Virtual Visits Research Articles

(384) Post-Vasectomy Semen Analysis Compliance Correlated with Patient Driving Distance to Drop-off Site

Abstract Introduction Successful vasectomy is confirmed with post-vasectomy semen analysis (PVSA) completed eight to sixteen weeks after the procedure. However, compliance rates remain low throughout the literature with an estimated 34% to 58% of patients never receiving a PVSA. Objective We sought to quantify the relationship between driving time and compliance with PVSA. Methods A retrospective chart review was conducted of vasectomies provided by urologists from an academic hospital system between 4/1/2020 and 12/31/2022. Physicians who primarily performed in-office PVSA or referred patients to outside clinics were excluded from the study. Compliance with post-vasectomy semen analysis was defined as at least 1 PVSA sample submitted. In our study we considered variables including age, virtual or in-person preoperative visit, paternity, and driving time. The shortest driving time was calculated from each patient’s residence to the single PVSA drop-off site using ArcGIS. The study received IRB approval. The factors associated with compliance were analyzed via multivariable logistic regression. Driving time, age at vasectomy, paternity, and preop location were included as predictors. Driving time and age were included as continuous variables. For driving time the odds ratio reflects the change in odds of PVSA per 30 minutes of driving; for age the odds ratio reflects the change in odds of PVSA per 10 years of age. A generalized additive model was used to explore a nonlinear relationship between driving time and PVSA compliance. Results A total of 515 patients were included in the analysis. 296 patients obtained a PVSA (57.5%). Of those who obtained a PVSA, 41% took more than 16 weeks to do so. The median driving distance for those who obtained a PVSA was 18.9 miles (11.3, 26.4) and 22.3 miles (13.9, 34.3) for those who did not (p<0.01). The median estimated driving times for those who did and did not provide PVSA were 30.6 minutes (23.0, 42.1) and 34.2 minutes (25.5, 46.8) respectively (p<0.05). Adjusted for age, paternity, and pre-op location, each 30 minutes of driving time was associated with a 48% (63%, 27%) reduction in the odds of obtaining a PVSA (p<0.001). Age at vasectomy, paternity, and pre-op location were not found to be associated with decreased PVSA compliance. (Table 1). The generalized additive model shows a similar relationship between driving distance and compliance (Figure 1). Conclusions These results demonstrate a statistically significant correlation between longer driving time to a drop-off site and probability of PVSA non-compliance. However, factors such as paternity, age at vasectomy, and pre-op visit format were not significant. Increasing access to semen analysis drop-off centers close to patients residences may serve to increase compliance with PVSA. At-home PVSA kits and in-office semen analyses are other options for reducing this barrier. Further research is needed to see if this relationship between driving time and compliance is seen in other aspects of medical care. Disclosure No.

Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education.

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.

Comparative Effectiveness of Virtual Versus In-person Visits for Abdominal Pain During the COVID-19 Pandemic.

The COVID-19 pandemic has highlighted the importance of telemedicine in improving healthcare access and reducing costs. This study aimed to assess order compliance in the virtual versus in-person setting for the initial evaluation of abdominal pain (AP) prior to and during the pandemic. A retrospective evaluation of virtual and in-person outpatient gastroenterology visits for AP were identified through natural language processing from January 2019 through September 2021 at the Cleveland Clinic main campus and regional hospitals in Ohio. We assessed the number and type of orders placed for patients and measured compliance through order completion. This study received Institutional Review Board approval (IRB 21-514). Among 20,356 patients at their initial visit, 79% had orders placed, of which 40% had pandemic in-person visits, 13% had pandemic virtual visits, and 47% had pre-pandemic in-person visits. Patients seen virtually were 65.1% less likely to complete orders compared to patients seen in-person (p < 0.001) during the pandemic. Patients seen in a pandemic virtual setting were 71.0% less likely to complete imaging orders (p < 0.001), 82.6% less likely to complete procedure orders (p < 0.001), and 60.5% less likely to complete lab orders (p < 0.001). Compared with in-person visits, patients seen virtually for their first presentation of AP were less likely to complete labs, imaging, and endoscopic evaluations. In-person visits were more successful with patient order completion during the pandemic. These findings highlight that virtual visits for AP, despite convenience, may compromise care delivery and warrant additional care coordination to achieve compliance with medical recommendations.

Virtual follow-up care among breast and prostate cancer patients during and beyond the COVID-19 pandemic: Association with distress.

The purpose of this study was to investigate associations between self-reported distress (anxiety/depression) and satisfaction with and desire for virtual follow-up (VFU) care among cancer patients during and beyond the COVID-19 pandemic. Breast and prostate cancer patients receiving VFU at an urban cancer centre in Toronto, Canada completed an online survey on their sociodemographic, clinical, and technology, characteristics and experience with and views on VFU. EQ5D-5 L was used to assess distress. Statistical models adjusted for age, gender, education, income and Internet confidence. Of 352 participants, average age was 65 years, 48% were women,79% were within 5 years of treatment completion, 84% had college/university education and 74% were confident Internet users. Nearly, all (98%) had a virtual visit via phone and 22% had a virtual visit via video. The majority of patients (86%) were satisfied with VFU and 70% agreed that they would like VFU options after the COVID-19 pandemic. Participants who reported distress and who were not confident using the Internet for health purposes were significantly less likely to be satisfied with VFU (OR = 0.4; 95% CI: 0.2-0.8 and OR = 0.19; 95% CI: 0.09-0.38, respectively) and were less likely to desire VFU option after the COVID-19 pandemic (OR = 0.49; 95% CI: 0.30-0.82 and OR = 0.41; 95% CI: 0.23-0.70, respectively). The majority of respondents were satisfied with VFU and would like VFU options after the COVID-19 pandemic. Future research should determine how to optimize VFU options for cancer patients who are distressed and who are less confident using virtual care technology.

