Virtual Specialist Care During the COVID-19 Pandemic: Multimethod Patient Experience Study

Abstract

Background Transitioning nonemergency, ambulatory medical care to virtual visits in light of the COVID-19 global pandemic has been a massive shift in philosophy and practice that naturally came with a steep learning curve for patients, physicians, and clinic administrators. Objective We undertook a multimethod study to understand the key factors associated with successful and less successful experiences of virtual specialist care, particularly as they relate to the patient experience of care. Methods This study was designed as a multimethod patient experience study using survey methods, descriptive qualitative interview methodology, and administrative virtual care data collected by the hospital decision support team. Six specialty departments participated in the study (endoscopy, orthopedics, neurology, hematology, rheumatology, and gastroenterology). All patients who could speak and read English and attended a virtual specialist appointment in a participating clinic at St. Michael’s Hospital (Toronto, Ontario, Canada) between October 1, 2020, and January 30, 2021, were eligible to participate. Results During the study period, 51,702 virtual specialist visits were conducted in the departments that participated in the study. Of those, 96% were conducted by telephone and 4% by video. In both the survey and interview data, there was an overall consensus that virtual care is a satisfying alternative to in-person care, with benefits such as reduced travel, cost, time, and SARS-CoV-2 exposure, and increased convenience. Our analysis further revealed that the specific reason for the visit and the nature and status of the medical condition are important considerations in terms of guidance on where virtual care is most effective. Technology issues were not reported as a major challenge in our data, given that the majority of “virtual” visits reported by our participants were conducted by telephone, which is an important distinction. Despite the positive value of virtual care discussed by the majority of interview participants, 50% of the survey respondents still indicated they would prefer to see their physician in person. Conclusions Patient experience data collected in this study indicate a high level of satisfaction with virtual specialty care, but also signal that there are nuances to be considered to ensure it is an appropriate and sustainable part of the standard of care.

‘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

“…However, GBQM participants living with HIV did not report disruptions to HIV care access despite the shift to virtual care (Grey et al, 2022;Prabhu et al, 2020). Participants also described that the transition to virtual care presented new challenges around patient-provider relations due to the absence of physical contact and lack of physical examinations, as observed in similar studies (e.g., Dainty et al, 2022;Downing et al, 2021). Study participants compared telephone-based modalities with their previous in-person experiences, noting that face-to-face consultations promoted better care reception due to the ability to see visual cues and make physical connections.…”

“…Although video‐based modalities can potentially address barriers to visualisation generated by telephone care (Dainty et al., 2022), appointments through video conferencing also closed off possibilities for receiving good care for some GBQM. Josh said that scheduling appointments in advance with providers had become easier with virtual care, but he felt that ‘Zoom or a medical face‐to‐face app’ was ‘not near as good’ as in‐person appointments.…”

“…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).…”

“…Similarly, a nationwide survey of 1800 people in May 2020 by the CMA found that 91% of respondents were satisfied or very satisfied with the care they received virtually using phones, emails, video conferencing and text messaging (CMA, 2020). Despite these advantages, some patients have expressed concerns about the limitations of virtual care, especially concerning appointments requiring physical examination (Dainty et al., 2022; Triantafillou et al., 2021).…”

Experiences of patients and their caregivers in a Virtual Ward in Singapore: A descriptive qualitative study

“…Virtual Wards have been defined as “any interaction between patients and/or members of their circle of care, occurring remotely, using any forms of communication or information technologies, to facilitate or maximize the quality and effectiveness of patient care.” [1] . Virtual Wards have been implemented to provide care for patients with COVID-19 in the United Kingdom (UK), the United States (US), Canada, Australia, and China; these all have three key features: (1) program-specific admission criteria, (2) vital signs monitoring, and (3) telecommunication (telephone, video calls, via websites, applications, or chatbots) [2] , [3] , [4] , [5] , [6] . In these studies, Virtual Wards were established to be safe [3] while reducing hospital utilization [4] .…”