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The Covid-19 Pandemic Accelerates the Transition to Virtual Care

ABSTRACT: Investment in telemedicine and virtual care has helped maintain high levels of patient access and utilization at Kaiser Permanente in Southern California. Virtual encounters increased from 38% of total ambulatory visits in February to a peak of 87% at the end of April and then settled to 77% in the middle of July. Summary Kaiser Permanente responded to the Covid-19 pandemic by expanding existing and developing new virtual care modalities. Prior to the pandemic, virtual care consisted primarily of secure e-mail messaging, e-visits, telephone calls, and video visits with the patient’s primary care physician, nurse practitioner, or specialty care physician, all linked to the patient’s electronic medical record. With the onset of the pandemic, Kaiser Permanente developed a Covid-19 landing page on its main website, launched a patient self-assessment tool, and expanded e-visits to give guidance on Covid-19–related symptoms. By the week of July 12, Kaiser Permanente in Southern California was experiencing 681,000 virtual encounters per week, of which 11% were related to Covid-19 infection. Virtual encounters increased from 38% of total ambulatory visits in February to a peak of 87% at the end of April and then settled to 77% in the middle of July.

SUBMITTER: Robinson J

PROVIDER: S-EPMC7482586 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Project description:BackgroundTransitioning 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.ObjectiveWe 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.MethodsThis 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.ResultsDuring 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.ConclusionsPatient 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.

Project description:When the COVID-19 pandemic forced university campuses and healthcare agencies to temporarily suspend both undergraduate and graduate direct care educational experiences, nursing programs had to formulate alternative plans to facilitate clinical learning. Texas Woman's University used this opportunity to assemble a faculty group tasked with creating a set of college-wide guidelines for virtual simulation use as a substitution for traditional face-to-face clinical. The process included completing a needs assessment of both undergraduate and graduate level programs across three campuses and identifying regulatory requirements and limitations for clinical experiences. The task force utilized the information gathered to develop evidence-based recommendations for simulation hour equivalence ratios and compiled a list of virtual activities and products faculty could use to complete clinical experiences. Undergraduate and graduate student surveys were conducted to determine the effectiveness of the transition to virtual clinical experiences. Overall, the majority of survey results were positive regarding virtual simulation experiences providing students with valuable opportunities to enhance their learning. Negative comments regarding the impact of COVID-19 on a personal level included issues involving internet access and web conferencing logistics, lack of motivation to study, family difficulties, and faculty inexperience teaching in an online environment. Undergraduate pre-licensure students were provided with opportunities to successfully complete all remaining required clinical hours virtually, while graduate students were allowed to complete non-direct care hours as applicable using virtual clinical experiences. Highlights • A task force created guidelines for facilitating clinical in virtual simulation environments during the COVID-19 pandemic.• Comparison of available commercial products was summarized with determination of undergraduate versus graduate level usage.• An evaluation of literature led the task force to recommend utilization of a ratio of 2:1 clinical to simulation hours.• Undergraduate and graduate students expressed an overall positive response to the use of virtual simulation experiences.

Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic is thought to have increased use of virtual care, but population-based studies are lacking. We aimed to assess the uptake of virtual care during the COVID-19 pandemic using comprehensive population-based data from Ontario.MethodsThis was a repeated cross-sectional study design. We used administrative data to evaluate changes in in-person and virtual visits among all residents of Ontario before (2012-2019) and during (January-August 2020) the COVID-19 pandemic. We included all patients who had an ambulatory care visit in Ontario. We excluded claims for patients who were not Ontario residents or had an invalid or missing health card number. We compared monthly or quarterly virtual care use across age groups, neighbourhood income quintiles and chronic disease subgroups. We also examined physician characteristics that may have been associated with virtual care use.ResultsAmong all residents of Ontario (population 14.6 million), virtual care increased from 1.6% of total ambulatory visits in the second quarter of 2019 to 70.6% in the second quarter of 2020. The proportion of physicians who provided 1 or more virtual visits per year increased from 7.0% in the second quarter of 2019 to 85.9% in the second quarter of 2020. The proportion of Ontarians who had a virtual visit increased from 1.3% in 2019 to 29.2% in 2020. Older patients were the highest users of virtual care. The proportion of total virtual visits that were provided to patients residing in rural areas (v. urban areas) declined significantly between 2012 and 2020, reflecting a shift in virtual care to a service increasingly used in urban centres. The rates of virtual care use increased similarly across all conditions and across all income quintiles.InterpretationOur findings show that Ontario's approach to virtual care led to broad adoption across all provider groups, patient age, types of chronic diseases and neighborhood income. These findings have policy implications, including use of virtual care billing codes, for the ongoing use of virtual care during the second wave of the pandemic and beyond.

Project description:BackgroundPrior 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.ObjectiveThis 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.MethodsThis 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.ResultsSurvey 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.ConclusionsTransition 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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The Covid-19 Pandemic Accelerates the Transition to Virtual Care

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