Virtual health care & telehealth: Current therapy practice patterns

In the realm of healthcare, virtual care has emerged as a pivotal tool for patient-provider communication, particularly amid the challenges posed by the COVID-19 pandemic. In vascular surgery, the adoption of postoperative virtual visits has proved to be a safe, cost-effective, and efficient means of monitoring patient recovery while minimizing the need for in-person clinic appointments. But despite its potential benefits, the use of virtual postoperative visits remains suboptimal, prompting the creation of a quality improvement initiative aimed at enhancing their use. Background and local problem: Virtual postoperative visits play a crucial role in timely identification of complications such as wound infection, hematoma, or graft failure in vascular surgery patients. Yet even as the pandemic necessitated a shift towards virtual care, the rate of postoperative virtual visits in a cancer center remained steady at around 30%. Recognizing this as a local problem, efforts were directed towards increasing the utilization of virtual postoperative visits through targeted interventions. The quality improvement initiative encompassed several key interventions within the discharge process: a) implementation of scheduled virtual visits post-education and patient discussions pre-discharge; b) modification of the electronic health record to include smart phrases facilitating virtual visit education and built-in reminders for follow-up scheduling; c) adaptation of patient education materials to incorporate real-time demonstrations and keywords for virtual assessments; and d) staff training on virtual evaluation techniques for incisions and postoperative complications. Following the implementation of these interventions and iterative Plan-Do-Study-Act (PDSA) cycles, the rate of postoperative virtual visits surged to over 50% and was sustained. A sample of 49 patients revealed an impressive 87% completion rate for virtual visits within three weeks post-surgery. Additionally, associated benefits included a reduction in clinic no-show rates, 30-day readmission rates, and surgical site infections. Notably, the teach-back method emerged as an effective strategy for educating elderly patients on virtual visit technologies, underscoring the feasibility of virtual postoperative care among this demographic. The successful enhancement of postoperative virtual visits in vascular surgery not only underscores the safety and feasibility of virtual care but also offers avenues for future research. From exploring the impact of nursing care and patient education to ensuring equitable access among older adults, virtual postoperative care stands as a promising frontier in enhancing patient outcomes and optimizing healthcare delivery.

We have read the paper by Cheryl Modica et al on Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education. 1 We congratulate all authors who provide interesting information regarding health services that use virtual models that integrate self-care tools and technologies. This is interesting because since the beginning of the COVID-19 pandemic, health centers have switched to a virtual service delivery model. Providing efficient, coordinated and high-quality services is important for the prevention and management of chronic disease conditions in patients. Virtual health services that use self-care tools and technology are an important model for increasing access to care for hard-to-reach patients. 2 The study conducted by Cheryl Modica et al aimed to explore the use of virtual care models, implemented using a systems approach and patient-driven tools and technologies, on clinical measurement performance and patient experience. 1 However, there are several obstacles that have arisen that can be caused by virtual care, including communities whose connectivity and access to technology is still limited and also concerns about primary health services, where there is a focus on relational continuity of services based on relationships between patients and health workers due to the widespread use of virtual services. 3 Therefore we must pay attention to several things before using a virtual care model including (1) the guiding principles needed for measuring virtual care; (2) best practices implemented to measure the quality of virtual services aligned with face-to-face frameworks; (3) Increasing the implementation of virtual services which have an impact on patient access and experience as well as the scale of measurement; (4) constraints and barriers faced by organizations in developing a quality virtual service framework; and (5) Application of virtual services in various patient cases. 4 The results of Cheryl Modica et al's study showed a statistically significant improvement in patients who completed the initial 4 virtual visits and reported decreased depression and increased satisfaction with virtual care visits compared to inperson visits. 1 However, healthcare professionals also need to evaluate the use of virtual visit platforms in primary care, examine patient and physician preferences for virtual communication methods, and report on visit characteristics and patient experience of care. Although there are concerns that virtual visits will be overused by patients, many virtual visits appear to be replacing in-person visits. This approach can improve access and continuity of primary health services. 5 In conclusion we agree that primary healthcare services that implement virtual care models with patient self-care tools, technology, and education, experience improvements in chronic condition prevention and patient recovery. 1 However, it is important to review how the use of virtual health services has evolved and ensure patients have access to the platform for a longer period of time. Therefore, further research is needed which must also focus on the use of administrative data to track the impact of virtual services on the use of face-to-face primary health services, emergency department visits and hospitalizations, as well as exploring how the use of virtual care impacts. 5

