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Weitzman C, Nadler C, Blum NJ, Augustyn M. Health Care for Youth With Neurodevelopmental Disabilities: A Consensus Statement. Pediatrics 2024; 153:e2023063809. [PMID: 38596852 DOI: 10.1542/peds.2023-063809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Individuals with a neurodevelopmental disability (NDD) face significant health care barriers, disparities in health outcomes, and high rates of foregone and adverse health care experiences. The Supporting Access for Everyone (SAFE) Initiative was developed to establish principles of health care to improve equity for youth with NDDs through an evidence-informed and consensus-derived process. With the Developmental Behavioral Pediatric Research Network, the SAFE cochairs convened a consensus panel composed of diverse professionals, caregivers, and adults with NDDs who contributed their varied expertise related to SAFE care delivery. A 2-day public forum (attended by consensus panel members) was convened where professionals, community advocates, and adults with NDDs and/or caregivers of individuals with NDDs presented research, clinical strategies, and personal experiences. After this, a 2-day consensus conference was held. Using nominal group technique, the panel derived a consensus statement (CS) on SAFE care, an NDD Health Care Bill of Rights, and Transition Considerations. Ten CSs across 5 topical domains were established: (1) training, (2) communication, (3) access and planning, (4) diversity, equity, inclusion, belonging, and anti-ableism, and (5) policy and structural change. Relevant and representative citations were added when available to support the derived statements. The final CS was approved by all consensus panel members and the Developmental Behavioral Pediatric Research Network steering committee. At the heart of this CS is an affirmation that all people are entitled to health care that is accessible, humane, and effective.
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Affiliation(s)
| | - Cy Nadler
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Nathan J Blum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marilyn Augustyn
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts
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Söderberg D, Bonn SE, Sjöblom L, Dahlgren A, Muli I, Amer-Wåhlin I, Bertilson BC, Farrokhnia N, Hvitfeldt H, Taloyan M, Hägglund M, Trolle Lagerros Y. Individual Patient Factors Associated with the Use of Physical or Digital Primary Care in Sweden. Telemed J E Health 2024; 30:1289-1296. [PMID: 38394275 DOI: 10.1089/tmj.2023.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Introduction: Little is known about factors that influence patients' choice to use physical or digital primary care. This study aimed to compare self-rated health, internet habits, and what patients deem important when choosing health care between users of physical and digital primary health care. Methods: We recruited 2,716 adults visiting one of six physical or four digital primary health care providers in Stockholm, Sweden, October 2020 to May 2021. Participants answered a questionnaire with questions about sociodemography, self-rated health, internet habits, and what they considered important when seeking care. We used logistic regression and estimated odds ratios (ORs) for choosing digital care. Results: Digital users considered themselves healthier and used the internet more, compared with physical users (p < 0.001). Competence of health care staff was the most important factor when seeking care to both physical and digital users (90% and 78%, respectively). Patients considering it important to avoid leaving home were more likely to seek digital care (OR 29.55, 95% confidence interval [CI] 12.65-69.06), while patients valuing continuity were more likely to seek physical care (OR 0.25, 95% CI 0.19-0.32). These factors were significant also when adjusting for self-rated health and sociodemographic characteristics. Conclusion: What patients considered important when seeking health care was associated with what type of care they sought. Patient preferences should be considered when planning health care to optimize resource allocation.
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Affiliation(s)
- Daniel Söderberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Stephanie E Bonn
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Linnea Sjöblom
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Anna Dahlgren
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Irene Muli
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isis Amer-Wåhlin
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - Bo C Bertilson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nasim Farrokhnia
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Helena Hvitfeldt
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Norrtälje Hospital, Vårdbolaget Tiohundra, Stockholm, Sweden
| | - Marina Taloyan
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Hägglund
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Care Services, Stockholm, Sweden
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Halas G, Baldwin A, LaBine L, MacKay K, Singer A, Katz A. A Phenomenological Inquiry of the Shift to Virtual Care Delivery: Insights from Front-Line Primary Care Providers. Healthcare (Basel) 2024; 12:861. [PMID: 38667623 PMCID: PMC11050693 DOI: 10.3390/healthcare12080861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The rapid deployment of virtual primary care visits served as a first-line response to COVID-19 and can now be examined for insights, particularly as virtual care is playing an ongoing role in patient care and consultations. Input from primary care providers directly responsible for virtual care delivery is needed to inform policies and strategies for quality care and interactions. The overarching goal of this research study was to examine the use of virtual care as a mechanism for primary healthcare delivery. A phenomenological approach investigated the shift in primary care service delivery as experienced by primary care providers and initiated during the COVID-19 pandemic. Focus groups were conducted with primary care providers (n = 21) recruited through email, advertisements, and professional organizations, exploring how virtual care was delivered, the benefits and challenges, workflow considerations, and recommendations for future use. Integrating virtual care was performed with a great deal of autonomy as well as responsibility, and overwhelmingly depended on the telephone. Technology, communication, and workflow flexibility are three key operational aspects of virtual care and its delivery. Providers highlighted cross-cutting themes related to the dynamics of virtual care including balancing risk for quality care, physician work/life balance, efficiency, and patient benefits. Primary care providers felt that virtual care options allowed increased flexibility to attend to the needs of patients and manage their practice workload, and a few scenarios were shared for when virtual care might be best suited. However, they also recognized the need to balance in-person and virtual visits, which may require guidelines that support navigating various levels of care. Overall, virtual care was considered a good addition to the whole 'care package' but continued development and refinement is an expectation for optimizing and sustaining future use.
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Affiliation(s)
- Gayle Halas
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Alanna Baldwin
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Lisa LaBine
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Kerri MacKay
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Community Partner, Winnipeg, MB R3E 0W3, Canada
| | - Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Alan Katz
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
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Babaei N, Zamanzadeh V, Valizadeh L, Lotfi M, Kousha A, Samad-Soltani T, Avazeh M. Virtual care in the health care system: A concept analysis. Scand J Caring Sci 2024; 38:35-46. [PMID: 38009448 DOI: 10.1111/scs.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Health care providers need a better understanding of virtual care to recognise and use it for service delivery. AIM To provide a more comprehensive definition of the concept of virtual care. METHOD This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases. RESULTS The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services. CONCLUSION Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.
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Affiliation(s)
- Nasib Babaei
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Kousha
- Department of Health Education and Health Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marziyeh Avazeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Hedden L, Spencer S, Mathews M, Gard Marshall E, Lukewich J, Asghari S, Gill P, McCracken RK, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, Schacter G. "Technology has allowed us to do a lot more but it's not necessarily the panacea for everybody": Family physician perspectives on virtual care during the COVID-19 pandemic and beyond. PLoS One 2024; 19:e0296768. [PMID: 38422067 PMCID: PMC10903916 DOI: 10.1371/journal.pone.0296768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Early in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments. Our objective was to explore Canadian family physicians' perspectives on the strengths and limitations of virtual care implementation for their patient populations during the COVID-19 pandemic and implications for the integration of virtual care into broader primary care practice. METHODS We conducted semi-structured qualitative interviews with family physicians working in four Canadian jurisdictions (Vancouver Coastal health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region, Newfoundland and Labrador). We analyzed interview data using a structured applied thematic approach. RESULTS We interviewed 68 family physicians and identified four distinct themes during our analysis related to experiences with and perspectives on virtual care: (1) changes in access to primary care; (2) quality and efficacy of care provided virtually; (3) patient and provider comfort with virtual modalities; and (4) necessary supports for virtual care moving forward. CONCLUSIONS The move to virtual care enhanced access to care for select patients and was helpful for family physicians to better manage their panels. However, virtual care also created access challenges for some patients (e.g., people who are underhoused or living in areas without good phone or internet access) and for some types of care (e.g., care that required access to medical devices). Family physicians are optimistic about the ongoing integration of virtual care into broader primary care delivery, but guidance, regulations, and infrastructure investments are needed to ensure equitable access and to maximize quality of care.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Paul Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rita K. McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Faculty of Nursing, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Bender JL, Scruton S, Wong G, Abdelmutti N, Berlin A, Easley J, Liu ZA, McGee S, Rodin D, Sussman J, Urquhart R. Virtual follow-up care among breast and prostate cancer patients during and beyond the COVID-19 pandemic: Association with distress. Cancer Med 2024; 13:e6948. [PMID: 38466233 PMCID: PMC10926960 DOI: 10.1002/cam4.6948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate associations between self-reported distress (anxiety/depression) and satisfaction with and desire for virtual follow-up (VFU) care among cancer patients during and beyond the COVID-19 pandemic. METHODS Breast and prostate cancer patients receiving VFU at an urban cancer centre in Toronto, Canada completed an online survey on their sociodemographic, clinical, and technology, characteristics and experience with and views on VFU. EQ5D-5 L was used to assess distress. Statistical models adjusted for age, gender, education, income and Internet confidence. RESULTS Of 352 participants, average age was 65 years, 48% were women,79% were within 5 years of treatment completion, 84% had college/university education and 74% were confident Internet users. Nearly, all (98%) had a virtual visit via phone and 22% had a virtual visit via video. The majority of patients (86%) were satisfied with VFU and 70% agreed that they would like VFU options after the COVID-19 pandemic. Participants who reported distress and who were not confident using the Internet for health purposes were significantly less likely to be satisfied with VFU (OR = 0.4; 95% CI: 0.2-0.8 and OR = 0.19; 95% CI: 0.09-0.38, respectively) and were less likely to desire VFU option after the COVID-19 pandemic (OR = 0.49; 95% CI: 0.30-0.82 and OR = 0.41; 95% CI: 0.23-0.70, respectively). CONCLUSIONS The majority of respondents were satisfied with VFU and would like VFU options after the COVID-19 pandemic. Future research should determine how to optimize VFU options for cancer patients who are distressed and who are less confident using virtual care technology.
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Affiliation(s)
- Jacqueline L. Bender
- Cancer Rehabilitation and Survivorship, Department of Supportive CarePrincess Margaret Cancer CentreTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Sarah Scruton
- Cancer Rehabilitation and Survivorship, Department of Supportive CarePrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Geoff Wong
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Nazek Abdelmutti
- Cancer Quality Lab (CQual)Princess Margaret Cancer CentreTorontoOntarioCanada
- Cancer Digital IntelligencePrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Alejandro Berlin
- Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Julie Easley
- Department of Medical EducationHorizon Health NetworkFrederictonNew BrunswickCanada
| | - Zhihui Amy Liu
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Biostatistics DepartmentUniversity Health NetworkTorontoOntarioCanada
| | - Sharon McGee
- Division of Medical Oncology, Department of MedicineThe Ottawa Hospital and the University of OttawaOttawaOntarioCanada
| | - Danielle Rodin
- Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | | | - Robin Urquhart
- Department of Community Health and EpidemiologyDalhousie UniversityHalifaxNova ScotiaCanada
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Lee J, Manalew WS. Adoption of virtual prenatal visits linked to recurrent virtual or forgone visits for postpartum care. Midwifery 2024; 129:103904. [PMID: 38070218 DOI: 10.1016/j.midw.2023.103904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/20/2023] [Accepted: 12/03/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND To investigate the association between prenatal and postpartum visits, with a specific focus on the modality of these visits, and to assess whether barriers to virtual visits experienced during the prenatal period are linked to types of postpartum visits. METHODS The repeated cross-sectional study used the Pregnancy Risk Assessment Monitoring System from 2020 through 2021. Women who had prenatal visits and who also reported their postpartum visits were included (n = 11,258). The outcome was the modality of postpartum visits, and the key independent variable was virtual prenatal visit experience. Multinomial logistic regression analysis was performed to examine the relationship of postpartum visits with virtual prenatal visit experience. RESULTS Among those who had virtual prenatal visits, about one-third used virtual visits again for postpartum care. Individuals who had virtual prenatal visits showed greater odds of utilizing virtual visits (OR 8.54, 95%CI 7.05-10.35, p=<0.001) or no office visits (OR 1.61, 95%CI 1.25-2.07, p=<0.001) compared to in-person visits during the postpartum period. Women who reported a lack of virtual appointment availability (OR 0.58, 95%CI 0.40-0.86, P = 0.006) or cellular data (OR 0.18, 95%CI 0.05-0.68, p = 0.012) in their prenatal care had lower odds of virtual postpartum visits. CONCLUSIONS While virtual prenatal visits are linked to greater virtual visits for postpartum care, they are also associated with increased forgone care. The unavailability of virtual appointments and cellular data is a significant barrier to virtual visits. The findings provide practical implications for advancing equitable and sustainable care in a rapidly changing healthcare landscape.
