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

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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“…A questionnaire performed self-efficacy evaluation, an individual's confidence in the ability to complete a specific task [13]. Self-efficacy was also helpful in mediating the reduction of the knowledge-behavior gap among health care workers [14].…”

“…Responses of "not applicable" for any item were excluded. The self-efficacy was also designed based on the previous study [13], and the final tool consisted of 7 items.…”

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“…O Projeto Saúde Digital é um dos principais projetos de inovação tecnológica em implantação e andamento no HC. O projeto é realizado dentro da iniciativa Better Healthcare Program (BHP) 19 , que é um programa de cooperação entre o Governo do Reino Unido e o Ministério da Saúde, com o apoio da consultoria McKinsey 20 . O Hospital das Clínicas da Faculdade de Medicina da USP iniciou a utilização massiva e intensiva de novas tecnologias digitais em saúde.…”

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“…Virtual care can reduce the use of health‐care resources, improve access for some patients and minimise the risk of COVID‐19 transmission (Breton et al., 2021). Yet, virtual care can limit the relationship between patients and providers due to the absence of physical contact, impede the development of meaningful connections and a lack of opportunity to perform physical examinations (Dainty et al., 2022; Downing et al., 2021; Zhao et al., 2021). Limited access to high‐speed Internet, technological platforms (e.g., computers, tablets and smartphones) or unfamiliarity with digital communication portals can also create barriers to virtual care (Breton et al., 2021).…”