The rapid deployment of virtual primary care visits served as a first-line response to COVID-19 and can now be examined for insights, particularly as virtual care is playing an ongoing role in patient care and consultations. Input from primary care providers directly responsible for virtual care delivery is needed to inform policies and strategies for quality care and interactions. The overarching goal of this research study was to examine the use of virtual care as a mechanism for primary healthcare delivery. A phenomenological approach investigated the shift in primary care service delivery as experienced by primary care providers and initiated during the COVID-19 pandemic. Focus groups were conducted with primary care providers (n = 21) recruited through email, advertisements, and professional organizations, exploring how virtual care was delivered, the benefits and challenges, workflow considerations, and recommendations for future use. Integrating virtual care was performed with a great deal of autonomy as well as responsibility, and overwhelmingly depended on the telephone. Technology, communication, and workflow flexibility are three key operational aspects of virtual care and its delivery. Providers highlighted cross-cutting themes related to the dynamics of virtual care including balancing risk for quality care, physician work/life balance, efficiency, and patient benefits. Primary care providers felt that virtual care options allowed increased flexibility to attend to the needs of patients and manage their practice workload, and a few scenarios were shared for when virtual care might be best suited. However, they also recognized the need to balance in-person and virtual visits, which may require guidelines that support navigating various levels of care. Overall, virtual care was considered a good addition to the whole 'care package' but continued development and refinement is an expectation for optimizing and sustaining future use.

This study reports on a mixed methods evaluation conducted within a provincial cancer program in Alberta, Canada. The purpose was to capture key learnings from a rapid virtual care implementation because of the COVID-19 pandemic and to understand the impact on patient and staff experiences. Administrative data were collected for 21,362 patients who had at least one virtual or in-person visit to any provincial cancer center from April 1, 2020, to June 10, 2020. Patient surveys were conducted with 397 randomly selected patients who had received a virtual visit. Surveys were also conducted with 396 Cancer Care Alberta staff. 14,906 virtual visits took place in this period, and about 40% of weekly visits were virtual. Significant differences were observed in both patient-reported symptom questionnaire completion rates and referrals to supportive care services between patients seen in-person and virtually. Patients receiving active treatments reported significantly lower levels of satisfaction with virtual visits than those seen for follow-up, but overall 90% of patients indicated interest in receiving virtual care in the future. Staff thought virtual visits increased patients' access to care but less than one third (31.5%) felt confident meeting patients' emotional needs and having conversations about disease progression and/or end of life virtually. The COVID-19 pandemic has driven the rapid implementation of virtual visits for cancer care delivery in health care settings. The findings from this mixed methods evaluation provide a concrete set of considerations for organizations looking to develop a large-scale, enduring virtual care strategy.

CONTEXT: A key change for the health care system has been the implementation of virtual care solutions by primary care providers in response to physical distancing measures during the COVID-19 pandemic. The experiences of the public due to these changes require investigation. OBJECTIVE: To explore public perspectives of the usability, acceptability and sustainability of virtual primary care visits and how virtual healthcare delivery can be improved. DESIGN: Closed ended, self-administered online survey, co-created with a public advisory committee. SETTING: A link to the survey was provided through primary care office visits and advertisements in local news media. PARTICIPANTS: Responses were received from 325 individuals who self-reported a virtual visit with their primary care provider. The range in age was from 19-80 years with 76% of respondents identifying as female. The majority (77%) were from urban communities with 30 minutes or less travel time (69%) to their primary care clinics. OUTCOME MEASURES: The survey consisted of 18 questions regarding perceptions of the virtual care visit experience, the outcomes of the visit, and feedback on how virtual visits might be sustained in future. RESULTS: The virtual visits reported were primarily by telephone (98%) and used for a range of needs including follow-up for test results (36%), chronic conditions (32%) and seeking advice for a new health condition (32%). The virtual visit was reported to be helpful (90%), saved time (78%) and more convenient for access to care (66%). Among the respondents, 92% of the virtual visits were considered completed, with no follow up or follow up if needed. For future use, 67% reported they would like to have the option of ongoing phone or computer consultations while 27% were open to considering virtual visits for receiving test results, prescription renewal and follow up for a health problem. Future preferences are in-person (85%) or phone calls (78%) with one’s provider in their usual clinic. CONCLUSION: During pandemic restrictions, the use of virtual care and primarily telephone consultations that bridged care for patients were well received. A number of considerations were identified for integrating into longer term use. This survey was an effective means of obtaining public feedback, which is essential given that recipients of care are the ones most impacted by system changes.