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Affiliation(s)
- Jusung Lee
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX 78249, United States.
| | - Wondimu Samuel Manalew
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, United States
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Hensel JM, Lemoine J, Bolton SL, Perera E, Arpin M, Sareen J, Modirrousta M. When "virtual" works and when it doesn't: A survey of physician and patient experiences with virtual care during the COVID-19 pandemic. Digit Health 2024; 10:20552076241258390. [PMID: 38840659 PMCID: PMC11151755 DOI: 10.1177/20552076241258390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
Objective To assess the experience of virtual care among both patients and physicians across a range of clinical scenarios during the COVID-19 pandemic. Methods A web-based survey was disseminated to patients and physicians through a variety of media and healthcare communications from May 2020 to July 2021. Demographic details and attitudes across a range of virtual care domains were collected. Quantitative responses were analyzed descriptively. Open-text responses were gathered to contrast when a virtual visit was superior or inferior to an in-person one, and a thematic content analysis was used. Results There were 197 patients and 93 physician respondents, representing a range of demographic and practice characteristics. Patients noted several benefits of virtual care and felt it should continue to be available. Physicians felt they could do a lot of their care virtually. Common themes related to the superiority of virtual care were for "quick" visits, reviewing test results, chronic disease monitoring, and medication needs. Virtual care was less ideal when a physical exam was needed, and was not perceived as a good fit for an individual's cultural, language, or emotional needs. Certain conditions were identified as both ideal and non-ideal for the virtual format (e.g. mental healthcare). Discussion Certain situations are more amenable to virtual care with personal preferences among both patients and physicians. Future priorities should ensure that virtual care is effective across the range of clinical situations in which it may be used and that both virtual and in-person options are equally available to those who want them.
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Affiliation(s)
- Jennifer M. Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jocelyne Lemoine
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Bolton
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Essence Perera
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Megan Arpin
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mandana Modirrousta
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Halas G, Baldwin A, Mackay K, Cardenas E, LaBine L, Cherrett P, Abraham L, Fogarty V, Singer A, Katz A, Kirby S. Patients' and caregivers' experiences of virtual care in a primary care setting during the COVID-19 pandemic: A patient-oriented research study. Digit Health 2024; 10:20552076241232949. [PMID: 38410792 PMCID: PMC10896066 DOI: 10.1177/20552076241232949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
Objective This study explored patient and caregiver expectations and experiences of virtual primary care in Manitoba, Canada. This study focused on accessibility of care, acceptability and perceptions of quality from 'users' of primary healthcare services. Due to the rapid implementation of virtual primary care during the COVID-19 pandemic in Canada, patient/public input was largely bypassed. Methods A mixed method was conducted in collaboration with Patient and Caregiver Community Advisors. Data was obtained from 696 surveys and 9 focus groups (n = 41 patients and caregivers). Results Data suggest good acceptance of virtual visits, although considered a new experience despite almost exclusive use of the telephone. Participants preferred more input for choosing the type of visit but experienced less stress, time and inconvenience by using virtual care. There were mixed opinions of quality. More complex visits were associated with incomplete consultations and serve as one exemplar of the limitations due to lack of physical presence or contact. Unique communication skills were required to convey health concerns adequately and accurately. A more transactional approach was perceived from the lack of visual cues and the awkwardness associated with pauses during the phone conversation. Virtual care may be better used for certain circumstances but should encompass patient-centred decision making for when and how. Many expressed interests in video options; technology access and user ability are additional considerations for advancing virtual care. Conclusions The experiences and recommendations from patients and caregivers provide an important contribution to decision-making and integrating and sustaining quality virtual care for patient-centered healthcare service delivery. Keywords: Virtual care experiences, primary care, patient-oriented research, mixed methods, COVID-19.
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Affiliation(s)
- Gayle Halas
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alanna Baldwin
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Ernesto Cardenas
- Rady Faculty of Health Sciences, Dept of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Lisa LaBine
- Rady Faculty of Health Sciences, Dept of Family Medicine, University of Manitoba, Winnipeg, Canada
| | | | | | | | - Alexander Singer
- Rady Faculty of Health Sciences, Dept of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Rady Faculty of Health Sciences, Dept of Family Medicine, University of Manitoba, Winnipeg, Canada
- Rady Faculty of Health Sciences, Dept of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarah Kirby
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada
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Dale CM, Ambreen M, Kang S, Buchanan F, Pizzuti R, Gershon AS, Rose L, Amin R. Acceptability of the Long-Term In-Home Ventilator Engagement virtual intervention for home mechanical ventilation patients during the COVID-19 pandemic: A qualitative evaluation. Digit Health 2024; 10:20552076241228417. [PMID: 38282921 PMCID: PMC10822085 DOI: 10.1177/20552076241228417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
Background Clinical management of ventilator-assisted individuals (VAIs) was challenged by social distancing rules during the COVID-19 pandemic. In May 2020, the Long-Term In-Home Ventilator Engagement (LIVE) Program was launched in Ontario, Canada to provide intensive digital care case management to VAIs. The purpose of this qualitative study was to explore the acceptability of the LIVE Program hosted via a digital platform during the COVID-19 pandemic from diverse perspectives. Methods We conducted a qualitative descriptive study (May 2020-April 2021) comprising semi-structured interviews with participants from eight home ventilation specialty centers in Ontario, Canada. We purposively recruited patients, family caregivers, and providers enrolled in LIVE. Content analysis and the theoretical concepts of acceptability, feasibility, and appropriateness were used to interpret findings. Results A total of 40 individuals (2 VAIs, 18 family caregivers, 20 healthcare providers) participated. Participants described LIVE as acceptable as it addressed a longstanding imperative to improve care access, ease of use, and training provided; feasible for triaging problems and sharing information; and appropriate for timeliness of provider responses, workflows, and perceived value. Negative perceptions of acceptability among healthcare providers concerned digital workload and fit with existing clinical workflows. Perceived benefits accorded to LIVE included enhanced physical and psychological safety in the home, patient-provider relations, and VAI engagement in their own care. Conclusions Study findings identify factors influencing the LIVE Program's acceptability by patients, family caregivers, and healthcare providers during pandemic conditions including enhanced access to care, ease of case management triage, and VAI safety. Findings may inform the implementation of digital health services to VAIs in non-pandemic circumstances.
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Affiliation(s)
- Craig M. Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Munazzah Ambreen
- Medical Surgical Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sohee Kang
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Francine Buchanan
- Medical Surgical Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Regina Pizzuti
- Live Program, Ontario Ventilator Equipment Pool, Kingston, ON, Canada
| | - Andrea S. Gershon
- Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Louise Rose
- Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
- Department of Critical Care and Lane Fox Unit, Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Reshma Amin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Clinical Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
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11
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Hatherly K, Glista D, Testani D, Brunton L, Cunningham BJ. A scoping review of virtual synchronous intervention studies in preschool rehabilitation. Disabil Rehabil 2024; 46:232-240. [PMID: 36546349 DOI: 10.1080/09638288.2022.2157054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To summarize the available evidence for the delivery of synchronous virtual rehabilitation intervention services for preschoolers and to identify key factors associated with virtual intervention. METHODS Five databases were searched to identify peer-reviewed articles that assessed virtual interventions for preschoolers delivered by rehabilitation health professionals including physical therapists, occupational therapists, speech-language pathologists, audiologists, and their associated assistants. Relevant data regarding demographics, technology, mode of service delivery, timing, engagement, and measurement data were extracted, and charted. Data were then summarized quantitatively using frequency counts, and qualitatively using descriptive summaries. RESULTS Sixteen studies were identified. Virtual interventions primarily targeted language difficulties or disorders, therefore most services were delivered by a speech-language pathologist or audiologist. Most interventions were delivered using Skype or Zoom on a weekly basis. Various technological features (e.g., phonology software, 'e-helpers') were included, and multiple activities (e.g., playdough, bubbles) and strategies were used to support engagement. CONCLUSION This scoping review provides current knowledge about the delivery of virtual rehabilitation interventions for preschoolers to help guide best practices for clinicians. Future research could assess the validity of existing outcome measures in the virtual environment, and outline optimal session length and frequency for virtual preschool interventions.
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Affiliation(s)
- Kathryn Hatherly
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Canada
| | - Danielle Glista
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Canada
- National Centre for Audiology, Elborn College, Western University, London, Canada
| | - Daniela Testani
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Laura Brunton
- School of Physical Therapy, Elborn College, Western University, London, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Barbara Jane Cunningham
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
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12
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Young K, Xiong T, Lee R, Banerjee AT, Leslie M, Ko WY, Guo JYJ, Pham Q. Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study. J Med Internet Res 2023; 25:e49349. [PMID: 38153784 PMCID: PMC10784982 DOI: 10.2196/49349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/31/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors' care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities. OBJECTIVE This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic. METHODS An axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy. RESULTS Unmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as "eating bitterness," and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as "better than nothing;" it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants' desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians. CONCLUSIONS Chinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing "trickle-up" adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions.
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Affiliation(s)
- Karen Young
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ting Xiong
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rachel Lee
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Ananya Tina Banerjee
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Myles Leslie
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Wellam Yu Ko
- Men's Health Research Program, University of British Columbia, Vancouver, BC, Canada
| | - Julia Yu Jia Guo
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Quynh Pham
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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13
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Miller-Matero LR, Knowlton G, Vagnini KM, Yeh HH, Rossom RC, Penfold RB, Simon GE, Akinyemi E, Abdole L, Hooker SA, Owen-Smith AA, Ahmedani BK. The rapid shift to virtual mental health care: Examining psychotherapy disruption by rurality status. J Rural Health 2023. [PMID: 38148485 DOI: 10.1111/jrh.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Given the low usage of virtual health care prior to the COVID-19 pandemic, it was unclear whether those living in rural locations would benefit from increased availability of virtual mental health care. The rapid transition to virtual services during the COVID-19 pandemic allowed for a unique opportunity to examine how the transition to virtual mental health care impacted psychotherapy disruption (i.e., 45+ days between appointments) among individuals living in rural locations compared with those living in nonrural locations. METHODS Electronic health record and insurance claims data were collected from three health care systems in the United States including rurality status and psychotherapy disruption. Psychotherapy disruption was measured before and after the COVID-19 pandemic onset. RESULTS Both the nonrural and rural cohorts had significant decreases in the rates of psychotherapy disruption from pre- to post-COVID-19 onset (32.5-16.0% and 44.7-24.8%, respectively, p < 0.001). The nonrural cohort had a greater reduction of in-person visits compared with the rural cohort (96.6-45.0 vs. 98.0-66.2%, respectively, p < 0.001). Among the rural cohort, those who were younger and those with lower education had greater reductions in psychotherapy disruption rates from pre- to post-COVID-19 onset. Several mental health disorders were associated with experiencing psychotherapy disruption. CONCLUSIONS Though the rapid transition to virtual mental health care decreased the rate of psychotherapy disruption for those living in rural locations, the reduction was less compared with nonrural locations. Other strategies are needed to improve psychotherapy disruption, especially among rural locations (i.e., telephone visits).
