Virtual urgent care is here to stay: driving toward safe, equitable, and sustainable integration within emergency medicine

BACKGROUND

Virtual care in Canada rapidly expanded during the COVID-19 pandemic in a low-rules environment in response to pressing needs for ongoing access to care amid public health restrictions. Emergency medicine specialists now face the challenge of advising on which virtual urgent care services ought to remain as part of comprehensive emergency care. Consideration must be given to safe, quality, and appropriate care as well as issues of equitable access, public demand, and sustainability (financial and otherwise). The aim of this project was to summarize current literature and expert opinion and formulate recommendations on the path forward for virtual care in emergency medicine.

METHODS

We formed a working group of emergency medicine physicians from across Canada working in a variety of practice settings. The virtual care working group conducted a scoping review of the literature and met monthly to discuss themes and develop recommendations. The final recommendations were circulated to stakeholders for input and subsequently presented at the 2023 Canadian Association of Emergency Physicians (CAEP) Academic Symposium for discussion, feedback, and refinement.

RESULTS

The working group developed and reached unanimity on nine recommendations addressing the themes of system design, equity and accessibility, quality and patient safety, education and curriculum, financial models, and sustainability of virtual urgent care services in Canada.

CONCLUSION

Virtual urgent care has become an established service in the Canadian health care system. Emergency medicine specialists are uniquely suited to provide leadership and guidance on the optimal delivery of these services to enhance and complement emergency care in Canada.

A qualitative study of the feasibility and acceptability of a smoking cessation program for people living with HIV and emotional dysregulation

Despite high rates of co-occurring tobacco use and anxiety among persons living with HIV, evidence-based interventions for these individuals are limited. An existing cognitive-behavioral treatment protocol for smoking cessation and anxiety (Norton, P. J., & Barrera, T. L. (2012). Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depression and Anxiety, 29(10), 874-882. https://doi.org/10.1002/da.21974) was modified to address transdiagnostic constructs, such as anxiety sensitivity, distress tolerance, and depressive symptomatology (Labbe, A. K., Wilner, J. G., Kosiba, J. D., Gonzalez, A., Smits, J. A., Zvolensky, M. J., … O'Cleirigh, C. (2017). Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People with HIV: A Clinical Case Study. Cognitive and Behavioral Practice, 24(2), 200-214. https://doi.org/10.1016/j.cbpra.2016.03.009). This study examines the feasibility and acceptability of the intervention as determined from qualitative data from structured exit interviews from 10 participants who completed treatment. Results demonstrated that participants were very motivated to quit smoking and enrolled in the program for health-related reasons and to be able to quit. Participants found nearly all the treatment components to be useful for reaching their smoking cessation goal and in managing emotional dysregulation. Last, all participants stated that they would strongly recommend the treatment program. This qualitative study provides initial evidence for the feasibility and acceptability of a modified smoking cessation treatment protocol for HIV+ individuals with anxiety and emotional dysregulation. Future research will focus on evaluating the efficacy of the protocol in a full-scale randomized controlled trial, as well as working to collect qualitative data from participants who discontinue treatment to better understand reasons for treatment attrition.

11. Who is in charge? Introducing criteria to evaluate health human resource (HHR) policy documents

The maldistribution of and lack of access to health professionals continues to be a major issue for policymakers at all levels of government. Additionally, the basis by which Health Human Resource (HHR) policy is determined is unclear. Publications found in independent reports, peer-reviewed journals and most importantly, grey literature, can significantly influence or inform major policy decisions for “hot button” HHR issues (1) . We propose a framework that can be used to classify, rank and evaluate HHR policy/planning documents. Our framework creates six major criteria that are used to evaluate policy documents. These criteria are: 1) literature review, 2) source of primary information, 3) nature of recommendations, 4) implementation strategies, 5) credibility of authors and 6) credibility of publisher. Within each category, a score from zero to three (for criteria 1-4) or zero to two (criteria 5-6) is assigned, depending on the caliber of the document. Summing the scores from each section yields a document’s overall score. The intent of this measure is two-fold. Firstly, we want to create a tool that can be widely utilized by policymakers to help inform their decisions. Secondly, it can be used as a springboard to stimulate discussion and debate around HHR planning and policy formulation. National Information Center on Health Services Research and Health Care Technology. (NICHSR) Health Services Research and Health Policy Grey Literature Project: Summary Report. 2006. http://www.nlm.nih.gov/ nichsr/greylitreport_06.html. Accessed February 20, 2007.