Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 26, 2019
Date Accepted: Aug 21, 2019
(closed for review but you can still tweet)
Home virtual visits for out-patient follow-up care improve patient experience, save time and potentially reduce per-capita healthcare costs: results of a pilot study
ABSTRACT
Background:
Timely in-person access to health care remains a challenge for many Canadians living with conditions resulting in frailty, loss of independence, restrictions in driving and mobility and physical and cognitive decline. For stroke patients residing in Southeastern Ontario, health care access can be even more challenging due to rurality and long travel distances in sometimes inclement weather. There is a need to make healthcare more accessible, available and acceptable to millions of Canadians. Evisit, i.e. home virtual visit, may provide a solution to increase health care access for many Canadians. Evisit is a novel telemedicine modality by which the health care provider connects via secure personal video conferencing with the patient at their home using their device of choice, including smartphones, tablets, laptops, or desktops.
Objective:
We have implemented an Evisit pilot project in the stroke prevention clinic with the aim to assess the feasibility and logistics of implementing Evisits in an adult specialty disease clinic catering predominantly to seniors.
Methods:
The Evisit pilot was initiated at the Kingston Health Sciences Centre stroke prevention clinic in August 2018 for a 6-month trial period. During the pilot phase, Evisits were used only for follow-up patient encounters. An integrated evaluation was designed to evaluate the impact of the pilot program on clinic workflow and patient satisfaction. Patient satisfaction was evaluated by patient telephone interviews using a brief questionnaire.
Results:
There was a total of 75 patients in the phase 1 pilot. The median (IQR) age of the patients was 65 (56-73.5) years with 40% (n=29) residing in rural areas. The pilot demonstrated a significant reduction in the number of days waiting for an appointment for Evisit follow-up vs. in-person follow-up (mean (SD): 59.98 (48.36) days vs. 78.36(50.54), t=12.9, p<0.001, respectively). The Evisit was also very time efficient taking on an average of only 10 minutes to deliver follow-up care with a high degree of patient satisfaction. The median (IQR) time saved by the patient for every Evisit scheduled is 44 (21-69) minutes [travel time] and 80 (50-102) minutes [total time]. The median (IQR) travel distance avoided by the patients for every Evisit scheduled is 30.1 Km (11.2-82.2). The median (IQR) estimate for potential total out-of-pocket cost savings for patients for every Evisit is $52.83 (31.26-94.53) CND. The estimated opportunity cost for in-person outpatient care (direct and indirect cost) for our Evisit pilot project is $ 23,832 to $28,584 CND.
Conclusions:
The Evisit (Home virtual visit) program was well received by patients, deemed to be safe by physicians, avoided unnecessary travel and was inexpensive for patients, with potential for reduced per-capita healthcare costs. We plan to scale the project within the department and the institution.
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