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Affiliation(s)
- Lisa R Miller-Matero
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan, USA
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
| | - Gregory Knowlton
- Health Partners Institute, Research and Evaluation Division, Bloomington, Minnesota, USA
| | - Kaitlyn M Vagnini
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan, USA
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
| | - Hsueh-Han Yeh
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan, USA
| | - Rebecca C Rossom
- Health Partners Institute, Research and Evaluation Division, Bloomington, Minnesota, USA
| | - Robert B Penfold
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, USA
| | - Gregory E Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, USA
| | - Esther Akinyemi
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
| | - Lana Abdole
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
| | - Stephanie A Hooker
- Health Partners Institute, Research and Evaluation Division, Bloomington, Minnesota, USA
| | - Ashli A Owen-Smith
- Georgia State University, School of Public Health, Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia, USA
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan, USA
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
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14
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AGGARWAL MONICA, HUTCHISON BRIAN, ABDELHALIM REHAM, BAKER GROSS. Building High-Performing Primary Care Systems: After a Decade of Policy Change, Is Canada "Walking the Talk?". Milbank Q 2023; 101:1139-1190. [PMID: 37743824 PMCID: PMC10726918 DOI: 10.1111/1468-0009.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Policy Points Considerable investments have been made to build high-performing primary care systems in Canada. However, little is known about the extent to which change has occurred over the last decade with implementing programs and policies across all 13 provincial and territorial jurisdictions. There is significant variation in the degree of implementation of structural features of high-performing primary care systems across Canada. This study provides evidence on the state of primary care reform in Canada and offers insights into the opportunities based on changes that governments elsewhere have made to advance primary care transformation. CONTEXT Despite significant investments to transform primary care, Canada lags behind its peers in providing timely access to regular doctors or places of care, timely access to care, developing interprofessional teams, and communication across health care settings. This study examines changes over the last decade (2012 to 2021) in policies across 13 provincial and territorial jurisdictions that address the structural features of high-performing primary care systems. METHODS A multiple comparative case study approach was used to explore changes in primary care delivery across 13 Canadian jurisdictions. Each case consisted of (1) qualitative interviews with academics, provincial health care leaders, and health care professionals and (2) a literature review of policies and innovations. Data for each case were thematically analyzed within and across cases, using 12 structural features of high-performing primary care systems to describe each case and assess changes over time. FINDINGS The most significant changes include adopting electronic medical records, investments in quality improvement training and support, and developing interprofessional teams. Progress was more limited in implementing primary care governance mechanisms, system coordination, patient enrollment, and payment models. The rate of change was slowest for patient engagement, leadership development, performance measurement, research capacity, and systematic evaluation of innovation. CONCLUSIONS Progress toward building high-performing primary care systems in Canada has been slow and variable, with limited change in the organization and delivery of primary care. Canada's experience can inform innovation internationally by demonstrating how preexisting policy legacies constrain the possibilities for widespread primary care reform, with progress less pronounced in the attributes that impact physician autonomy. To accelerate primary care transformation in Canada and abroad, a national strategy and performance measurement framework is needed based on meaningful engagement of patients and other stakeholders. This must be accompanied by targeted funding investments and building strong data infrastructure for performance measurement to support rigorous research.
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Affiliation(s)
| | - BRIAN HUTCHISON
- Centre for Health Economics and Policy AnalysisMcMaster University
| | - REHAM ABDELHALIM
- Institute of Health PolicyManagement and EvaluationUniversity of Toronto
| | - G. ROSS BAKER
- Dalla Lana School of Public HealthUniversity of Toronto
- Institute of Health PolicyManagement and EvaluationUniversity of Toronto
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15
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Dainty KN, Seaton MB, Hall JN, Mondoux S, Abraham L, McCarron J, Tarride JE, McLeod SL. "It saved me from the emergency department": A qualitative study of patient experience of virtual urgent care in Ontario. PLoS One 2023; 18:e0285468. [PMID: 37738265 PMCID: PMC10516408 DOI: 10.1371/journal.pone.0285468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/11/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION In response to the COVID-19 pandemic, the Ontario Ministry of Health introduced a pilot program of 14 virtual urgent care (VUC) initiatives across the province to encourage physical distancing and provision of care by telephone and video-enabled visits. The implementation of the VUC pilot is currently being evaluated by an external academic team. The objective of this study was to understand patient experiences with VUC to determine barriers and facilitators to optimal virtual care as it rapidly expands during the current pandemic and beyond. METHOD The qualitative component of the evaluation used one-on-one telephone interviews with patients, families, providers, and program administrators as the main method of data collection. Patient and family participants were invited to participate by the triage nurse after their VUC visit. Data analysis, using thematic analysis, occurred in conjunction with data collection to monitor emerging themes and areas for further exploration. RESULTS Between April and October 2021, we completed 14 patient and/or family interviews from a representative cross-section of 6 pilot sites. Participants had a range of presenting complaints including infection, injury, medication side effects, and abdominal pain. The vast majority of participants were female (90%), and 70% were VUC patients themselves. Our analysis identified three key themes in the data which characterise patient and family member experience with VUC: a) emphasis on access to the ED; b) efficiency and quality of care; c) obtaining reassurance and next steps. CONCLUSION Virtual care options are valued by patients and families; however, the nature of care needed by those accessing VUC and who can best provide that care needs to be evaluated to position it for sustainability. Understanding how virtual care performs from both a provider and patient perspective during the current crisis has implications for designing alternative care options beyond the COVID-19 pandemic.
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Affiliation(s)
- Katie N. Dainty
- North York General Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Justin N. Hall
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shawn Mondoux
- Department of Emergency Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | | | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, And Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Shelley L. McLeod
- Schwartz/Reisman Emergency Medicine Institute (SREMI), Sinai Health System, Toronto, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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16
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Pradier C, Balinska MA, Bailly L. Enhancing multi-sectoral collaboration in health: the open arena for public health as a model for bridging the knowledge-translation gap. FRONTIERS IN HEALTH SERVICES 2023; 3:1216234. [PMID: 37790087 PMCID: PMC10544995 DOI: 10.3389/frhs.2023.1216234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
Effective public health interventions at local level must involve communities and stakeholders beyond the health services spectrum. A dedicated venue for structured discussion will ensure ongoing multi-sectoral collaboration more effectively than convening ad hoc meetings. Such a venue can be created using existing resources, at minimal extra cost. The University Hospital in Nice (France) has established an Open Arena for Public Health which can serve as a model for promoting collaborative partnerships at local level. The Arena has been successful in implementing sustainable interventions thanks to a set of principles, including: non-hierarchical governance and operating, fair representation of stakeholders, consensus as to best available evidence internationally and locally, policy dialogues: open, free-flowing discussions without preconceived solutions, and an experimental approach to interventions.
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Affiliation(s)
- Christian Pradier
- Department of Public Health, Nice University Hospital, University of Côte D'Azur, Nice, France
- Clinical Research Unit (UR2CA), Nice University Hospital, University of Côte D'Azur, Nice, France
| | - Marta A. Balinska
- Clinical Research Unit (UR2CA), Nice University Hospital, University of Côte D'Azur, Nice, France
| | - Laurent Bailly
- Department of Public Health, Nice University Hospital, University of Côte D'Azur, Nice, France
- Clinical Research Unit (UR2CA), Nice University Hospital, University of Côte D'Azur, Nice, France
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17
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Ko SQ, Chua CMS, Koh SH, Lim YW, Shorey S. Experiences of patients and their caregivers in a Virtual Ward in Singapore: A descriptive qualitative study. Int J Med Inform 2023; 177:105111. [PMID: 37307721 PMCID: PMC10232916 DOI: 10.1016/j.ijmedinf.2023.105111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The experiences of COVID-19 patients admitted to Virtual Wards and their caregivers are underexplored in Asian communities. A COVID-19 Virtual Ward (CVW) was recently established in Singapore. AIM This study aims to describe the experiences of high-risk COVID-19 patients admitted to a Virtual Ward and their caregivers in a multi-racial Asian community. METHODS A descriptive qualitative study was conducted from November 2021 to March 22 among high-risk COVID-19 patients and their caregivers who had been admitted to a CVW. The CVW involved teleconsultation whereby patients submitted their vital signs via a chatbot on their mobile phone and were supported remotely by a team of allied health professionals. In-depth interviews were conducted with patients and their caregivers and analyzed thematically. Findings The findings were supported by three themes. First, CVW admissions were perceived to be safe and effective. The second emerging theme related to the benefits and burdens of receiving care at home. The benefits of CVW were perceived comfort and familiarity with the home environment, while burdens included ensuring discipline in submitting health data and self-isolating from other household members. Last, the role of external factors such as informal support, paid domestic workers, and work arrangements was highlighted by the participants. Overall, key enablers for a successful CVW experience were the availability of social support, timely care from the care team, and 24/7 access to the team. CONCLUSION In conclusion, CVW was perceived as a safe and effective strategy to manage high-risk patients at home. We recommend that Virtual Wards should be further developed to expand bed capacity in both pandemic and non-pandemic settings.
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Affiliation(s)
- Stephanie Q Ko
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, 119228 Singapore, Singapore.
| | - Crystal Min Siu Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597 Singapore, Singapore.
| | - Shu Hua Koh
- NUHS Community Care Team, National University Health System, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore.
| | - Yee Wei Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore; Medical Affairs - Research, Innovation & Enterprise, Alexandra Hospital, National University Health System, 378 Alexandra Road, 159964 Singapore, Singapore.
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597 Singapore, Singapore.