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers. This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven tools and technology, on the performance of clinical and patient experience measures. A virtual care model, applied using a systems approach offered by the Value Transformation Framework (VTF), was combined with self-care tools and technology in twenty health centers across 17 states to drive improvement efforts. Changes in clinical measures and patient experience were compared. A total of 385 patients were enrolled and 270 (70.1%) completed a baseline visit and at least four virtual visits during the six-month intervention period. Statistically significant improvements were seen in measures for HbA1c, systolic and diastolic blood pressure, and bodyweight. Among the 270 who completed the baseline and at least 4 virtual visits, the percentage up-to-date for colorectal cancer screening increased from 113/270 (41.9%) to 169/270 (62.6%) after six months, p<0.001, a 20.7% increase. Patients completing the baseline visit and at least 4 virtual visits reported a 10.7% decrease in depression and increased satisfaction with virtual care visits compared to in-person visits (p<0.001). Health centers applying the Value Transformation Framework's organizing framework to the use of virtual care models together with patient self-care tools, technology, and education, had improvements in measures for chronic and preventive conditions and patient experience.

Virtual Care during the COVID-19 Pandemic Among Patients with Hematologic Malignancies - a Princess Margaret Cancer Centre Experience

Arthritis: a broader approach

Edema assessment and management practice patterns among hand therapists: Survey research

Aim: To investigate patterns of virtual prenatal visits and examine reasons for not pursuing virtual visits for prenatal care. Methods: A pooled cross-sectional study used Pregnancy Risk Assessment Monitoring System from October 2020 through June 2021, a nationally representative surveillance system targeted at women who recently gave live birth. Individuals (n = 11,829) who reported their prenatal care experiences were included. A modified poison regression estimated prevalence ratios for virtual prenatal visits and reasons for not using virtual services. Results: One-third of participants used virtual prenatal care. Hispanics were more likely to use virtual prenatal care than whites. Compared with college graduates, those with high school graduation (Prevalence Ratios [PR] 0.87, 95% confidence interval [CI] 0.76-0.99; p = 0.033) or some college education (PR 0.86, 95% CI 0.77-0.96; p = 0.009) were less likely to use virtual visits. A preference for in-person was the most common reason for not pursuing virtual visits (77.1%), followed by no available virtual appointments (29.5%), technology barriers (6.1%), and no private space (1.7%). Individuals with less than or with high school graduation had 4.16 times (95% CI 2.32-7.46; p ≤ 0.001) and 2.72 times (95% CI 1.67-4.43; p ≤ 0.001) greater technology barriers, and 10.03 times (95% CI 3.42-29.46; p ≤ 0.001) and 4.29 times (95% CI 1.56-11.80; p = 0.005) greater likelihood of lacking private space, respectively, while they had a lesser in-person preference. Conclusions: In a disrupted health care landscape, barriers to accessing virtual prenatal care may have further exacerbated access to care and effective management of pregnancy among those underserved. The findings provide practical implications for safe and effective prenatal care.

Client buy-in: An essential consideration for graded motor imagery in hand therapy

Patient Perspectives on Virtual vs In-Person Posttreatment Care for Brain Metastases

Virtual care utilization has exponentially grown since the onset of the pandemic. However, unknown are the factors associated with incomplete virtual care visits. The purpose of this study is to investigate the factors associated with telemedicine call drops. We utilized an on-demand virtual urgent care service to examine the differences between completed and uncompleted visits. We conducted a cross-sectional study of 22,721 telemedicine encounters. We found that older adults were associated with higher rates of completing telemedicine visits, with higher odds with telephone visits. This study adds new knowledge about the factors that may lead to unsuccessful virtual care visits, which is of interest to policy makers.

