Article Figures & Data
Figures
- Figure 1. Quadruple aim framework
Tables
n % Patients (n = 31)a Age, years 18–30 5 16 31–45 6 19 46–60 11 35 >61 9 29 Visit types Phone only 18 58 Video only 3 10 Phone and video 10 32 Provider types seen virtually Primary care 24 77 Therapists or social worker 8 26 Physiotherapists 5 16 Past experience with virtual care No experience 26 84 Minimal 5 16 Providers (n = 36) Age, years 18–30 3 8 31–45 18 50 46–60 10 28 >61 5 14 Employed >5 years 22 61 Provider type Primary care 16 44 Therapist or social worker 16 44 Physiotherapist 4 11 Past experience with virtual care No experience 8 22 Minimal 28 67 aSome patients saw more than one provider type.
Sub-theme Illustrative quote Equitable access(n = 25/31 patient transcripts)(n = 36/36 provider transcripts) 'My biggest barrier to health care even before the pandemic was transportation. When your appointment runs two hours late and you're sitting in a waiting room, there are better things that you could be doing with your day as opposed to having to navigate public transit.' (London InterCommunity Health Centre, patient)'There are days that I can’t get up and get to the centre, but now I can address those problems. I would imagine if there’s other handicapped people that would be a real asset for them too.' (Chatham-Kent, patient)'For one of my patients, it would cost her $20 to come here and go back home. So, of course this eliminates that cost for a lot of people.' (Chigamik, provider)'The limitations have much to do with poverty as anything else.' (London InterCommunity Health Centre, provider) Sub-theme Illustrative quote Patient–provider relationships(n = 25/31 patient transcripts)(n = 34/36 provider transcripts) 'I wasn’t worried about my care because I knew the person that I was primarily dealing with.' (Southeast Ottawa, patient)'I don't think I would have done virtual care for my counselling visits. Some of the things that [provider’s name] and I discuss, is built on that trust. I wouldn’t have that trust with a new provider all of a sudden.' (Chatham-Kent, patient)'For me I prefer in person or video. I can see the person and it’s a much better conversation, and to share body language too.' (NorWest, patient)'For new patients, I would like having that initial appointment face to face, and then virtual. You can’t build trust and rapport very well over virtual visits, you need to be in-person for that.' (NorWest, provider) Care provision(n = 14/31 patient transcripts)(n = 36/36 provider transcripts) ' […] I wanted to discuss one thing about my daughter’s thigh and I could only describe it with my words […], so I sent a picture, but it wasn't easier to assess it.' (Access Alliance, patient)'A virtual appointment with video or without does not give you the complete picture that you may have in regards to having somebody in front of you. It definitely has its limitations, especially if somebody is describing something quite minimally and it’s actually quite significant.' (Southeast Ottawa, provider) Maintaining privacy(n = 24/36 provider transcripts) 'I've explained to patients the issues of privacy and confidentiality. They’ll say, “I'm at Walmart, but I don’t care. Let’s just talk now.” I found that hard because a lot of people will say, “No, no, don't call me back.”' (Chatham-Kent, provider) Technical issues(n = 10/31 patient transcripts)(n = 18/36 provider transcripts) ' […] there are times when the technology just doesn't cooperate and so we have to hop on a phone call instead, which can be really disruptive.' (Chigamik, patient)' […] I’m not a technical person, I’m stressed enough to make sure I do it right. Whereas, when you go to the office, you know you’re going to have your appointment no matter what.' (NorWest, patient)'It’s very frustrating for us because we get behind and we're spending time coaching the patient about how to use the technology. Not a good use of our time.' (London InterCommunity Health Centre, provider) Aspects of care suited for virtual delivery(n = 31/31 patient transcripts)(n = 36/36 provider transcripts) 'I do like the in-person scenario. However, there are things that come up from time to time that are easy for me to deal with by phone.' (Chigamik, patient)'Yeah, I mean [virtual appointments] are so much easier. I probably benefit more from my therapy sessions because I'm more relaxed at home and so I'm able to be more present because I didn’t have all of that stress of getting there.' (London InterCommunity Health Centre, patient)'I think that virtual care is excellent in certain ways […] I would often question why I'm bringing an 85-year-old woman out of her home in February to come talk about her blood work or her bone density test?' (Chigamik, provider)' […] personally, I prefer in person. That’s always better for counselling. You need to understand the person, the story, how they feel, how they lived through their issues, and all the clues are important that you see in person.' (Chatham-Kent, provider) Sub-theme Illustrative quote Greater efficiency(n = 33/36 provider transcripts) 'I have a lot fewer no-shows because I can catch them with the phone or with video. This has removed barriers so patients can actually come to counselling where if they were coming physically, they're not going to show up.' (Chigamik, provider)'Usually, I give them a call, sometimes if they don’t answer right away, I call them again ten minutes later or try a different number. In-person, I wouldn’t be able to do, it’s either they show up or they don’t'. (NorWest, provider) Sub-theme Illustrative quote Team communication(n = 22/36 provider transcripts) ' […] management started a COVID café, which was not only a chance to learn different things relevant for your job, but also to connect with other staff members and feel less isolated.' (Southeast Ottawa, provider)'The system that we've got is so user-friendly to be able to stay connected with my colleagues. No, it’s still just as good as ever.' (London InterCommunity Health Centre, provider) Work–life balance(n = 9/36 provider transcripts) ' […] it’s been amazing to have more time in the morning. You don't spend all that time getting ready, you can take a walk, and enjoy the sunshine with your coffee outside. When your workday ends at four, it really ends, there’s no commute, so those are definitely a personal benefit.' (Southeast Ottawa, provider) Additional training(n = 12/36 provider transcripts) 'There was no training on how to adapt your delivery of care virtually or even how to use maybe the PS Suites video platform.' (NorWest, provider)'I think the only hindrance was technological. The fact that we were all — I don’t think many of us had used Zoom before. There was a learning curve there.' (Access Alliance, provider)
Supplementary Data
- SB_BJGPO.2022.0031_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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Using the quadruple aim to understand the impact of virtual delivery of care within Ontario community health centres: a qualitative study
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