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18
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Dulude C, Sutherland S, Vanderhout S, King WJ, Zuijdwijk C, Major N, Audcent T, Howley H, Cloutier P, Buba M, Jain R, Litwinska J, Findlay L, Malic C, Macaulay K, Parker K, Kouri C, Goldbloom EB. A pediatric virtual care evaluation framework and its evolution using consensus methods. BMC Pediatr 2023; 23:402. [PMID: 37592246 PMCID: PMC10433580 DOI: 10.1186/s12887-023-04229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The use of virtual care has increased dramatically in response to the COVID-19 pandemic, yet evidence is lacking regarding the impact of virtual care on patient outcomes, particularly in pediatrics. A standardized evaluation approach is required to support the integration of virtual care into pediatric health care delivery programs. The objective of this work was to develop a comprehensive and structured framework for pediatric virtual care evaluation. This framework is intended to engage and guide care providers, health centres, and stakeholders towards the development of a standardized approach to the evaluation of pediatric virtual care. METHODS We brought together a diverse multidisciplinary team, including pediatric clinicians, researchers, digital health leads and analysts, program leaders, a human factors engineer, a family advisor and our manager of health equity and diversity. The team reviewed the literature, including published evaluation frameworks, and used a consensus-based method to develop a virtual care evaluation framework applicable to a broad spectrum of pediatric virtual care programs. We used an iterative process to develop framework components, including domains and sub-domains, examples of evaluation questions, measures, and data sources. Team members met repeatedly over seven months to generate and provide feedback on all components of the framework, making revision as needed until consensus was reached. The framework was then applied to an existing virtual care program. RESULTS The resulting framework includes four domains (health outcomes, health delivery, individual experience, and program implementation) and 19 sub-domains designed to support the development and evaluation of pediatric virtual care programs. We also developed guidance on how to use the framework and illustrate its utility by applying it to an existing pediatric virtual care program. CONCLUSIONS This virtual care evaluation framework expands on previously developed frameworks by providing additional detail and a structure that supports practical application. It can be used to evaluate a wide range of pediatric virtual care programs in a standardized manner. Use of this comprehensive yet easy to use evaluation framework will inform appropriate implementation and integration of virtual care into routine practice and support its sustainability and continuous improvement.
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Affiliation(s)
- Catherine Dulude
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Stephanie Sutherland
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Shelley Vanderhout
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, Canada
| | - W James King
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Caroline Zuijdwijk
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Tobey Audcent
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Heather Howley
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Paula Cloutier
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
| | - Melanie Buba
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute Family Leader Program, 401 Smyth Rd, Ottawa, ON, Canada
| | - Raagini Jain
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Justyna Litwinska
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Leanne Findlay
- Children's Hospital of Eastern Ontario Research Institute Family Leader Program, 401 Smyth Rd, Ottawa, ON, Canada
| | - Claudia Malic
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - Karen Macaulay
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Kasey Parker
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Christine Kouri
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Ellen B Goldbloom
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, Canada.
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
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Clay-Williams R, Hibbert P, Carrigan A, Roberts N, Austin E, Fajardo Pulido D, Meulenbroeks I, Nguyen HM, Sarkies M, Hatem S, Maka K, Loy G, Braithwaite J. The diversity of providers' and consumers' views of virtual versus inpatient care provision: a qualitative study. BMC Health Serv Res 2023; 23:724. [PMID: 37400807 DOI: 10.1186/s12913-023-09715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND A broad-based international shift to virtual care models over recent years has accelerated following COVID-19. Although there are increasing numbers of studies and reviews, less is known about clinicians' and consumers' perspectives concerning virtual modes in contrast to inpatient modes of delivery. METHODS We conducted a mixed-methods study in late 2021 examining consumers' and providers' expectations of and perspectives on virtual care in the context of a new facility planned for the north-western suburbs of Sydney, Australia. Data were collected via a series of workshops, and a demographic survey. Recorded qualitative text data were analysed thematically, and surveys were analysed using SPSS v22. RESULTS Across 12 workshops, 33 consumers and 49 providers from varied backgrounds, ethnicities, language groups, age ranges and professions participated. Four advantages, strengths or benefits of virtual care reported were: patient factors and wellbeing, accessibility, better care and health outcomes, and additional health system benefits, while four disadvantages, weaknesses or risks of virtual care were: patient factors and wellbeing, accessibility, resources and infrastructure, and quality and safety of care. CONCLUSIONS Virtual care was widely supported but the model is not suitable for all patients. Health and digital literacy and appropriate patient selection were key success criteria, as was patient choice. Key concerns included technology failures or limitations and that virtual models may be no more efficient than inpatient care models. Considering consumer and provider views and expectations prior to introducing virtual models of care may facilitate greater acceptance and uptake.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia.
| | - Peter Hibbert
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- Centre for Elite Performance, Macquarie University, Expertise & Training, Sydney, NSW, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
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Kuschke S, Moodie S, Kirubalingam K, O'Hagan R, Glista D. Parents' Perceptions of the Factors Influencing the Uptake of Remote Pediatric Hearing Aid Support: Development of a Conceptual Framework. JMIR Pediatr Parent 2023; 6:e47358. [PMID: 37279061 DOI: 10.2196/47358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND To achieve effective integration of virtual care into family-centered audiology practices, participatory research methods, including parents as vital participants in the delivery of pediatric audiology care, should be considered. A better understanding of the barriers and facilitators influencing the adoption of virtual care for families is warranted. OBJECTIVE This study aimed to develop a conceptual framework of the factors perceived to influence the adoption of remote pediatric hearing aid support among the parents of children with hearing loss. METHODS A total of 12 parents of children who wear hearing aids, between the ages of 0-17 years, were recruited to participate in group or individual interviews as part of the 6-step participatory-based concept mapping (CM) process. Data collection was specific to parents in a Canadian context. Analyses included multidimensional scaling and hierarchical cluster analysis. RESULTS The CM process resulted in 6 main themes, displayed in a cluster map according to their order of importance. These themes include access to timely, consistent care; technology considerations; convenience; child engagement; cost; and partnership considerations. Key underlying statements and subthemes are highlighted per theme. CONCLUSIONS Findings from this study demonstrate the use of CM in participatory research with parents and as part of a family-centered care model. Future research should aim to investigate the factors that influence the uptake of remote hearing aid support in different contexts, for example, in low- to middle-income countries versus those in high-income countries.
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Affiliation(s)
| | - Sheila Moodie
- School of Communication Sciences and Disorders, Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada
- National Centre for Audiology, The University of Western Ontario, London, ON, Canada
| | - Keshinisuthan Kirubalingam
- Department of Otolaryngology - Head & Neck Surgery, The University of Western Ontario, London, ON, Canada
| | - Robin O'Hagan
- National Centre for Audiology, The University of Western Ontario, London, ON, Canada
| | - Danielle Glista
- School of Communication Sciences and Disorders, Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada
- National Centre for Audiology, The University of Western Ontario, London, ON, Canada
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21
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Teles S, Crudo V, Sangrar R, Langlois S. Enabling Patients as Partners on Virtual Teams: A Scoping Review. J Patient Exp 2023; 10:23743735231177205. [PMID: 37283697 PMCID: PMC10240866 DOI: 10.1177/23743735231177205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Developing partnerships among patients and healthcare providers improves quality of virtual care. Successful patient engagement is influenced by digital literacy. Although adults (35-64) with chronic health challenges may be motivated to use virtual services, they may not have the required skills or orientation to effectively participate on their virtual team. This scoping review aimed to identify resources available to enable adults with chronic health challenges to participate as partners on their virtual teams. Peer-reviewed and grey literature data from 2011 to 2022 were searched. A total of 432 peer-reviewed and 357 grey literature sources were retrieved and screened, and 14 and 84 sources, respectively, met the inclusion criteria. Relevant information from the sources was extracted and analyzed in duplicate and synthesized qualitatively. Key findings include (1) virtual workflow processes/frameworks, (2) 'webside manner' guidelines which emphasize "the how" as opposed to "the what" of facilitating team interactions, and (3) virtual patient support personnel. Overall, analyses suggest there are persisting gaps to be addressed in synchronous virtual care resources for adults with chronic health challenges.
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Affiliation(s)
- Sabrina Teles
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vanessa Crudo
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sylvia Langlois
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Advancing Collaborative Healthcare and Education, University Health Network and University of Toronto, Toronto, Canada
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22
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Tao X, Zhu W, Chu M, Zhang Y. Nurse-led virtual interventions in managing chronic diseases: a protocol for a systematic review of randomised controlled trials. BMJ Open 2023; 13:e070583. [PMID: 37188471 DOI: 10.1136/bmjopen-2022-070583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Technological advances are changing nursing practice; however, nurse-led virtual care for chronic disease management has not yet been adequately explored and described. This study will review and analyse the effects of nurse-led virtual services and describe the virtual intervention characteristics relevant to the scope of nursing practice in chronic disease management. METHODS AND ANALYSIS This study will systematically review randomised controlled trials evaluating the effects of nurse-led virtual care interventions on patients with chronic conditions. Databases including PubMed, Embase, Web of Science, CINAHL, Chinese National Knowledge Infrastructure, Wanfang (Chinese) and VIP Chinese Science and Technology Periodicals will be searched. All studies will be screened and selected using the criteria described in 'population, intervention, comparison, outcome and study design' format. Relevant studies will be searched using the reference lists of eligible studies and review articles. The risk of bias will be assessed using the Joanna Briggs Institute Quality Appraisal Form. Two reviewers will independently extract data from all the included studies using a standardised data extraction form on the Covidence platform. RevMan V.5.3 software will be used to perform the meta-analysis. Data synthesis will be conducted with descriptive synthesis by summarising and tabulating the data and presenting them according to the research questions. ETHICS AND DISSEMINATION Formal ethical approval is not required as the data used in this systematic review are abstracted from the pre-existing literature. The results of this study will be disseminated through peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022361260.
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Affiliation(s)
- Xingjuan Tao
- Shanghai JiaoTong University School of Nursing, Shanghai, China
| | - Weishan Zhu
- Shanghai JiaoTong University School of Nursing, Shanghai, China
| | - Mingzi Chu
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuanyuan Zhang
- Shanghai JiaoTong University School of Nursing, Shanghai, China
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23
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Sanderson V, Vujcic B, Coulson S, Lim R. Qualitative analysis of values and motivation reported by families utilizing a paediatric virtual care emergency clinic launched during the SARS-CoV-2 pandemic. CAN J EMERG MED 2023:10.1007/s43678-023-00505-2. [PMID: 37087712 PMCID: PMC10122871 DOI: 10.1007/s43678-023-00505-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/28/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE This is the first study to take an in-depth qualitative approach to identify motivating factors for caregivers who chose the paediatric emergency virtual care option in Canada during the SARS-CoV-2 pandemic. The role that virtual care may play moving forward is also considered. METHODS Between May 2020 and May 2021, 773 respondents attending the virtual clinic completed a follow-up survey with open-ended questions. For qualitative content analysis, comments were coded and analysed until thematic saturation was reached. Sub-codes were subsumed into major coding categories to identify themes. RESULTS Three major themes, including safety, reassurance and convenience, and an overarching theme of satisfaction emerged from this analysis. Paediatric virtual clinic use was motivated in part by a desire to avoid the hospital environment. In-person Emergency Department visits were reported to be challenging and stressful, particularly due to perceived infection risk. Respondents appreciated that the clinic provided reassurance by assisting in navigating the healthcare system during a time of uncertainty and felt the virtual option allowed them to use healthcare resources responsibly. The convenience and ease of access to virtual care allowed for improved family-centred care in vulnerable populations. The overarching theme of satisfaction was emphasized by numerous comments for this service to be offered post-pandemic. CONCLUSION Our study indicates that virtual care was an attractive option for caregivers due to the safety, reassurance, and convenience provided. The strong patient desire for continued availability post-pandemic will be important considerations in this rapidly developing area of care.
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Affiliation(s)
- Victoria Sanderson
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Branka Vujcic
- Division of Emergency Medicine, London Health Sciences Centre, London, ON, Canada
| | - Sherry Coulson
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Rodrick Lim
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- Division of Emergency Medicine, London Health Sciences Centre, London, ON, Canada.
- Children's Health Research Institute, London, ON, Canada.
