PROJECT HIGHLIGHTS

Governance Organization

SMH – St. Michael’s Hospital Medical Services Association

Project Title

SMH-21-010 – Evaluating Telephone-Based Specialist Care Provided During a Pandemic to Inform Best Practice Guidance

Project Highlights

The COVID-19 pandemic necessitated a rapid transition from primarily in-person to primarily “virtual” medical care in order to reduce infectious risk and adhere to social distancing recommendations, while ensuring patients continued to have access to timely care. However, this shift was sudden and unexpected, leaving clinicians, patients, and administrators without time to adequately prepare, optimize care pathways, or evaluate the success and quality of virtual care in a careful and rigorous manner. Providing optimal and safe care during the COVID19 pandemic and beyond, requires an understanding of the key factors associated with successful experiences of virtual care, particularly as they relate to patient-reported outcomes. The aim of our study was to understand how patient and provider experience informs the development of guidance regarding characteristics associated with high satisfaction of virtual specialist care during the COVID-19 pandemic. This study was conducted at St. Michael’s Hospital in downtown Toronto, using a multi-method patient, physician and administrator experience study using survey methods, descriptive qualitative interview methodology and administrative virtual care data collected by the hospital decision support team. Sampling occurred from a wide range of medical and surgical specialties to obtain a variety of specialties, patient complaints and appointment types. Patients and physicians were asked to complete an online survey, followed by the opportunity to participate in qualitative interviews. Interviews followed a semi-structured format addressing key topics, including understanding of the patient’s functional status, health concerns, and experience of the virtual visit, and conducted by an experienced qualitative interviewer. Between October 2020 and January 2021, 216 patients from 7 different specialty clinics completed the survey. Over half were >60 years of age, and 60% were female. 85% were follow-up visits, and 87% were over telephone, while 10% were over video. Over 90% of patients were satisfied with the visit, felt the physician spent sufficient time with them, and felt the virtual visit saved time. There were very few technical difficulties. Despite this, 50% still would prefer in-person visits, and one third felt that the virtual assessments lacked the same level of physician-patient relationship. About 85% of patients felt that the virtual consultation was appropriate for follow-up visits, with only about 36% reporting that it was acceptable for initial consultation and 55% for urgent issues. Our physician survey demonstrated that the majority had minimal to no experience with virtual care prior to the pandemic and close to 90% were using telephone as their primary modality. When asked about accessibility, 90% of physicians agreed that is is acceptable to use virtual care where appropriate but that it does not enable equitable access to care. Only a minority described any technical difficulties. However, less than 60% were satisfied with the provider experience. As expected, there were concerns around performing an objective examination. Finally, greater than 80% of practitioners thought that virtual care should be offered after the pandemic. Our study adds to the growing literature on virtual care in the era of the COVID-19 pandemic, and helps to inform virtual care implementation beyond the pandemic. We need to use experience data such as that presented here to understand how virtual care performs in real-time, from both the perspective of those who access it and deliver it. Based on our data, our recommendations would include the implementation of a blended care model which allows flexibility for access and appropriate approaches based on type of appointment and patient preference. One size will not fit all, and a blended model combining in-person and virtual visits when each is most appropriate follows a patient-centered approach to care delivery. Virtual visits (including telephone visits) appear particularly well-suited for follow-up appointments and discussion of non-urgent matters, and where travel is either too costly or burdensome for patients. However, further work is required to delineate the balance between telephone and video-based virtual care, and to determine which types of care visits are most effective virtually, and ensuring privacy, confidentiality and data quality as new virtual systems emerge. We must also evaluate impact of virtual care on healthcare equity, as not all patients will have access to the same technology and we must ensure that socioeconomic disparities are not widened or exacerbated by the adoption of virtual healthcare options.

Theme

Virtual Health Care

Primary Project Lead for Contact

Jeff Mosko

Email

jeff.mosko@unityhealth.to

Secondary Project Lead for Contact

Charles Kassardjian

Email

charles.kassardjian@unityhealth.to

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