Virtual Care Access and Health Equity during the COVID-19 Pandemic, a qualitative study of patients with chronic diseases from Canada

Chan-Nguyen, Sophy; Ritsma, Benjamin; Nguyen, Lisa; Srivastava, Siddhartha; Shukla, Garima; Appireddy, Ramana

doi:10.1177/20552076221074486

Cited by 19 publications

(16 citation statements)

References 44 publications

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“…Unlike older patient groups, characterized by lower rates of increase in virtual adoption but with high baseline pre-pandemic levels of usage, minority sectors (mainly the Arab sector) demonstrated a low virtual adoption rate together with low absolute rates before the pandemic. The variation by age and sector confirms the need to improve adoption of virtual care among minority sectors, patient groups which are currently characterized by underutilization [ 17 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 95%

Trends in the Volume and Types of Primary Care Visits during the Two Years of the COVID-19 Pandemic in Israel

Miron

Sagy

Yaron

et al. 2022

IJERPH

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Background: The outbreak of the COVID-19 pandemic led to a decrease in primary health care in-person visits and a simultaneous increase in virtual encounters. Objective: To quantify the change in the total volume of primary care visits and mix of visit types during the two years of the pandemic in Israel. Design: Cross-sectional study. Participants: All primary care visits by members of the largest healthcare organization in Israel, during three one-year periods: the pre-COVID-19 year (March 2019–February 2020), the first year of COVID-19 (March 2020–February 2021), and the second year of COVID-19 (March 2021–February 2022). Main measures: Total volume of primary care visits and mix of visit types. Results: More than 112 million primary care visits were included in the study. The total visit rate per 1000 members did not change significantly between the pre-COVID year (19) and the first COVID year (19.8), but was 21% higher in the second COVID-19 year (23). The rate of in-person visits per 1000 members decreased from 12.0 in the pre-COVID year to 7.7 in the first COVID year and then increased to 9.6 in the second. The rate of phone visits and asynchronous communication increased from 0.7 and 6.3, respectively, in the pre-COVID year, to 4.1 and 8, respectively, in the first COVID year, and remained unchanged in the second. There was substantial variation across age groups and sectors in the adoption of virtual platforms. Conclusions: The rapid introduction of virtual encounters in primary care tended to displace in-person visits in the first year of the pandemic, but they appear to have been additive in the second. This transition should be monitored, with the goal of ensuring appropriate planning efforts and resource allocation to deal with the potential added burden on medical staff. Efforts should be invested in encouraging the use of virtual platforms in patient groups that currently underutilize it, such as minorities.

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Section: Discussionmentioning

confidence: 95%

Trends in the Volume and Types of Primary Care Visits during the Two Years of the COVID-19 Pandemic in Israel

Miron

Sagy

Yaron

et al. 2022

IJERPH

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“…However, far from dismissing virtual care as inadequate compared to in-person services, participants noted that virtual care had several advantages linked to convenience and efficiency, which similar studies also found (Breton et al, 2021;Chan-Nguyen et al, 2022). While some participants acknowledged the disruption in health-care services due to the COVID-19 pandemic, others described the accelerated development of virtual care as a time and money saver.…”

Section: Discussionmentioning

confidence: 97%

‘It’s not as good as the face‐to‐face contact’: A sociomaterialist analysis of the use of virtual care among Canadian gay, bisexual and queer men during the COVID‐19 pandemic

