Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
BMC Health Serv Res. 2023 Apr 4;23(1):338. doi: 10.1186/s12913-023-09256-3.
Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians' perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic.
We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes.
We identified three prominent themes throughout participants' reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers.
Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.
在大流行之前，加拿大在虚拟医疗的采用方面落后于经济合作与发展组织的其他国家。然而，COVID-19 的爆发导致几乎普遍转向虚拟初级保健，以尽量降低接触风险。随着司法管辖区进入大流行后恢复阶段，虚拟和面对面就诊之间的平衡正在恢复，但不太可能恢复到大流行前的水平。我们的目标是探讨加拿大家庭医生在 COVID-19 大流行期间快速转向虚拟医疗的观点，为未来初级保健的大流行规划以及在大流行之外将虚拟医疗更有效地融入更广泛的初级保健背景提供信息。
我们在 2020 年 10 月至 2021 年 6 月期间在加拿大四个地区对 68 名家庭医生进行了半结构化访谈。我们采用了有目的的、最大变化的抽样方法，在每个地区继续招募，直到达到饱和。对家庭医生的访谈探讨了他们在大流行期间的角色和经验，以及他们在继续为患者提供支持方面遇到的促进因素和障碍。访谈进行了录音、转录，并进行了主题分析以确定反复出现的主题。
我们在参与者对实施虚拟医疗的反思中确定了三个突出的主题：大流行期间虚拟模式的实施和演变；实施虚拟医疗的促进因素和障碍；以及未来的虚拟医疗。虽然一些家庭医生之前有过远程评估的经验，但随着各省将面对面就诊限于基本和紧急护理，大多数人不得不突然实施和适应虚拟医疗。随着大流行的进展，最初的视频咨询尝试经常被电话咨询所取代，而医生也重新平衡了虚拟和面对面就诊的比例。对于家庭医生来说，具有虚拟访问集成能力的医疗记录系统、计费代码、支持性的诊所团队以及与患者的长期关系是这种快速过渡的促进因素，而这些因素的缺失往往构成障碍。
尽管与虚拟初级保健相关的经验和偏好各不相同，但医生们认为虚拟访问应该在大流行后继续提供，但需要更明确的监管和指导方针来规范其未来的使用。
