JMIR Publications

ABSTRACT

Background:

In-person health care has been the standard model of care delivery for patients with atrial fibrillation (AF). Despite the growing use of remote technology, virtual healthcare has received limited formal study. It is essential to understand the virtual care experiences of patients in specialized AF clinics and their views of deficits and successes with virtual care to help inform future planning of AF clinic care.

Objective:

This qualitative study aimed to understand patients' virtual AF clinic care experiences during the pandemic.

Methods:

Participants were recruited from a pool of patients enrolled in a larger study and receiving care from an AF clinic. Facilitators asked participants questions about their experiences of virtual care, the perceived quality of virtual care, and technology supports. Data were initially open coded by three team members until a preliminary coding framework was created. As analysis progressed with subsequent interviews, code clusters were further collapsed and renamed.

Results:

Eight focus groups with 30 participants were conducted between March and May 2021. A majority of participants were male (70%), 65 years and older (67%), and college graduates (73%). Patients’ experiences of virtual care revolved around four inter-related themes: practical benefits of virtual care, communication, the “fit” of virtual care, and the future of virtual care. Practical benefits included flexibility, convenience, and time/cost savings of virtual care. Within the communication, most participants found that virtual communication with their providers was acceptable in making them feel “cared for”, having their needs and questions addressed, and not constrained by time. Effective communication was dependent (1) on their ability to focus and adequately communicate their needs and concerns, and/or (2) on the provider’s ability to listen, interpret the information, and act on it to address their concerns. Without the benefit of in-person physical assessments, patients expressed uncertainty, insecurity, and lack of confidence they were communicating what was necessary and correct to their providers, or that they remembered to tell them. In terms of the “fit,” patients supported virtual care for small, quick, mundane issues (e.g., medication refills) but found it sub-optimal for new and serious issues which they expressed should warrant an in-person visit. Lastly, participants had two primary recommendations in moving forward with virtual care including use of a hybrid model of care, and integrating patient reported data (i.e., blood pressure measurements) in virtual care delivery. They preferred a predominantly virtual approach with periodic in-person visits.

Conclusions:

While patients valued virtual AF care, they did not see it as replacing in-person care. Instead, patients recommended that virtual care be used as a supplement for in-person care. Further research may be warranted to evaluate this response in different communities or to look at barriers to care and ways to overcome them. Clinical Trial: N/A