen Novak; Stewart, Kurtis; Abu‐Laban, Riyad B.; Scheuermeyer, Frank; Grafstein, Eric; Christenson, Jim; Sundhu, Sandra

doi:10.9778/cmajo.20200265

Cited by 24 publications

(30 citation statements)

References 5 publications

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“…Recently Ho et al, described the HealthLink BC Emergency iDoctor-in-assistance (HEiDi) program, which is a free virtual healthcare service offered to residents of British Columbia seeking urgent care [ 13 ]. Call volumes, median length of the virtual visit and patient demographics were very similar to those seen in our study.…”

Section: Discussionmentioning

confidence: 99%

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

et al. 2022

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Introduction As part of the COVID-19 pandemic response, the Ontario Ministry of Health funded a virtual care pilot program intended to support emergency department (ED) diversion of patients with low acuity complaints and reduce the need for face-to-face contact. The objective was to describe the demographic characteristics, outcomes and experience of patients using the provincial pilot program. Methods This was a prospective cohort study of patients using virtual care services provided by 14 ED-led pilot sites from December 2020 to September 2021. Patients who completed a virtual visit were invited by email to complete a standardized, 25-item online survey, which included questions related to satisfaction and patient-reported outcome measures. Results There were 22,278 virtual visits. When patients were asked why they contacted virtual urgent care, of the 82.7% patients who had a primary care provider, 31.0% said they could not make a timely appointment with their family physician. Rash, fever, abdominal pain, and COVID-19 vaccine queries represented 30% of the presenting complaints. Of 19,613 patients with a known disposition, 12,910 (65.8%) were discharged home and 3,179 (16.2%) were referred to the ED. Of the 2,177 survey responses, 94% rated their overall experience as 8/10 or greater. More than 80% said they had answers to all the questions they had related to their health concern, believed they were able to manage the issue, had a plan they could follow, and knew what to do if the issue got worse or came back. Conclusions Many presenting complaints were low acuity, and most patients had a primary care provider, but timely access was not available. Future work should focus on health equity to ensure virtual care is accessible to underserved populations. We question if virtual urgent care can be safely and more economically provided by non-emergency physicians. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00407-9.

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Section: Discussionmentioning

confidence: 99%

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

et al. 2022

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“…Telehealth options to offer ED services for children with low-complexity complains may offer an alternative to reduce frequent ED use, particularly in the absence of primary care services. 30 The changing age-specific IR for the lowest neighbourhood income quintile suggests that the greatest effect of income on need for ED care is in the early teen years and special supports for such patients may be beneficial. The dramatic changes in the effect of sex over age suggest that tailoring health delivery programmes by sex and age group may be warranted, with particular attention to boys aged less than five and girls aged at least 14 years.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Age-varying effects of repeated emergency department presentations for children in Canada

Rosychuk

Chen

McRae

et al. 2022

J Health Serv Res Policy

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Objectives Repeated presentations to emergency departments (EDs) may indicate a lack of access to other health care resources. Age is an important predictor of frequent ED use; however, age-varying effects are not generally investigated. This study examines the age-specific effects of predictors on ED presentation frequency for children in Alberta and Ontario, Canada. Methods This retrospective study used population-based data during April 2010 to March 2017. Data were extracted from the National Ambulatory Care Reporting System for children aged <18 who were members of the top 10% of ED users in any one of the fiscal years 2011/2012 to 2015/2016 along with a comparison sample from the bottom 90%. A marginal regression model studied the age-varying associations on the frequency of ED presentations with province, sex, access to primary health care provider (for Ontario only), area of residence and lowest neighbourhood income quintile. Results There were 2,481,172 patients who made 9,229,156 ED presentations. The effects of sex, lowest income quintile, rural residence, access to primary health care provider and province on the frequency of presentations varied by age. Notably, boys go from having more frequent presentations than girls when aged ≤5 (i.e. adjusted intensity ratio [IR]=1.04 at age 5, 95% confidence interval [CI] = 1.03,1.06) to less frequent for ages 8–11 years and beyond 14 (i.e. IR = 0.80 at age 15, 95% CI = 0.78,0.81). Adolescents aged ≥15 without access to a primary care provider had more frequent presentations compared to those with a primary care provider. Conclusions When examining the frequency of ED presentations in children, age-varying effects of predictors should be considered. Our more nuanced examination of age provides insights into how health services might better target programmes for different ages to potentially reduce unnecessary ED use by providing other health care alternatives.

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“…Beyond research and development, the methods described in this report could also be adapted to rural or resource-limited settings where real-time virtual support from expert health providers could improve outcomes. 9 , 10 …”

Section: Discussionmentioning

confidence: 99%

Videoconferencing for Large Animal Trauma Experiments During COVID-19: A Cross-Continent Experience

et al. 2022

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Introduction COVID-19 shutdowns in many research facilities across North America impacted preclinical trauma-related research and development. Shutdown limited the speed and resources available for large animal experiments necessary for advancing medical devices and technologies. However, the pandemic led to the rapid adoption and expansion of videoconferencing in social circles, workplaces, and primary care health settings. Here, we describe the use of simple videoconferencing equipment to plan and carry out 3 total weeks of large animal experiments with a large, cross-continent, interdisciplinary team testing a novel technology in swine models of noncompressible intraabdominal hemorrhage and junctional hemorrhage. Materials and Methods Animal experiments using swine were scheduled over 3 weeks in February and March 2021 to take place in Toronto, Canada. All relevant animal protocols and COVID-19 site-specific risk assessments were completed and approved by the responsible institutional committees. Experiments were conducted by connecting 12 total research personnel from 3 sites by a simple video conferencing setup which included low-cost, high-definition webcams and standard smartphones streaming to Zoom. Results Video conferencing allowed for 3 weeks of trauma experiments to take place at the height of Toronto’s third peak of COVID-19 cases. Up to 3 experiments were completed for models requiring 6 hours of monitoring, and up to 5 experiments were completed for models requiring 3 hours of monitoring. The large amount of digital data collected during these experiments was rapidly shared with our network of collaborators, who analyzed results and interpreted findings in real time. Conclusions The system described in this paper has the potential to reduce costs of trauma animal model development and allow for rapid testing and implementation of life-saving devices in settings with limited onsite personnel as experienced during the COVID-19 pandemic.

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Integration of virtual physician visits into a provincial 8-1-1 health information telephone service during the COVID-19 pandemic: a descriptive study of HealthLink BC Emergency iDoctor-in-assistance (HEiDi)

Abstract: have received personal fees from HealthLink BC for work done as HEiDi virtual physicians during the course of the study. Kendall Ho has also received grants from HealthLink BC and the BC Joint Standing Committee on Rural Issues, Rural Coordination Centre of BC.

Cited by 24 publications

References 5 publications

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

Age-varying effects of repeated emergency department presentations for children in Canada

Videoconferencing for Large Animal Trauma Experiments During COVID-19: A Cross-Continent Experience

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