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24
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Glista D, O'Hagan R, DiFabio D, Moodie S, Muñoz K, Curca IA, Meston C, Richert F, Pfingstgraef D, Nageswaran L, Brown C, Joseph K, Bagatto M. Phase 1 of collaborative action around the implementation of virtual hearing aid care: Development of a clinical practice guideline. J Eval Clin Pract 2023; 29:614-621. [PMID: 37084185 DOI: 10.1111/jep.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
RATIONALE There is a growing demand for comprehensive, evidence-based, and accessible clinical practice guidelines (CPGs) to address virtual service delivery. This demand was particularly evident within the field of hearing healthcare during the COVID-19 pandemic, when providers were faced with an immediate need to offer services at a distance. Considering the recent advancement in information and communication technologies, the slow uptake of virtual care, and the lack of knowledge tools to support clinical integration in hearing healthcare, a Knowledge-to-Action Framework was used to address the virtual care delivery research-to-practice gap. AIMS AND OBJECTIVES This paper outlines the development of a CPG specific to provider-directed virtual hearing aid care. Clinical integration of the guideline took place during the COVID-19 pandemic and in alignment with an umbrella project aimed at implementing and evaluating virtual hearing aid care incorporating many different stakeholders. METHOD Evidence from two systematic literature reviews guided the CPG development. Collaborative actions around knowledge creation resulted in the development of a draft CPG (v1.9) and the mobilisation of the guideline into participating clinical sites. RESULTS AND CONCLUSION Literature review findings are discussed along with the co-creation process that included 13 team members, from various research and clinical backgrounds, who participated in the writing, revising, and finalising of the draft version of the guideline.
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Affiliation(s)
- Danielle Glista
- National Centre for Audiology, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Robin O'Hagan
- National Centre for Audiology, Western University, London, Ontario, Canada
| | - Danielle DiFabio
- Faculty of Health Sciences, School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Sheila Moodie
- National Centre for Audiology, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Karen Muñoz
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan, Utah, USA
| | - Ioan Aurelian Curca
- National Centre for Audiology, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- H. A. Leeper Speech and Hearing Clinic, Western University, London, Ontario, Canada
| | - Christine Meston
- National Centre for Audiology, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- H. A. Leeper Speech and Hearing Clinic, Western University, London, Ontario, Canada
| | - Frances Richert
- National Centre for Audiology, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- H. A. Leeper Speech and Hearing Clinic, Western University, London, Ontario, Canada
| | - Dave Pfingstgraef
- Elgin Audiology Consultants, London & St. Thomas, Thomas, Ontario, Canada
| | - Luxshmi Nageswaran
- Department of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Christine Brown
- H. A. Leeper Speech and Hearing Clinic, Western University, London, Ontario, Canada
| | - Keiran Joseph
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Marlene Bagatto
- National Centre for Audiology, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
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25
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Shahid S, Hogeveen S, Sky P, Chandra S, Budhwani S, de Silva R, Bhatia RS, Seto E, Shaw J. Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study. Int J Equity Health 2023; 22:44. [PMID: 36906566 PMCID: PMC10007658 DOI: 10.1186/s12939-023-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/18/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. METHODS We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. RESULTS Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. CONCLUSION This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system.
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Affiliation(s)
- Simone Shahid
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Philina Sky
- Waasegiizhig Nanaandawe'iyewigamig, PO Box 320, Keewatin, ON, P0X 1C0, Canada
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Suman Budhwani
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Ryan de Silva
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - R Sacha Bhatia
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, 90 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
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Ashcroft R, Donnelly C, Lam S, Kourgiantakis T, Adamson K, Verilli D, Dolovich L, Sheffield P, Kirvan A, Dancey M, Gill S, Mehta K, Sur D, Brown JB. Qualitative examination of collaboration in team-based primary care during the COVID-19 pandemic. BMJ Open 2023; 13:e067208. [PMID: 36731930 PMCID: PMC9895917 DOI: 10.1136/bmjopen-2022-067208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe Ontario primary care teams' experiences with collaboration during the COVID-19 pandemic. Descriptive qualitative methods using focus groups conducted virtually for data collection. SETTING Primary care teams located in Ontario, Canada. PARTICIPANTS Our study conducted 11 focus groups with 10 primary care teams, with a total of 48 participants reflecting a diverse range of interprofessional healthcare providers and administrators working in primary care. RESULTS Three themes were identified using thematic analysis: (1) prepandemic team functioning facilitated adaptation, (2) new processes of team interactions and collaboration, and (3) team as a foundation of support. CONCLUSIONS Results revealed the importance of collaboration for provider well-being, and the challenges of providing collaborative team-based primary care in the pandemic context. Caution against converting primary care collaboration to predominantly virtual modalities postpandemic is recommended. Further research on team functioning during the COVID-19 pandemic in other healthcare organisations will offer additional insight regarding how primary care teams can work collaboratively in a postpandemic environment.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Donnelly
- Rehabilitation Therapy, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - David Verilli
- Village Family Health Team, Toronto, Ontario, Canada
| | - Lisa Dolovich
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Anne Kirvan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Maya Dancey
- Telfer School of Management University of Ottawa, Ottawa, Ontario, Canada
| | - Sandeep Gill
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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27
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Leung T, Burton L, Loewen P, Wilson R, Singh S, Moroz L, Andrade JG. Patients' Experiences With the Fit of Virtual Atrial Fibrillation Care During the Pandemic: Qualitative Descriptive Study. JMIR Cardio 2023; 7:e41548. [PMID: 36716096 PMCID: PMC9926347 DOI: 10.2196/41548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/23/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In-person health care has been the standard model of care delivery for patients with atrial fibrillation (AF). Despite the growing use of remote technology, virtual health care has received limited formal study in populations with AF. Understanding the virtual care experiences of patients in specialized AF clinics is essential to inform future planning of AF clinic care. OBJECTIVE This qualitative descriptive study aimed to understand patients' virtual AF clinic care experiences during the COVID-19 pandemic. METHODS Participants were recruited from a pool of patients who were receiving care from an AF clinic and who were enrolled in a larger survey study. A total of 8 virtual focus groups (n=30) were conducted in 2 waves between March 2021 and May 2021. Facilitators used a semistructured discussion guide to ask participants questions about their experiences of virtual care and the perceived quality of virtual care and technology support. Three team members initially open coded group data to create a preliminary coding framework. As the analysis progressed, with subsequent focus groups, the code clusters were refined. RESULTS The participants were primarily male (21/30, 70%), aged ≥65 years (20/30, 67%), and college graduates (22/30, 73%). Patients found virtual care to be highly beneficial. Central to their experiences of virtual care was its fit or lack of fit with their health needs, which was integrally connected to communication effectiveness and their preferred virtual care future. Practical benefits included flexibility, convenience, and time and cost savings of virtual care. Virtual care fit occurred for small, quick, and mundane issues (eg, medication refills) but was suboptimal for new and more complex issues that patients thought warranted an in-person visit. Fit often reflected the effectiveness of communication between patient and provider and that of in-clinic follow-up. There was near-complete agreement among participants on the acceptability of virtual communication with their providers in addressing their needs, but this depended on adequate reciprocal communication. Without the benefit of in-person physical assessments, patients were uncertain and lacked confidence in communicating the needed, correct, and comprehensive information. Finally, participants described concerns related to ongoing virtual care with recommendations for their preferred future using a hybrid model of care and integrating patient-reported data (ie, blood pressure measurements) in virtual care delivery. CONCLUSIONS Virtual care from a specialty AF clinic provides practical benefits for patients, but they must be weighed against the need for virtual care's fit with patients' needs and problems. The stability and complexity of patients' health needs, their management, and their perceptions of communication effectiveness with providers and clinics must be considered in decisions about appointment modality. Patients' recommendations for future virtual care through use of hybrid models together with systems for data sharing have the potential to optimize fit.
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Affiliation(s)
| | - Lindsay Burton
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, Vancouver, BC, Canada
| | - Ryan Wilson
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Sarah Singh
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Lana Moroz
- Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Jason G Andrade
- Centre for Cardiovascular Innovation, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
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28
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Development and Evaluation of a Virtual Model for Fetal Alcohol Spectrum Disorder (FASD) Assessment and Diagnosis in Children: A Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020196. [PMID: 36832325 PMCID: PMC9955009 DOI: 10.3390/children10020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
The diagnostic process for fetal alcohol spectrum disorder (FASD) involves a multi-disciplinary team and includes neurodevelopmental, physical, and facial assessments and evidence of prenatal alcohol exposure during the index pregnancy. With the increased use of virtual care in health care due to the pandemic, and desire of clinics to be more efficient when providing timely services, there was a need to develop a virtual diagnostic model for FASD. This study develops a virtual model for the entire FASD assessment and diagnostic process, including individual neurodevelopmental assessments. It proposes a virtual model for assessment and diagnosis of FASD in children and evaluates the functionality of this model with other national and international FASD diagnostic teams and caregivers of children being assessed for FASD.
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DiFabio D, Moodie S, O’Hagan R, Pardal S, Glista D. Barriers and facilitators to paediatric caregivers' participation in virtual speech, language, and hearing services: A scoping review. Digit Health 2023; 9:20552076231216684. [PMID: 38033515 PMCID: PMC10687955 DOI: 10.1177/20552076231216684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose Virtual care-related technologies are transforming the way in which health services are delivered. A growing number of studies support the use of virtual care in the field of audiology and speech-language pathology; however, there remains a need to identify and understand what influences caregiver participation within the care that is virtual and family-focused. This review aimed to identify, synthesize, and summarize the literature around the reported barriers and facilitators to caregiver participation in virtual speech/hearing assessment and/or intervention appointments for their child. Methods A scoping review was conducted following the Joanna Briggs Institute manual for evidence synthesis. A search was conducted using six databases including MEDLINE, CINAHL, SCOPUS, ERIC, Nursing and Allied Health, and Web of Science to collect peer-reviewed studies of interest. Data was extracted according to a protocol published on Figshare, outlining a predefined data extraction form and search strategy. Results A variety of service delivery models and technology requirements were identified across the 48 included studies. Caregiver participation was found to vary across levels of attendance and involvement according to eight categories: Attitudes, child behavioral considerations, environment, opportunities, provider-family relationship, role in care process, support, and technology. Conclusions This review presents a description of the key categories reported to influence caregiver participation in virtual care appointments. Future research is needed to explore how the findings can be used within family-centered care models to provide strategic support benefiting the use and outcomes of virtual care.
