JMIR Publications

ABSTRACT

Background:

Healthcare access plays a central role in reducing inequities across populations. Virtual care can mitigate these inequities by facilitating more inclusive and accessible healthcare delivery. In residential aged care homes (RACHs), virtual care has the potential to enable timely and efficient access to general practitioners (GPs) for residents. However, as context, technologies and users are complex, the implementation, acceptance and use of virtual care technologies in RACHs remain challenging.

Objective:

The aim of this study was to evaluate the barriers and facilitators to implementing, accepting and using virtual care technologies to connect residents with GPs for healthcare delivery in RACHs.

Methods:

A qualitative study was performed in general practice and RACH settings using semi-structured interviews with 32 participants (11 GPs, 11 RACH nurses, 3 practice managers, 5 residents and 2 carers). Data were analysed thematically and mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model.

Results:

Our investigation revealed more barriers than enablers to implementing, accepting and using virtual care technologies to deliver care to RACH residents. Whilst barriers were found across all SEIPS domains for GPs, most of the barriers for residents and carers were identified in the ‘people’ and ‘organisational’ domains, and in addition to these, ‘technology and tools’ domain for RACH nurses. Although many barriers are common across the people (e.g. resistance to using new technology), technology (e.g. inadequate system integration) and organisation (e.g. logistical challenges) domains for RACH nurses and GPs, our study revealed unique barriers to virtual care delivery for residents and carers (e.g. interruptions, potential to exclude residents from conversations) whose views are often absent from existing literature. Our findings also revealed that there is no standardised virtual care consultation process between RACHs and GPs – a key concern strongly associated with the identified work system barriers. Whilst virtual care was seen as beneficial, participants identified some unintended consequences to patients (e.g. loss of doctor-patient relationship), clinicians (e.g. additional workload) and healthcare organisations (e.g. infection control).

Conclusions:

Our study offers new evidence that can be used to improve virtual care delivery and healthcare access for residents in RACHs, to enable more timely and high-quality care. Our work has implications for residents and carers, who may gain more timely access to general practice services; for GPs, who can be supported to deliver high‑quality virtual care; and for RACHs, which can strengthen care coordination and improve overall service delivery through effective virtual care models.