JMIR Publications

ABSTRACT

Background:

Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone/video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts.

Objective:

To reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally-enabled rural micro practice, which has provided 10-15% virtual care since 2016 and 70% virtual care since March 2020.

Methods:

Three focus groups, one with providers (physician and medical office manager) and two with a total of eight patients of a rural micro practice in British Columbia, were conducted in November and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team’s journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed.

Results:

Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider’s home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micro practice, solutions took about 5 years to optimize with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19.

Conclusions:

The micro practice’s hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and be comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs/symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present and opportunities to address care gaps should be sought. Clinical Trial: N/A