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Affiliation(s)
- Danielle DiFabio
- School of Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Sheila Moodie
- School of Health and Rehabilitation Sciences, Western University, London, ON, Canada
- The National Centre for Audiology, Western University, London, ON, Canada
- The School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Robin O’Hagan
- The National Centre for Audiology, Western University, London, ON, Canada
| | - Simrin Pardal
- School of Health Studies, Western University, London, ON, Canada
| | - Danielle Glista
- School of Health and Rehabilitation Sciences, Western University, London, ON, Canada
- The National Centre for Audiology, Western University, London, ON, Canada
- The School of Communication Sciences and Disorders, Western University, London, ON, Canada
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Kleib M, Arnaert A, Nagle LM, Ali S, Idrees S, Kennedy M, da Costa D. Digital health education and training for undergraduate and graduate nursing students: a scoping review protocol. JBI Evid Synth 2022:02174543-990000000-00112. [PMID: 36728743 DOI: 10.11124/jbies-22-00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this review is to collate and analyze literature reporting on digital health education and training courses, or other pedagogical interventions, for nursing students at the undergraduate and graduate level to identify gaps and inform the development of future educational interventions. INTRODUCTION In this era of technology-driven health care, upskilling and/or reskilling the nursing workforce is urgently needed for nurses to lead the digital health future and improve patient care. While informatics competency frameworks serve to inform nursing education and practice, they do not address the entire digital health spectrum. INCLUSION CRITERIA This review will include research studies, theoretical/discussion papers, and reports, as well as gray literature from relevant sources published in the last 10 years. Opinion pieces, editorials, conference proceedings, and papers published in languages other than English will be excluded. METHODS The JBI methodology for scoping reviews will be followed. Searches will be conducted in Embase, CINAHL, ERIC, MEDLINE, Scopus, and Education Research Complete to retrieve potentially relevant studies. Hand searches of reference lists of included studies will be completed. Two reviewers will independently screen records against predefined eligibility criteria and consult a third reviewer if conflicts arise. Decisions will be documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram. Quantitative data will be analyzed using descriptive statistics. Content analysis will be applied to qualitative data to identify categories and themes. Findings will be synthesized and reported in tables and narrative format. SCOPING REVIEW REGISTRATION Open Science Framework osf.io/42eug.
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Affiliation(s)
- Manal Kleib
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Lynn M Nagle
- University of New Brunswick, Fredericton, NB, Canada
| | - Shamsa Ali
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Sobia Idrees
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- John W. Scott Health Sciences Library, University of Alberta Library, Walter C. Mackenzie Health Sciences Centre, Edmonton, AB, Canada
| | - Daniel da Costa
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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Singer A, Kosowan L, LaBine L, Shenoda D, Katz A, Abrams EM, Halas G, Wong ST, Talpade S, Kirby S, Baldwin A, Francois J. Characterizing the use of virtual care in primary care settings during the COVID-19 pandemic: a retrospective cohort study. BMC PRIMARY CARE 2022; 23:320. [PMID: 36496379 PMCID: PMC9736717 DOI: 10.1186/s12875-022-01890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. METHODS: Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescriptions) and provider (sex, age, clinic location, provider type, remuneration, country of graduation, return visit rate) characteristics describe the study population by visit type. Generalized estimating equation models describe factors associated with virtual care. RESULTS: There were 146,372 visits provided by 154 primary care providers between 03/14/20 and 06/30/20, of which 33.6% were virtual care. Female patients (OR 1.16, CI 1.09-1.22), patients with ≥ 3 comorbidities (OR 1.71, CI 1.44-2.02), and patients with ≥ 10 prescriptions (OR 2.71, 2.2-1.53) had higher odds of receiving at least one virtual care visit compared to male patients, patients with no comorbidities and patients with no prescriptions. There was no significant difference between the number of follow-up visits that were provided as a clinic visit compared to a virtual care visit (8.7% vs. 5.8%) (p = 0.6496). CONCLUSION Early in the pandemic restrictions, approximately one-third of visits were virtual. Virtual care was utilized by patients with more comorbidities and prescriptions, suggesting that patients with chronic disease requiring ongoing care utilized virtual care. Virtual care as a primary care visit type continues to evolve. Ongoing provision of virtual care can enhance quality, patient-centered care moving forward.
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Affiliation(s)
- Alexander Singer
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Leanne Kosowan
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Lisa LaBine
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Daniel Shenoda
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Alan Katz
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Departments of Community Health Science and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Manitoba Centre for Health Policy, Winnipeg, MB Canada
| | - Elissa M Abrams
- grid.21613.370000 0004 1936 9609Department of Pediatrics, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC Canada
| | - Gayle Halas
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Sabrina T. Wong
- grid.17091.3e0000 0001 2288 9830School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC Canada
| | - Siddhesh Talpade
- grid.416388.00000 0001 1245 5369Planning and Knowledge Management, Manitoba Health and Seniors Care, Winnipeg, MB Canada
| | - Sarah Kirby
- grid.21613.370000 0004 1936 9609George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB Winnipeg, Canada
| | - Alanna Baldwin
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Jose Francois
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
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Shepherd L, McConnell A, Watling C. Good for patients but not learners? Exploring faculty and learner virtual care integration. MEDICAL EDUCATION 2022; 56:1174-1183. [PMID: 35732194 DOI: 10.1111/medu.14861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The pandemic catapulted the adoption of virtual care far ahead of its anticipated maturation date, forcing faculty to role model and teach learners with barely enough time to master it themselves. With a scant body of prepandemic literature now accompanied by experience gained under extraordinary circumstances, we can benefit from understanding ad hoc strategies implemented by those on the front lines and from listening to learners about what is working and what is not. The purpose of this study was to explore the experience of learner integration into virtual care from both the faculty and learner perspectives. METHODS Using a constructivist grounded theory methodology and sociomateriality as a sensitising concept, we recruited participants using purposeful and theoretical sampling from a Canadian University with limited prepandemic virtual care provision. We interviewed 16 faculty and 5 learners spanning a breadth of specialties and years of practice/education to probe their experience of teaching and learning virtual care. Data collection and analysis were conducted iteratively with themes identified through constant comparative analysis. RESULTS Integrating learners into virtual care proved challenging initially because of a lack of familiarity with the process and later because of disrupted workflow, triggered by the structure and logistics of the virtual care clinic. Both faculty and learners identified learning deficiencies in the virtual care experience when compared with in-person clinics, but several unique and valuable learning affordances were noted. All faculty expressed a desire to keep virtual care as part of their future clinic practice, but paradoxically most felt that they were unlikely to include learners. CONCLUSIONS Training learners in virtual care is an educational challenge that will not disappear with COVID-19, even if our participants wished it could. The perceived value for patients but not learners begs a reconsideration of the sociomaterial contribution to this pandemic paradox.
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Affiliation(s)
- Lisa Shepherd
- Centre for Education Research & Innovation, Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Allison McConnell
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Watling
- Department of Oncology and Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Hoffman B, Braund H, McKeown S, Dalgarno N, Godfrey C, Appireddy R. Telemedicine and medical education: a mixed methods systematic review protocol. JBI Evid Synth 2022; 20:3045-3057. [PMID: 35946805 DOI: 10.11124/jbies-21-00481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to synthesize and appraise the available research on educational strategies required to prepare medical learners for engaging in telemedicine and virtual care. INTRODUCTION The COVID-19 pandemic has resulted in significant uptake of virtual care and telemedicine, highlighting the growing need for health care organizations and medical institutions to support physicians and learners navigating this new model of health care delivery, clinical learning, and assessment. Developing a better understanding of how best to prepare medical trainees across the continuum of undergraduate, postgraduate, and continuing professional development to engage in virtual care is critical in ensuring our continued ability to meet educational mandates and provide ambulatory care that is safe, efficient, and timely. INCLUSION CRITERIA Eligible studies will include medical learners who receive education on how to deliver telemedicine. The quantitative component of the review will compare learners exposed to educational interventions with learners not exposed to an intervention, or to a different intervention. Outcomes will include competencies in telemedicine delivery, knowledge, and behaviors. The qualitative component of the review will explore learners' experiences with the delivery of educational strategies that address telemedicine. METHODS Embase, MEDLINE, Evidence-Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Education Source, and ProQuest Dissertations and Theses Global will be searched to identify published and unpublished studies. No date or language restrictions will be applied. This systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews using a convergent segregated approach. Titles and abstracts of potential studies will be screened, and potentially relevant studies will undergo full-text review for eligibility and critical appraisal of the study methodology. Data will be extracted from those studies selected for inclusion. Findings will be described relating to the effectiveness of educational curricula, initiatives, and best practices in trainee engagement in telemedicine and virtual care. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021264332.
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Affiliation(s)
- Bryn Hoffman
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sandra McKeown
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Christina Godfrey
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Faculty of Health Sciences, Queen's University; Division of Neurology, Department of Medicine, School of Medicine, Queen's University, Kingston, ON, Canada
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Seaton CL, Rondier P, Rush KL, Li E, Plamondon K, Pesut B, Oelke ND, Dow-Fleisner S, Hasan K, Currie LM, Kurtz D, Jones C, Bottorff JL. Community stakeholder-driven technology solutions towards rural health equity: A concept mapping study in Western Canada. Health Expect 2022; 25:3202-3214. [PMID: 36245334 DOI: 10.1111/hex.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/24/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Technology holds great potential for promoting health equity for rural populations, who have more chronic illnesses than their urban counterparts but less access to services. Yet, more participatory research approaches are needed to gather community-driven health technology solutions. The purpose was to collaboratively identify and prioritize action strategies for using technology to promote rural health equity through community stakeholder engagement. METHODS Concept mapping, a quantitative statistical technique, embedded within a qualitative approach, was used to identify and integrate technological solutions towards rural health equity from community stakeholders in three steps: (1) idea generation; (2) sorting and rating feasibility/importance and (3) group interpretation. Purposeful recruitment strategies were used to recruit key stakeholders and organizational representatives from targeted rural communities. RESULTS Overall, 34 rural community stakeholders from western Canada (76% female, mean age = 55.4 years) participated in the concept mapping process. In Step 1, 84 ideas were generated that were reduced to a pool of 30. Multidimensional scaling and cluster analysis resulted in a six-cluster map representing how technological solutions can contribute toward rural health equity. The clusters of ideas included technological solutions and applications, but also ideas to make health care more accessible regardless of location, training and support in the use of technology, ensuring digital tools are simplified for ease of use, technologies to support collaboration among healthcare professionals and ideas for overcoming challenges to data sharing across health systems/networks. Each cluster included ideas that were rated as equally important and feasible. Key themes included organizational and individual-level solutions and connecting patients to newly developed technologies. CONCLUSIONS Overall, the grouping of solutions revealed that technological applications require not only access but also support and collaboration. Concept mapping is a tool that can engage rural community stakeholders in the identification of technological solutions for promoting rural health equity. PATIENT OR PUBLIC CONTRIBUTION Rural community stakeholders were involved in the generation and interpretation of technological solutions towards rural health equity in a three-step process: (1) individual brainstorming of ideas, (2) sorting and rating all ideas generated and (3) collective interpretation and group consensus on final results.
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Affiliation(s)
- Cherisse L Seaton
- School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Pierre Rondier
- Research and Innovation Office, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Eric Li
- Faculty of Management, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Katrina Plamondon
- School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Barb Pesut
- School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada.,University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Nelly D Oelke
- School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada.,Rural Coordination Centre of British Columbia, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Sarah Dow-Fleisner
- School of Social Work, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Khalad Hasan
- Computer Science, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Leanne M Currie
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Kurtz
- School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Charlotte Jones
- Faculty of Medicine, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Joan L Bottorff
- School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
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Abdallah L, Stolee P, Lopez KJ, Whate A, Boger J, Tong C. "Virtual care yes, but it has to be in addendum": A Qualitative Study of COVID-19's Impact on Older Adults' Perceptions of Virtual Care. JMIR Aging 2022; 5:e38546. [PMID: 36054599 PMCID: PMC9586256 DOI: 10.2196/38546] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is “here to stay.” As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support. Objective This research aims to understand older adults’ perspectives and experiences of virtual care during the pandemic. Methods As part of a larger study on older adults’ technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data. Results Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. Conclusions Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post–COVID-19.
