Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
School of Nursing, University of Northern British Columbia, Prince George, BC, Canada.
J Med Internet Res. 2024 Nov 26;26:e52552. doi: 10.2196/52552.
Virtual health care has transformed health care delivery, with its use dramatically increasing since the COVID-19 pandemic. While it has been quickly adopted for its convenience and efficiency, there has been a relative lack of in-depth exploration of its human impact, specifically how both patients and providers experience clinical encounters.
This analysis aims to identify and explore themes of change in how patients and providers in a geographically dispersed renal service described their experiences with virtual care, including those changes that occurred during the COVID-19 pandemic.
Hermeneutics is an interpretive research methodology that treats human experience as inherently interpretive, generating meaning through interactions with others in specific, historically conditioned, social contexts. A total of 17 patients and 10 providers from various disciplines were interviewed by phone as part of a study on health care implementation in the context of a kidney care service in northern British Columbia, Canada. The interview data were analyzed using a hermeneutic approach, which emphasizes careful attention to reported experiences in relation to the relationships and contexts of care.
During analysis, the interdisciplinary team identified themes related to changes in the clinical encounter and how virtual care influenced perceptions of care among both providers and patients. We organized these themes into 2 categories: the structure and content of the encounter. The structure category included the convenience for patients, who no longer had to travel long distances for appointments, as well as changes in care networks. For example, communication between specialist services and local primary care providers became more crucial for ensuring continuity of care. The content category included issues related to trust-building and assessment. Providers expressed concerns about the difficulty in assessing and understanding their patients' physical and social well-being beyond laboratory results.
Patients in the study appreciated the convenience of not needing to travel for appointments, while still having the option for in-person contact with local providers or specialists if their condition changed. Providers were more concerned about the loss of visual cues and sensory data for assessments, as well as the reduced opportunity to build relationships through conversation with patients. Providers also described changes in the locus of control and boundaries, as patients could join phone encounters from anywhere, bypassing traditional privacy and confidentiality boundaries. The study offers a nuanced view of the effects of virtual care on clinical encounters in one setting, seen through the experiences of both patients and providers.
虚拟医疗改变了医疗服务模式，自 COVID-19 大流行以来，其使用量急剧增加。虽然它因其便利性和效率而被迅速采用，但对于其对人类的影响，特别是患者和提供者如何体验临床接触，还缺乏深入的探索。
本分析旨在确定并探讨在地理上分散的肾脏服务中，患者和提供者如何描述他们对虚拟护理的体验中发生的变化主题，包括在 COVID-19 大流行期间发生的变化。
诠释学是一种解释性研究方法，它将人类体验视为具有内在的解释性，通过与特定的、历史条件下的社会背景中的其他人的互动来产生意义。作为加拿大不列颠哥伦比亚省北部肾脏护理服务中医疗保健实施研究的一部分，共有 17 名患者和 10 名来自不同学科的提供者通过电话接受了采访。使用诠释学方法对访谈数据进行了分析，该方法强调仔细关注与护理关系和背景相关的报告经验。
在分析过程中，跨学科团队确定了与临床接触变化以及虚拟护理如何影响提供者和患者对护理的看法相关的主题。我们将这些主题组织成 2 个类别：接触的结构和内容。结构类别包括患者的便利性，他们不再需要长途跋涉去预约，以及护理网络的变化。例如，专科服务与当地初级保健提供者之间的沟通对于确保护理连续性变得更加重要。内容类别包括与建立信任和评估相关的问题。提供者对评估和了解患者身体和社会福祉的难度表示担忧，超出了实验室结果的范围。
研究中的患者欣赏无需旅行就诊的便利性，同时如果病情发生变化，仍可选择与当地提供者或专家进行面对面接触。提供者更关心评估时视觉线索和感官数据的缺失，以及通过与患者交谈建立关系的机会减少。提供者还描述了控制和边界的变化，因为患者可以从任何地方加入电话会议，绕过传统的隐私和保密性边界。该研究通过患者和提供者的经验，提供了对虚拟护理对临床接触影响的细致观察。
