Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center

Srinivasan, Malathi; Asch, Steven M.; Vilendrer, Stacie; Thomas, Samuel; Bajra, Rika; Barman, Linda; Edwards, Lauren Michelle; Filipowicz, Heather; Giang, Lena; Jee, Olivia; Mahoney, Megan; Nelligan, Ian; Phadke, Anuradha; Torres, Elise; Artandi, Maja

doi:10.7326/m20-1814

Cited by 86 publications

(159 citation statements)

References 24 publications

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“…21,22 An Ontario pilot study of virtual care showed that, when provided with a choice of audio, video or text messaging on an integrated platform, more than 90% of visits occurred using asynchronous, secure text messaging followed by audio, yet there are no billing codes for text messaging. 28 Despite extensive use of virtual care in the COVID-19 pandemic, [23][24][25][26][27] the appropriate role of virtual care remains to be determined. It is not possible to separate the role of physician funding for virtual care from the impact of the pandemic itself in the major uptake of virtual care.…”

Section: Discussionmentioning

confidence: 99%

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Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Glazier

Green

et al. 2021

CMAJ

309

342

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BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the in itial months of the pandemic in Ontario, Canada. METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.

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Section: Discussionmentioning

confidence: 99%

“…Despite extensive use of virtual care in the COVID-19 pandemic, 23 – 27 the appropriate role of virtual care remains to be determined. It is not possible to separate the role of physician funding for virtual care from the impact of the pandemic itself in the major uptake of virtual care.…”

Section: Discussionmentioning

confidence: 99%

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Glazier

Green

et al. 2021

CMAJ

309

342

View full text Add to dashboard Cite

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“…Staff were redeployed to primary care offices. The electronic health record (EHR) technical teams completed all configurations, templates and phrases, billing and coding changes, and technical set-up for televisits in a few weeks, similar to experiences elsewhere in USA [59][60][61][62][63]. Use of telehealth increased rapidly to a peak of c. 62% outpatient encounters (Figure 5).…”

Section: United States Of America a Healthcare Systemmentioning

confidence: 92%

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

et al. 2021

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Objective: Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned. Methods: IMIA Primary Care Informatics Working Group members from Australia, Canada, United Kingdom and United States developed a standardised template for collection of information. The template guided a rapid literature review. We also included experiential learning from primary care and public health perspectives. Results: All countries responded rapidly. Common themes included rapid reductions then transformation to virtual visits, pausing of non-COVID related informatics projects, all against a background of non-standardized digital development and disparate territory or state regulations and guidance. Common barriers in these four and in less-resourced countries included disparities in internet access and availability including bandwidth limitations when internet access was available, initial lack of coding standards, and fears of primary care clinicians that patients were delaying care despite the availability of televisits. Conclusions: Primary care clinicians were able to respond to the COVID crisis through telehealth and electronic record enabled change. However, the lack of coordinated national strategies and regulation, assurance of financial viability, and working in silos remained limitations. The potential for primary care informatics to transform current practice was highlighted. More research is needed to confirm preliminary observations and trends noted.

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“…In Canada, as elsewhere, the COVID-19 pandemic served as a catalyst to increase virtual care uptake, 13 with virtual care quickly becoming the dominant outpatient-care delivery model. However, this news media analysis revealed that the initial push to implement virtual care quickly tapered off after only 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…Virtual and in-office care provided by primary care clinicians is vital during disasters and pandemics to route people away from ED and hospital use while providing continuity of care and urgent, nonemergency care. 5,13,14 News media provision of concrete behavioral recommendations, as with instructional messaging, during pandemic times can increase perceived self-efficacy and improve behavioral intentions. 16 However, we found that safety and protection messages were often contradictory, which may undermine trust, an essential element of risk communication.…”

Section: Safetymentioning

confidence: 99%

News Article Portrayal of Virtual Care for Health Care Delivery in the First 7 Months of the COVID-19 Pandemic

Rush

Burton

Smith

et al. 2021

Telemedicine Reports

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Objectives: The onset of the 2020 coronavirus pandemic resulted in rapid implementation of virtual care solutions at an unprecedented pace. The news media, as a trusted source for many Canadians, plays a vital role during emergencies by reporting on changes in health care protocols, policies, and technologies. This article presents the results of a qualitative analysis of Canadian news articles between February and August of 2020 to identify critical themes with respect to virtual care. Methods: A full-text search of the database Canadian Newsstream resulted in 1542 articles (708 duplicates), of which 294 articles were included in the final analysis. Inductive analysis was used to generate themes and identify voices, contradictions, and tensions in the articles. Results: Analysis generated four themes: coronavirus disease (COVID-19) as a catalyst for virtual care, safety and protection, economic impacts, and telehealth as a model of care. Media portrayals represented some voices (e.g., physicians) while limiting others (e.g., patients), reflected some contradictory messaging with respect to safety and protection, and raised key issues and concerns about virtual health care delivery during the first 7 months of COVID-19. Conclusions: Our findings of successful and rapid uptake, uses and concerns around funding, and privacy and virtual care adoption reported in the news media can be used to inform longer term implementation and sustainability. Policy makers could benefit from crafting messages that balance information and reassurance. Public/patient perspectives, which were largely missing from news media, are needed to gauge receptivity and sustainability.

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Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center

Cited by 86 publications

References 24 publications

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

News Article Portrayal of Virtual Care for Health Care Delivery in the First 7 Months of the COVID-19 Pandemic

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