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Affiliation(s)
- Lama Abdallah
- University of Waterloo, 200 University Ave. West, Waterloo, CA
| | - Paul Stolee
- University of Waterloo, 200 University Ave. West, Waterloo, CA
| | | | - Alexandra Whate
- University of Waterloo, 200 University Ave. West, Waterloo, CA
| | - Jennifer Boger
- University of Waterloo, 200 University Ave. West, Waterloo, CA
| | - Catherine Tong
- University of Waterloo, 200 University Ave. West, Waterloo, CA
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Selick A, Durbin J, Hamdani Y, Rayner J, Lunsky Y. Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res 2022; 6:e38916. [PMID: 35951444 PMCID: PMC9400841 DOI: 10.2196/38916] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. Objective The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. Methods We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. Results We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that “one size does not fit all,” and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients’ abilities to access necessary health care. Conclusions This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models.
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Affiliation(s)
- Avra Selick
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janet Durbin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yani Hamdani
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Rayner
- Alliance for Healthier Communities, Toronto, ON, Canada
- Centre for Studies in Family Medicine, Western University, London, ON, Canada
| | - Yona Lunsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Examining virtual visit use during a pandemic and perspectives of primary care providers, patients and caregivers: a mixed-methods research protocol. BMJ Open 2022. [PMCID: PMC9361746 DOI: 10.1136/bmjopen-2022-062807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction COVID-19 prompted rapid shifts to virtual primary care; however, the secondary implications and ideal applications of this change require further consideration. Patient and public stakeholder input has been bypassed. To integrate virtual care (VC) in what currently appears to be a lengthier battle against COVID-19 and related sequelae, further investigation is needed to support ideal implementation and use. This study aims to describe factors associated with the use of virtual visits in primary care practices, along with more in-depth description of users’ experiences and perspectives. Methods and analysis This study will be conducted in three phases, using a mixed-methods approach and in consultation with community advisors. Phase 1 will analyse data from electronic medical records (EMRs) to characterise the use and users of VC in primary care during the early phase of the COVID-19 pandemic. Analysis will be primarily descriptive; regression modelling will assess associations between patient and provider factors with a virtual visit. In phase 2, we will use an EMR-facilitated process to automate the distribution of patient surveys within an estimated 10 clinics. These surveys aim to describe care experiences, transactional use and perspectives of VC. In phase 3, focus groups with patients, caregivers and primary care clinicians will seek more in-depth exploration of VC regarding accessibility of care, acceptability and perceptions of quality care. Interpretive phenomenological analysis will be used for thematic analysis. The framework method will employ a matrix structure to organise the data and to facilitate comparison, integration and further interpretation. Ethics and dissemination This study has been approved by the University of Manitoba’s Health Research Ethics Board (HS24197). A co-designed dissemination strategy will include reports and infographics to policymakers and the public, manuscripts and presentations to academic and clinician audiences, and contributions to a learning plan for professional development.
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Day N, Wass M, Smith K. Virtual opioid agonist treatment: Alberta's virtual opioid dependency program and outcomes. Addict Sci Clin Pract 2022; 17:40. [PMID: 35902924 PMCID: PMC9330968 DOI: 10.1186/s13722-022-00323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Virtually delivered healthcare (telehealth, telemedicine) has the potential to reduce gaps in access to opioid agonist therapy (OAT). Barriers to accessing OAT such as lack of transportation, in-person induction requirements, employment demands and limited childcare options reduce treatment opportunities for clients. A completely virtual model of care has been developed in Alberta, Canada. This paper introduces the unique virtual clinic model and describes outcomes from that model. Methods A retrospective chart review was conducted using datasets within existing electronic health records and databases from Alberta’s Virtual Opioid Dependency Program (VODP). Outcome data were extracted at admission to ongoing care by Case Management within the VODP and at 3, 6 and 12 months for the duration of treatment. Utilization trends over three years were analyzed, including admissions, discharges and active client information. Data regarding clinical outcomes for clients engaged in ongoing care with the VODP were aggregated for analysis over four time periods, including treatment retention rates at 6 and 12 months. Results A total of 440 client records were included in the study sample. Descriptive analysis showed rapid growth in utilization over three fiscal years. Despite rapid growth in utilization, median wait days for treatment decreased from 6 to 0 days with the initiation of a Same Day Start service to support low barrier immediate access to treatment. Treatment retention rates for clients in ongoing care were comparable to published reports, with 90% of the study sample remaining in treatment over 6 months, and 58% showing retention over 12 months. Clients reported high levels of satisfaction (90%) and outcomes reflected reductions in drug use and overdose as well as improved social functioning. Conclusions The VODP model demonstrated high levels of client satisfaction, rapid growth in utilization and positive preliminary clinical outcomes. Entirely virtual delivery of opioid agonist therapy is a promising option to facilitate access to evidence based treatment for opioid use disorder (OUD) in the context of a fentanyl overdose crisis, particularly for individuals living in rural or underserved areas.
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Affiliation(s)
- Nathaniel Day
- Addiction & Mental Health, Alberta Health Services, Ponoka, AB, Canada.,Virtual Opioid Dependency Program, P.O. Box 1000, T4J 1R8, Ponoka, AB, Canada
| | - Maureen Wass
- Addiction & Mental Health, Alberta Health Services, Ponoka, AB, Canada. .,Virtual Opioid Dependency Program, P.O. Box 1000, T4J 1R8, Ponoka, AB, Canada.
| | - Kelly Smith
- Addiction & Mental Health, Alberta Health Services, Ponoka, AB, Canada.,Virtual Opioid Dependency Program, P.O. Box 1000, T4J 1R8, Ponoka, AB, Canada
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Patterson PB, Roddick J, Pollack CA, Dutton DJ. Virtual care and the influence of a pandemic: Necessary policy shifts to drive digital innovation in healthcare. Healthc Manage Forum 2022; 35:272-278. [PMID: 35775144 PMCID: PMC9253722 DOI: 10.1177/08404704221110084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The potential for virtual healthcare to improve access to primary care services in Canada has long been a topic of discussion; however, implementation has been slow despite growing interest among the public. Non-essential service lockdowns implemented in 2020 in response to the COVID-19 pandemic catalyzed rapid and widespread uptake of virtual healthcare delivery. It is important to consider how to maintain equitable access to virtual care following the pandemic. We conducted a narrative scoping review to understand barriers related to the sustained adoption of virtual primary care delivery in Canada. Barriers at the system, healthcare provider, and patient levels were related to digital health infrastructure, and the regulatory environment governing virtual care provision and remuneration for healthcare professionals. The article identifies areas where policy shifts by health system leaders could sustain the longer-term availability of Canadian virtual care services.
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McCrady E, Strychowsky JE, Woolfson JP. Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study. JMIR Pediatr Parent 2022; 5:e34115. [PMID: 35666938 PMCID: PMC9202653 DOI: 10.2196/34115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. OBJECTIVE This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. METHODS This study took place at the Children's Hospital at London Health Sciences Centre, a children's hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. RESULTS Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. CONCLUSIONS Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care.
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Affiliation(s)
- Emma McCrady
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, ON, Canada
| | - Julie E Strychowsky
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Jessica P Woolfson
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, ON, Canada.,Division of Pediatric Gastroenterology, London Health Sciences Centre Children's Hospital, London, ON, Canada
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DiFabio DL, O'Hagan R, Glista D. A Scoping Review of Technology and Infrastructure Needs in the Delivery of Virtual Hearing Aid Services. Am J Audiol 2022; 31:411-426. [PMID: 35580238 DOI: 10.1044/2022_aja-21-00247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The digital health revolution has brought forward integral technological advancements enabling virtual care as a readily accessible delivery model. Despite this forward momentum, the field of audiology still faces barriers that impede the uptake of virtual services into routine clinical practice. The aim of this study was to gather, synthesize, and summarize the literature around virtual hearing aid intervention studies and the related technology and infrastructure requirements. METHOD A scoping review was conducted using MEDLINE, CINAHL, Scopus, Nursing and Allied Health, and Web of Science databases. Objectives, inclusion criteria, and scoping review methods were specified in advance and documented in a protocol. RESULTS The 11 studies identified through this review related to virtual hearing aid services delivered by a licensed health care provider and/or facilitator(s) specific to hearing aid management, programming, verification, and validation services. Service delivery models varied according to patient population, technology experience, type(s) and time course of care, type of remote location, and technology/support requirements. Barriers and facilitators to implementation-related themes including technology access and function, client sociotechnical, convenience, education and training, interaction quality, service delivery, and technology innovation. CONCLUSIONS This scoping review provides evidence around the technology and infrastructure required for full integration of virtual hearing aid services into practice and according to care type. Low-tech versus high-tech requirements may be used to guide virtual service delivery triaging efforts. Research and development efforts in the areas of pediatrics, clinical support tools, and hearing aid/app-based solutions will support further uptake of virtual service delivery in audiology.
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Affiliation(s)
- Danielle L. DiFabio
- National Centre for Audiology, University of Western Ontario, London, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Robin O'Hagan
- National Centre for Audiology, University of Western Ontario, London, Canada
| | - Danielle Glista
- National Centre for Audiology, University of Western Ontario, London, Canada
- School of Communication Sciences and Disorders, Faculty of Health Sciences, University of Western Ontario, London, Canada
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Borycki EM, Kushniruk AW. Reinventing virtual care: Bridging the healthcare system and citizen silos to create an integrated future. Healthc Manage Forum 2022; 35:135-139. [PMID: 35473445 PMCID: PMC9047099 DOI: 10.1177/08404704211062575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The pandemic has accelerated the move to virtual care. This has included remote monitoring and implementation of technologies that allow for patient care at home and assisted living for ageing in place. Technologies are available to help consumers to maintain their health and wellness. However, challenges associated with implementing virtual care remain. In this article, we describe some of these challenges, along with the need to develop new models for promoting effective and sustainable virtual care. This includes the need for integration of institutional efforts (eg, government and hospital) with emerging access to commercially available home technologies supplied to patients and citizens. The authors argue that consideration of a personal digital ecosystem and its relation to institutional digital health ecosystems is critical. The authors suggest virtual care be considered in the combined context of the person and healthcare system. Implications for future research directions for virtual care are discussed.
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Burton L, Rush KL, Smith MA, Davis S, Rodriguez Echeverria P, Suazo Hidalgo L, Görges M. Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers. JMIR Form Res 2022; 6:e32528. [PMID: 35413002 PMCID: PMC9049644 DOI: 10.2196/32528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/08/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone or video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts. OBJECTIVE This study aims to reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally enabled rural micropractice, which has provided 10%-15% virtual care since 2016 and 70% virtual care since March 2020. METHODS Three focus groups, 1 with providers (physician and medical office manager) and 2 with a total of 8 patients from a rural micropractice in British Columbia, were conducted in November 2020 and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team's journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed. RESULTS Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider's home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micropractice, solutions took about 5 years to optimize, with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19. CONCLUSIONS The micropractice's hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and being comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs or symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present, and opportunities to address care gaps should be sought.
