JMIR Publications

ABSTRACT

Background:

Virtual early psychosis intervention (EPI) services have been viewed favourably by both patients and providers in survey and qualitative studies. Given the high uptake of virtual EPI care, there is a need for structured, validated assessments of virtual care quality from the perspectives of patients and families, recognizing their integral role in EPI treatment and in supporting their loved ones’ engagement with services.

Objective:

Using a mixed-methods design, this study examined the perspectives of patients, family, and clinicians on the virtual delivery of EPI services.

Methods:

Patients and their family members receiving services from a large EPI program were invited to complete the Virtual Client Experience Survey (VCES), a recently validated measure of virtual care quality that captures several domains (efficient, timely, effective, patient-centred, and safe), as part of routine clinical care. Purposeful sampling was used to recruit 8 patients and 9 family members for qualitative interviews that explored VCES domains. A focus group with 6 EPI clinicians was also conducted to triangulate patient and family perspectives. Descriptive statistics were calculated to describe demographic and technology-use characteristics of survey respondents and to identify the proportions who agreed or strongly agreed with each VCES item. Qualitative data were analyzed through iterative thematic analysis and a deductive coding scheme based on VCES domains.

Results:

Among a total of 69 patients and family members who completed the VCES survey, most were patients (54/69, 78%). A majority of patients and family members agreed or strongly agreed that virtual appointments were easy to access (65/68, 95.6%), the wait time for services was reasonable (62/66, 93.9%), and they could get a virtual appointment sooner than an in-person one (43/47, 91.5%). They also positively endorsed feeling emotionally and physically safe during their virtual appointments (61/65, 93.8%); however, only 78.5% (51/65) believed that virtual care was just as effective as in-person care. Qualitatively, most patients and family members reported that they or their loved one felt safe during appointments and noted that virtual care facilitated communication and collaboration, helped save time and money, and provided greater flexibility in scheduling. However, some reported mixed perceptions of the quality of the therapeutic relationship and felt less accountable to and engaged in video appointments. Clinicians reported difficulty in conducting mental status examinations remotely.

Conclusions:

This study is unique in providing a validated assessment of virtual care quality in EPI from the perspectives of patients, families, and clinicians. We found that patients and family members largely reported that care was efficient, timely, safe, and patient-centred. Despite this, perceptions of the effectiveness of virtual appointments compared to in-person care were mixed, with qualitative interviews revealing concerns about the therapeutic alliance, privacy, accountability, and clinical assessments. A hybrid model of care may help leverage the benefits of both formats.