eHealth Centre of Excellence, Kitchener, Ontario, Canada.
Hamilton Family Health Team, Hamilton, Ontario, Canada.
PLoS One. 2021 Jun 24;16(6):e0253665. doi: 10.1371/journal.pone.0253665. eCollection 2021.
The COVID-19 pandemic has rapidly transformed how healthcare is delivered to limit the transmission of the virus. This descriptive cross-sectional study explored the current use of virtual visits in providing care among primary care providers in southwestern Ontario during the first wave of the COVID-19 pandemic and the anticipated level of utilization post-pandemic. It also explored clinicians' perceptions of the available support tools and resources and challenges to incorporating virtual visits within primary care practices.
Primary care physicians and nurse practitioners currently practicing in the southwestern part of Ontario were invited to participate in an online survey. The survey invite was distributed via email, different social media platforms, and newsletters. The survey questions gathered clinicians' demographic information and assessed their experience with virtual visits, including the proportion of visits conducted virtually (before, during the pandemic, and expected volume post-pandemic), overall satisfaction and comfort level with offering virtual visits using modalities, challenges experienced, as well as useful resources and tools to support them in using virtual visits in their practice.
We received 207 responses, with 96.6% of respondents offering virtual visits in their practice. Participants used different modalities to conduct virtual visits, with the vast majority offering visits via phone calls (99.5%). Since the COVID-19 pandemic, clinicians who offered virtual visits have conducted an average of 66.4% of their visits virtually, compared to an average of 6.5% pre-pandemic. Participants anticipated continuing use of virtual visits with an average of 43.9% post-pandemic. Overall, 74.5% of participants were satisfied with their experience using virtual visits, and 88% believed they could incorporate virtual visits well within the usual workflow. Participants highlighted some challenges in offering virtual care. For example, 58% were concerned about patients' limited access to technology, 55% about patients' knowledge of technology, and 41% about the lack of integration with their current EMR, the increase in demand over time, and the connectivity issues such as inconsistent Wi-Fi/Internet connection. There were significant differences in perception of some challenges between clinicians in urban vs, rural areas. Clinicians in rural areas were more likely to consider the inconsistent Wi-Fi and limited connectivity as barriers to incorporating virtual visits within the practice setting (58.8% vs. 40.2%, P = 0.030). In comparison, clinicians in urban areas were significantly more concerned about patients overusing virtual care services (39.4% vs. 21.6%, P = 0.024). As for support tools, 47% of clinicians advocated for virtual care standards outlined by their profession's college. About 32% identified change management support and technical training as supportive tools. Moreover, 39% and 28% thought local colleagues and in-house organizational support are helpful resources, respectively.
Our study shows that the adoption of virtual visits has exponentially increased during the pandemic, with a significant interest in continuing to use virtual care options in the delivery of primary care post-pandemic. The study sheds light on tools and resources that could enhance operational efficiencies in adopting virtual visits in primary care settings and highlights challenges that, when addressed, can expand the health system capacity and sustained use of virtual care.
新冠疫情迅速改变了医疗服务的提供方式，以限制病毒的传播。本描述性横断面研究旨在探讨安大略省西南部的初级保健提供者在新冠疫情第一波期间提供虚拟就诊的当前使用情况，以及疫情后预期的使用水平。它还探讨了临床医生对现有支持工具和资源的看法，以及在初级保健实践中纳入虚拟就诊的挑战。
邀请安大略省西南部目前执业的初级保健医生和执业护士参加在线调查。调查邀请通过电子邮件、不同的社交媒体平台和时事通讯分发。调查问题收集了临床医生的人口统计学信息，并评估了他们的虚拟就诊经验，包括在虚拟就诊中进行的就诊比例（疫情前、疫情期间和疫情后预期的就诊量）、使用各种模式提供虚拟就诊的总体满意度和舒适度、体验到的挑战，以及支持他们在实践中使用虚拟就诊的有用资源和工具。
我们收到了 207 份回复，其中 96.6%的受访者在其诊所提供虚拟就诊。参与者使用不同的模式进行虚拟就诊，绝大多数通过电话提供虚拟就诊（99.5%）。自新冠疫情以来，提供虚拟就诊的临床医生平均进行了 66.4%的虚拟就诊，而疫情前的平均比例为 6.5%。参与者预计在疫情后将继续使用虚拟就诊，平均比例为 43.9%。总体而言，74.5%的参与者对使用虚拟就诊的体验感到满意，88%的参与者认为他们可以很好地将虚拟就诊融入日常工作流程。参与者强调了提供虚拟护理的一些挑战。例如，58%的人担心患者获取技术的机会有限，55%的人担心患者对技术的了解，41%的人担心与当前电子病历的整合，随着时间的推移需求的增加，以及连接问题，如不一致的 Wi-Fi/互联网连接。城乡地区临床医生对某些挑战的看法存在显著差异。农村地区的临床医生更有可能认为 Wi-Fi 不稳定和连接有限是在实践中纳入虚拟就诊的障碍（58.8%对 40.2%，P = 0.030）。相比之下，城市地区的临床医生更担心患者过度使用虚拟护理服务（39.4%对 21.6%，P = 0.024）。至于支持工具，47%的临床医生提倡他们所在专业协会制定的虚拟护理标准。约 32%的人确定了变革管理支持和技术培训作为支持工具。此外，39%和 28%的人认为当地同事和内部组织支持是有帮助的资源。
我们的研究表明，在疫情期间，虚拟就诊的采用呈指数级增长，并且在疫情后继续使用虚拟护理服务来提供初级保健的意愿强烈。该研究揭示了可以提高在初级保健环境中采用虚拟就诊的运营效率的工具和资源，并强调了可以扩大卫生系统容量和维持虚拟护理使用的挑战。