Daroya,

Grey,

Klassen

et al. 2023

Sociology Health & Illness

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The COVID‐19 pandemic led to the widespread adoption of virtual care—the use of communication technologies to receive health care at home. We explored the differential impacts of the rapid transition to virtual care during the COVID‐19 pandemic on health‐care access and delivery for gay, bisexual and queer men (GBQM), a population that disproportionately experiences sexual and mental health disparities in Canada. Adopting a sociomaterial theoretical perspective, we analysed 93 semi‐structured interviews with GBQM (n = 93) in Montreal, Toronto and Vancouver, Canada, conducted between November 2020 and February 2021 (n = 42) and June‐October 2021 (n = 51). We focused on explicating how the dynamic relations of humans and non‐humans in everyday virtual care practices have opened or foreclosed different care capacities for GBQM. Our analysis revealed that the rapid expansion and implementation of virtual care during the COVID‐19 pandemic enacted disruptions and challenges while providing benefits to health‐care access among some GBQM. Further, virtual care required participants to change their sociomaterial practices to receive health care effectively, including learning new ways of communicating with providers. Our sociomaterial analysis provides a framework that helps identify what works and what needs to be improved when delivering virtual care to meet the health needs of GBQM and other diverse populations.

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Section: Discussionmentioning

confidence: 99%

“…Other patient populations that are often disproportionally impacted by disparate access to virtual care include: those with limited access to or familiarity with technology, elderly persons, those with cognitive, visual or auditory impairments, and non-native language speakers. 24–27 At its inception, LUC3 adopted a telephone clinic model, circumventing the need for computers or smart phones. English and Spanish are primary languages in the local community; thus, LUC3’s written resources were prepared in both languages; written materials were later translated into Arabic in response to patient requests.…”

Section: Discussionmentioning

confidence: 99%

Applying the lessons of design thinking: a unique programme of care for acutely unwell, community-dwelling COVID-19 patients

Devlin,

McIntyre,

Ramer

et al. 2024

BMJ Open Qual

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BackgroundThe COVID-19 pandemic limited access to primary care and in-person assessments requiring healthcare providers to re-envision care delivery for acutely unwell outpatients. Design thinking methodology has the potential to support the robust evolution of a new clinical model.AimTo demonstrate how design thinking methodology can rapidly and rigorously create and evolve a safe, timely, equitable and patient-centred programme of care, and to share valuable lessons for effective implementation of design thinking solutions to address complex problems.MethodWe describe how design thinking methodology was employed to create a new clinical model of care. Using the example of a novel telemedicine programme to support acutely unwell, community-dwelling COVID-19-positive patients called the London Urgent COVID-19 Care Clinic (LUC3), we show how continuous quality outcomes (safety, timeliness, equity and patient-centredness), as well as patient experience survey responses, can drive iterative changes in programme delivery.ResultsThe inspiration phase identified four key needs for this patient population: monitoring COVID-19 signs and symptoms; self-managing COVID-19 symptoms; managing other comorbidities in the setting of COVID-19; and escalating care as needed. Guided by these needs, a cross-disciplinary stakeholder group was engaged in the ideation and implementation phases to create a unique and comprehensive telemedicine programme (LUC3). During the implementation phase, LUC3 assessed 2202 community-based patients diagnosed with acute COVID-19; the collected quality outcomes and end-user feedback led to evolution of programme delivery.ConclusionDesign thinking methodology provided an essential framework and valuable lessons for the development of a safe, equitable, timely and patient-centred telemedicine care programme. The lessons learnt here—the importance of inclusive collaboration, using empathy to guide equity-focused interventions, leveraging continuous metrics to drive iteration and aiming for good-if-not-perfect plans—can serve as a road map for using design thinking for targeted healthcare problems.

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Virtual Care Access and Health Equity during the COVID-19 Pandemic, a qualitative study of patients with chronic diseases from Canada

Cited by 19 publications

References 44 publications

Trends in the Volume and Types of Primary Care Visits during the Two Years of the COVID-19 Pandemic in Israel

Trends in the Volume and Types of Primary Care Visits during the Two Years of the COVID-19 Pandemic in Israel

‘It’s not as good as the face‐to‐face contact’: A sociomaterialist analysis of the use of virtual care among Canadian gay, bisexual and queer men during the COVID‐19 pandemic

Applying the lessons of design thinking: a unique programme of care for acutely unwell, community-dwelling COVID-19 patients

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