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Affiliation(s)
- Lindsay Burton
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Mindy A Smith
- Kootenay Boundary Patient Advisory Committee & Community, Trail, BC, Canada.,Department of Family Medicine, Michigan State University, East Lansing, MI, United States
| | - Selena Davis
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Matthias Görges
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
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Dainty KN, Seaton MB, Estacio A, Hicks LK, Jamieson T, Ward S, Yu CH, Mosko JD, Kassardjian CD. Virtual Specialist Care during the COVID-19 Pandemic: A Multi-Method Study of Patient Experience. JMIR Med Inform 2022; 10:e37196. [PMID: 35482950 PMCID: PMC9239568 DOI: 10.2196/37196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Katie N Dainty
- North York General Hospital, 4001 Leslie StreetLE-140, Toronto, CA
| | - M Bianca Seaton
- North York General Hospital, 4001 Leslie StreetLE-140, Toronto, CA
| | | | - Lisa K Hicks
- Unity Health - St. Michael's Hospital, Toronto, CA
| | | | - Sarah Ward
- Unity Health - St. Michael's Hospital, Toronto, CA
| | | | - Jeff D Mosko
- Unity Health - St. Michael's Hospital, Toronto, CA
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Anghelescu BAM, Bruno V, Martino D, Roach P. Effects of the COVID-19 Pandemic on Parkinson's Disease: a Single-Centered Qualitative Study. Can J Neurol Sci 2022; 49:171-183. [PMID: 33843516 PMCID: PMC8160494 DOI: 10.1017/cjn.2021.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/01/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The public health measure restrictions across the world due to COVID-19 have inadvertently impacted the routines for people with Parkinson's disease (PD) and their care partners not only in terms of compromised neurological clinical care but also drastically changing the way of life to minimize the risk of becoming infected. This study explores initial PD patients' lived experiences to observe how quality of life and health care has been affected at the start of the COVID-19 pandemic and provide insight into the importance of patient engagement and virtual care. METHODS Twenty-two virtual, in-depth semi-structured interviews with persons diagnosed with PD who usually attend a Movement Disorders specialty clinic in Calgary, Alberta, were completed between April 28 and May 13, 2020, and the care partners that wished to participate. Interviews were recorded and transcribed, after which transcripts were analyzed and coded into relevant themes using NVivo 12. RESULTS Impacts from the public health measures and COVID-19 results into three main themes: (1) Impacts of COVID-19 on PD Clinical Care; (2) Activities of Daily Living; (3) Attitudes and Perceptions. Participants reported worsening in motor and nonmotor symptoms and had to accommodate to clinical care via virtual means which were associated with limitations and suggestions for improvement of remote care. CONCLUSION This study provides a unique opportunity for researchers to better understand the lived experiences of PD patients in all aspects of their life suggesting that innovative means are needed for facilitating virtual health care medicine and increased social interaction.
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Affiliation(s)
| | - Veronica Bruno
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Pamela Roach
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Family Medicine, University of Calgary, Calgary, Canada
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Chinni V, El-Khoury J, Laswrentschuk N, Bolton D. A Glass Half-Full: Positive Aspects of Covid-19 Pandemic on Delivery of Public Hospital Urology Care. BJU Int 2022; 130 Suppl 1:37-38. [PMID: 35224826 DOI: 10.1111/bju.15722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Affiliation(s)
- V Chinni
- Department of Urology, Austin Health, VIC, AUSTRALIA.,Department of Surgery, The University of Melbourne Victoria, Australia
| | - J El-Khoury
- Department of Urology, Austin Health, VIC, AUSTRALIA.,Department of Surgery, The University of Melbourne Victoria, Australia
| | - N Laswrentschuk
- Department of Surgery, The University of Melbourne Victoria, Australia.,Department of Urology, Division of Surgery, Royal Melbourne Hospital, VIC, Australia
| | - D Bolton
- Department of Urology, Austin Health, VIC, AUSTRALIA.,Department of Surgery, The University of Melbourne Victoria, Australia
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Budhwani S, Fujioka J, Thomas-Jacques T, De Vera K, Challa P, De Silva R, Fuller K, Shahid S, Hogeveen S, Chandra S, Bhatia RS, Seto E, Shaw J. Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews. J Am Med Inform Assoc 2022; 29:990-999. [PMID: 35187571 PMCID: PMC9006706 DOI: 10.1093/jamia/ocac022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We sought to understand and synthesize review-level evidence on the challenges associated with accessibility of virtual care among underserved population groups and to identify strategies that can improve access to, uptake of, and engagement with virtual care for these populations. MATERIALS AND METHODS A scoping review of reviews was conducted (protocol available at doi: 10.2196/22847). A total of 14 028 records were retrieved from MEDLINE, EMBASE, CINAHL, Scopus, and Epistemonikos databases. Data were abstracted, and challenges and strategies were identified and summarized for each underserved population group and across population groups. RESULTS A total of 37 reviews were included. Commonly occurring challenges and strategies were grouped into 6 key thematic areas based on similarities across communities: (1) the person's orientation toward health-related needs, (2) the person's orientation toward health-related technology, (3) the person's digital literacy, (4) technology design, (5) health system structure and organization, and (6) social and structural determinants of access to technology-enabled care. We suggest 4 important directions for policy development: (1) investment in digital health literacy education and training, (2) inclusive digital health technology design, (3) incentivizing inclusive digital health care, and (4) investment in affordable and accessible infrastructure. DISCUSSION AND CONCLUSION Challenges associated with accessibility of virtual care among underserved population groups can occur at the individual, technological, health system, and social/structural determinant levels. Although the policy approaches suggested by our review are likely to be difficult to achieve in a given policy context, they are essential to a more equitable future for virtual care.
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Affiliation(s)
- Suman Budhwani
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Jamie Fujioka
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Tyla Thomas-Jacques
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kristina De Vera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Priyanka Challa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ryan De Silva
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Simone Shahid
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Sophie Hogeveen
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Shivani Chandra
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Ontario Health, Toronto, Ontario, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Centre for Global eHealth Innovation, University Health Network, Techna Institute, Toronto, Ontario, Canada
| | - James Shaw
- Corresponding Author: James Shaw, PhD, Women’s College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, ON M5S 1B3, Canada;
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Kueper JK, Terry A, Bahniwal R, Meredith L, Beleno R, Brown JB, Dang J, Leger D, McKay S, Pinto A, Ryan BL, Zwarenstein M, Lizotte DJ. Connecting artificial intelligence and primary care challenges: findings from a multi stakeholder collaborative consultation. BMJ Health Care Inform 2022; 29:bmjhci-2021-100493. [PMID: 35091423 PMCID: PMC8804627 DOI: 10.1136/bmjhci-2021-100493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/06/2022] [Indexed: 11/15/2022] Open
Abstract
Despite widespread advancements in and envisioned uses for artificial intelligence (AI), few examples of successfully implemented AI innovations exist in primary care (PC) settings.
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Affiliation(s)
- Jacqueline K Kueper
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada .,Department of Computer Science, Western University Faculty of Science, London, Ontario, Canada
| | - Amanda Terry
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Schulich Interfaculty Program in Public Health, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Ravninder Bahniwal
- Schulich Interfaculty Program in Public Health, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Leslie Meredith
- Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Ron Beleno
- Age-Well NCE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Janet Dang
- London Middlesex Primary Care Alliance, London, Ontario, Canada.,Thames Valley Family Health Team, London, Ontario, Canada
| | - Daniel Leger
- Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Scott McKay
- Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Andrew Pinto
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Merrick Zwarenstein
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Daniel J Lizotte
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Computer Science, Western University Faculty of Science, London, Ontario, Canada
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Pham Q, El-Dassouki N, Lohani R, Jebanesan A, Young K. The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic. J Med Internet Res 2022; 24:e29876. [PMID: 34994707 PMCID: PMC8783290 DOI: 10.2196/29876] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/18/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has fundamentally changed how Canadians access health care. Although it is undeniable that the rapid adoption of virtual care has played a critical role in reducing viral transmission, the gap in equitable access to virtual care remains pervasive for Canada’s aging and ethnocultural minority communities. Existing virtual care solutions are designed for the English-speaking, health-literate, and tech-savvy patient population, excluding older ethnic adults who often do not see themselves reflected in these identities. In acknowledging the permanency of virtual care brought on by the pandemic, we have a collective responsibility to co-design new models that serve our older ethnic patients who have been historically marginalized by the status quo. Building on existing foundations of caregiving within ethnocultural minority communities, one viable strategy to realize culturally equitable virtual care may be to engage the highly motivated and skilled family caregivers of older ethnic adults as partners in the technology-mediated management of their chronic disease. The time is now to build a model of shared virtual care that embraces Canada’s diverse cultures, while also providing its older ethnic adults with access to health innovations in partnership with equally invested family caregivers who have their health at heart.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Noor El-Dassouki
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Raima Lohani
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Aravinth Jebanesan
- Global Health Office, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Karen Young
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Pearce C, McLeod A, Supple J, Gardner K, Proposch A, Ferrigi J. Responding to COVID-19 with real-time general practice data in Australia. Int J Med Inform 2022; 157:104624. [PMID: 34741891 PMCID: PMC8564317 DOI: 10.1016/j.ijmedinf.2021.104624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/14/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION As SARS-CoV-2 spread around the world, Australia was no exception. Part of the Australian response was a robust primary care approach, involving changes to care models (including telehealth) and the widespread use of data to inform the changes. This paper outlines how a large primary care database responded to provide real-time data to inform policy and practice. Simply extracting the data is not sufficient. Understanding the data is. The POpulation Level Analysis and Reporting (POLAR) program is designed to use GP data for multiple objectives and is built on a pre-existing engagement framework established over a fifteen-year period. Initially developed to provide QA activities for general practices and population level data for General Practice support organisations, the POLAR platform has demonstrated the critical ability to design and deploy real-time data analytics solutions during the COVID-19 pandemic for a variety of stakeholders including state and federal government agencies. METHODS The system extracts and processes data from over 1,300 general practices daily. Data is de-identified at the point of collection and encrypted before transfer. Data cleaning for analysis uses a variety of techniques, including Natural Language Processing and coding of free text information. The curated dataset is then distilled into several analytic solutions designed to address specific areas of investigation of interest to various stakeholders. One such analytic solution was a model we created that used multiple data inputs to rank patient geographic areas by the likelihood of a COVID-19 outbreak. The model utilised pathology ordering, COVID-19 related diagnoses, indication of COVID-19 related concern (via progress notes) and also incorporated state based actual confirmed case figures. RESULTS Using the methods described, we were able to deliver real-time data feeds to practices, Primary Health Networks (PHN) and other agencies. In addition, we developed a COVID-19 geographic risk stratification based on local government areas (LGAs) to pro-actively inform the primary care response. Providing PHNs with a list of geographic priority hotspots allowed for better targeting and response of Personal Protective Equipment allocation and pop-up clinic placement. CONCLUSIONS The program summarised here demonstrates the ability of a well-designed system underpinned by accurate and reliable data, to respond in real-time to a rapidly evolving public health emergency in a way which supports and enhances the health system response.
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Affiliation(s)
- Christopher Pearce
- Director of Research, Outcome Health, Adjunct Associate Professor in General Practice, Monash University, 1 Chapel Street, Blackburn 3130, Australia.
| | - Adam McLeod
- Chief Executive Officer, Outcome Health, Australia
| | - Jamie Supple
- Director of Business Intelligence, Outcome Health, Australia
| | | | - Amanda Proposch
- Chief Executive Officer, Gippsland Primary Health Network, Australia
| | - Jason Ferrigi
- Chief Information Officer, Outcome Health, Australia
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