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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:BackgroundThe global COVID-19 pandemic led to rapid changes in both medical care and medical education, particularly involving the rapid substitution of virtual solutions for traditional face-to-face appointments. There is a need for research into the effects and impacts of such changes. The objective of this article investigates the perspectives of Family Medicine Residents in one university program in order to understand the impact of this transition to virtual care and learning.MethodsThis is a qualitative focus group study. Four focus groups, stratified by site type (Rural = 1; Semi-Urban = 1; Urban = 2) were conducted, with a total of 25 participants. Participants were either first or second-year Residents in Family Medicine. Focus group recordings were analyzed thematically, based upon a five-level socio-ecological model (individual, family, organization, community, environment and policy context).ResultsTwo main themes were identified: (1) Residents' experiences of Virtual Learning and Virtual Care, and (2) Living and Learning in Pandemic Times. In the first theme, Residents reported challenges both individually, in their family context, and in their training organizations. Of particular concern was the loss of hands-on experience with clinical skills such as conducting physical examinations. In the second theme, Residents reported disruption of self-care routines and family life. These Residents were unable to engage in the relationships outside of the workplace with their preceptors and peers which they had expected, and which play key roles in social support as well as in future decisions about practice location.ConclusionsWhile many patients appreciated virtual care, in the eyes of these Residents it is not the ideal modality for learning the practice of Family Medicine, and they awaited a return to normal times. Despite this, the pandemic has pointed out important ways in which residency training needs to adapt to an evolving world.

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:BackgroundDuring the COVID-19 pandemic, patient portals and their message platforms allowed remote access to health care. Utilization patterns in patient messaging during the COVID-19 crisis have not been studied thoroughly. In this work, we propose characterizing patients and their use of asynchronous virtual care for COVID-19 via a retrospective analysis of patient portal messages.ObjectiveThis study aimed to perform a retrospective analysis of portal messages to probe asynchronous patient responses to the COVID-19 crisis.MethodsWe collected over 2 million patient-generated messages (PGMs) at Mayo Clinic during February 1 to August 31, 2020. We analyzed descriptive statistics on PGMs related to COVID-19 and incorporated patients' sociodemographic factors into the analysis. We analyzed the PGMs on COVID-19 in terms of COVID-19-related care (eg, COVID-19 symptom self-assessment and COVID-19 tests and results) and other health issues (eg, appointment cancellation, anxiety, and depression).ResultsThe majority of PGMs on COVID-19 pertained to COVID-19 symptom self-assessment (42.50%) and COVID-19 tests and results (30.84%). The PGMs related to COVID-19 symptom self-assessment and COVID-19 test results had dynamic patterns and peaks similar to the newly confirmed cases in the United States and in Minnesota. The trend of PGMs related to COVID-19 care plans paralleled trends in newly hospitalized cases and deaths. After an initial peak in March, the PGMs on issues such as appointment cancellations and anxiety regarding COVID-19 displayed a declining trend. The majority of message senders were 30-64 years old, married, female, White, or urban residents. This majority was an even higher proportion among patients who sent portal messages on COVID-19.ConclusionsDuring the COVID-19 pandemic, patients increased portal messaging utilization to address health care issues about COVID-19 (in particular, symptom self-assessment and tests and results). Trends in message usage closely followed national trends in new cases and hospitalizations. There is a wide disparity for minority and rural populations in the use of PGMs for addressing the COVID-19 crisis.

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The Covid-19 Pandemic Accelerates the Transition to Virtual Care

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