Virtual Care for Indigenous Populations in Canada, the United States, Australia, and New Zealand: Protocol for a Scoping Review

Camp, Patricia; Girt, Mirha; Wells, Alix; Malas, Adeeb; Peter, Maryke; Crosbie, Stephanie; Holyk, Travis

doi:10.2196/21860

Cited by 11 publications

(12 citation statements)

References 195 publications

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“…28,29 Further research is needed to ensure that virtual care meets the needs of Indigenous peoples and Indigenous communities, which may be different from other vulnerable groups in Canada. 28,30 None of the evaluations of virtual care were conducted in Canada and the evaluation guidance documents only have representation of Canada through 2 publications from the Heart and Stroke Foundation of Canada. 21,22 The document published by the Pan American Health Organization was not informed by Canadian representatives.…”

Section: Limitationsmentioning

confidence: 99%

Approaches to Evaluations of Virtual Care in Primary Care

Hui¹,

Dolcine²,

Loshak³

2022

cjht

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A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada. Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity. Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive. Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole. Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted. Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending. Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care. Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care. Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care). Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.

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Section: Limitationsmentioning

confidence: 99%

Approaches to Evaluations of Virtual Care in Primary Care

Hui¹,

Dolcine²,

Loshak³

2022

cjht

View full text Add to dashboard Cite

show abstract

“…Although it is widely recognized that the use of virtual care and other health technologies deserves careful consideration, there is currently limited and/or emerging evidence. [59][60][61][62] Additionally, while almost half of Indigenous people live in rural or remote communities, more than half reside in urban settings. 63 These contextual differences highlight the importance of unique considerations when developing approaches and policies for virtual care.…”

Section: First Nations Inuit and Métis Populationsmentioning

confidence: 99%

Effective Modalities of Virtual Care to Deliver Mental Health and Addictions Services in Canada

Lo¹,

Strudwick²,

Mah³

et al. 2022

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About Us: The Ontario COVID-19 Science Advisory Table is a group of scientific experts and health system leaders who evaluate and report on emerging evidence relevant to the COVID-19 pandemic, to inform Ontario's response. Our mandate is to provide weekly summaries of relevant scientific evidence for the COVID-19 Health Coordination Table of the Province of Ontario, integrating information from existing scientific tables, Ontario's universities and agencies, and the best global evidence. The Science Table summarizes its findings for the Health Coordination Table and the public in Science Briefs. The Mental Health Working Group comprises scientific experts and public health leaders with specific expertise in mental health. Their expertise spans mental health of children and youth, adults and geriatric populations, mental health of health care providers, women's health, mental health among LGBTQ persons, mental health among Black, Indigenous, and other racialized populations, and COVID-19. The Working Group evaluates emerging scientific evidence related to maintaining mental health during COVID-19, the mental health burden of disease and public health interventions on individuals across the lifespan, including children and adolescents, and the older adult population, as well as the need for assessment and recommendations

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“…Face-to-face health care interactions are valued by Indigenous peoples, and culturally sensitive and trauma-informed care can enhance health outcomes and experiences in this patient population [ 10 ]. Further exploration is warranted to understand the utility and acceptability of telehealth in Indigenous day-to-day life given the health inequities arising from the effects of colonization, including disparities in the social and Indigenous determinants of health, cultural oppression, and all forms of racism and intergenerational trauma that contribute to the health care experiences of Indigenous peoples [ 10 , 11 ].…”

mentioning

confidence: 99%