BackgroundVirtual visits are clinical interactions in health care that do not involve the patient and provider being in the same room at the same time. The use of virtual visits is growing rapidly in health care. Some health systems are integrating virtual visits into primary care as a complement to existing modes of care, in part reflecting a growing focus on patient-centered care. There is, however, limited empirical evidence about how patients view this new form of care and how it affects overall health system use.ObjectiveDescriptive objectives were to assess users and providers of virtual visits, including the reasons patients give for use. The analytic objective was to assess empirically the influence of virtual visits on overall primary care use and costs, including whether virtual care is with a known or a new primary care physician.MethodsThe study took place in British Columbia, Canada, where virtual visits have been publicly funded since October 2012. A survey of patients who used virtual visits and an observational study of users and nonusers of virtual visits were conducted. Comparison groups included two groups: (1) all other BC residents, and (2) a group matched (3:1) to the cohort. The first virtual visit was used as the intervention and the main outcome measures were total primary care visits and costs.ResultsDuring 2013-2014, there were 7286 virtual visit encounters, involving 5441 patients and 144 physicians. Younger patients and physicians were more likely to use and provide virtual visits (P<.001), with no differences by sex. Older and sicker patients were more likely to see a known provider, whereas the lowest socioeconomic groups were the least likely (P<.001). The survey of 399 virtual visit patients indicated that virtual visits were liked by patients, with 372 (93.2%) of respondents saying their virtual visit was of high quality and 364 (91.2%) reporting their virtual visit was “very” or “somewhat” helpful to resolve their health issue. Segmented regression analysis and the corresponding regression parameter estimates suggested virtual visits appear to have the potential to decrease primary care costs by approximately Can $4 per quarter (Can –$3.79, P=.12), but that benefit is most associated with seeing a known provider (Can –$8.68, P<.001).ConclusionsVirtual visits may be one means of making the health system more patient-centered, but careful attention needs to be paid to how these services are integrated into existing health care delivery systems.

AimsThe purpose of our study was to determine which groups of orthopaedic providers favour virtual care, and analyze overall orthopaedic provider perceptions of virtual care. We hypothesize that providers with less clinical experience will favour virtual care, and that orthopaedic providers overall will show increased preference for virtual care during the COVID-19 pandemic and decreased preference during non-pandemic circumstances.MethodsAn orthopaedic research consortium at an academic medical system developed a survey examining provider perspectives regarding orthopaedic virtual care. Survey items were scored on a 1 to 5 Likert scale (1 = “strongly disagree”, 5 = “strongly agree”) and compared using nonparametric Mann-Whitney U test.ResultsProviders with less experience were more likely to recommend virtual care for follow-up visits (3.61 on the Likert scale (SD 0.95) vs 2.90 (SD 1.23); p = 0.006) and feel that virtual care was essential to patient wellbeing (3.98 (SD 0.95) vs 3.00 (SD 1.16); p < 0.001) during the pandemic. Less experienced providers also viewed virtual visits as providing a similar level of care as in-person visits (2.41 (SD 1.02) vs 1.76 (SD 0.87); p = 0.006) and more time-efficient than in-person visits (3.07 (SD 1.19) vs 2.34 (SD 1.14); p = 0.012) in non-pandemic circumstances. During the pandemic, most providers viewed virtual care as effective in providing essential care (83.6%, n = 51) and wanted to schedule patients for virtual care follow-up (82.2%, n = 50); only 10.9% (n = 8) of providers preferred virtual visits in non-pandemic circumstances.ConclusionOrthopaedic providers with less clinical experience seem to favourably view virtual care both during the pandemic and under non-pandemic circumstances. Providers in general appear to view virtual care positively during the pandemic but are less accommodating towards it in non-pandemic circumstances.Cite this article: Bone Jt Open 2021;2(6):405–410.