Abstract WP52: Evaluation of Post Stroke Telehealth Services in Texas (Vast-1)

Background: Shortly after AHA/ASA released an updated policy on stroke care systems, COVID-19 disrupted these systems. Lockdowns and social distancing were considered critical to mitigate COVID-19 transmission but altered public perceptions about stroke medical care. As a result, telehealth expanded rapidly across Texas. However, little is known how to optimally integrate telehealth services into the continuum of stroke care. Methods: To identify barriers and facilitators of post-acute stroke telehealth services among stroke survivors’ facilities of the Lone Star Stroke Consortium (LSSC) Research Consortium, we conducted semi-structured interviews with stroke providers and focus groups with patients. Audiotapes were transcribed, and files prepared for analysis. Using a grounded theory approach, we performed data analysis to allow theory to emerge from data. Two independent reviewers read transcripts, developed coding using an iterative consensus building, verified codes, developed concepts, and created categories. Constant comparison process found emerging themes within each category. Results: We enrolled 23 providers and 34 patients. Access, telemedicine encounter and technology were revealed as major categories of post-acute stroke telehealth among providers and patients. Facilitators of access included increased accessibility and elimination of barriers. Reliable internet connection and technological skills were barriers for both groups. Patients and providers identified virtual visits as good. However, full medical exam, including cognitive evaluation, was a barrier for patients and providers. Technology increased ability to communicate with patients and providers. Barriers included constrains of internet services, lack of documentation for virtual visits, and lack of telemedicine platform. Conclusion: Our study will contribute to future telehealth services integration into continuum of stroke care.

Sustaining telehealth in pediatric diabetology beyond COVID-19: How to set the tone.

In the post-COVID-19 era, telehealth experience and knowledge must be structured to deliver high-quality care. Type 1 diabetes is a chronic disease that lends itself to being a model for telehealth diffusion, especially in the pediatric setting where the use of cloud-connected technologies is widespread. Here, we present "how to set the tone" and manage a telemedicine session according to our experiences and those reported in the literature, according to the health professional perspective. A practical workflow on how healthcare professionals can structure a virtual diabetes clinic is reported, as well as critical issues related to limits in physical examination, communication registers, relationships, and visit settings. A proactive virtual visit model could be feasible, stratifying patients according to continuous glucose monitoring metrics, and personalized interventions can be provided to each patient. Analysis of benefits and hassles due to telehealth for each patient has to be considered, as well as their personal perspective, expectations, and reported barriers, mainly related to connection issues and digital literacy.

Pharmacist perceptions of delivering patient care through telehealth.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To evaluate pharmacists' perceptions of the benefits of and barriers to telehealth as experienced in actual telehealth visits with patients. This qualitative study used virtual focus groups and a validated questionnaire (the Health Optimum Telemedicine Acceptance [HOTA] survey) to assess telehealth facilitators and barriers. Participants were included if they were licensed pharmacists utilizing telehealth in the outpatient setting. Pharmacist focus group responses were transcribed and analyzed using Miles and Huberman's qualitative data analysis model. Six pharmacists participated in this study. Their responses were placed into 2 categories: clinical effectiveness and patient experience. All participants had performed at least 20 virtual visits, and all agreed that telehealth improved patients' health status. Respondents agreed that telehealth results in more frequent patient interactions and allows for provision of multiple types of care virtually. However, technological difficulties and the inability to provide physical examinations and obtain laboratory values were identified limitations. The surveyed pharmacists agreed that the main benefit that patients gained from telehealth was the elimination of transportation concerns, allowing increased access to care. However, pharmacists voiced their concern for patient privacy and barriers to educating patients on proper use of medical devices. Pharmacists felt that telehealth was useful in several clinical scenarios. However, they also identified opportunities to improve its development in clinical practice. Further investigation must be done to better grasp impediments to telehealth in order to provide the most effective patient care.

Healthcare utilization before and during the COVID-19 pandemic among mothers and birthing parents with elevated levels of postpartum depression symptoms

ABSTRACT Little is known about the healthcare utilization of mothers and birthing parents experiencing elevated levels of symptoms of postpartum depression (PPD), particularly during the COVID-19 pandemic. This study examined how healthcare utilization changed in these individuals during COVID-19. Individuals living in Ontario, Canada, with Edinburgh Postnatal Depression Scale Scores ≥ 10 were recruited into two separate randomized controlled trials of a 1-day intervention for PPD before (pre-COVID-19, n = 441) and during the pandemic (COVID-19, n = 287). Participants in both samples completed the same health resource use questionnaire, self-reporting the number of virtual and/or in-person visits to specific healthcare services over the three months preceding their treatment intervention. Use of medications, mental health care, primary care, hospital-based care, allied health care, and overall healthcare utilization were compared between the pre-COVID-19 and COVID-19 groups. While participants had higher levels of PPD symptoms during COVID-19, differences were not seen in the use of specific categories of care (e.g. mental health and primary care). However, before and after statistically adjusting for covariates, overall healthcare utilization decreased from an average of 9.5 visits prior to COVID-19 to 6.9 during COVID-19 (p < .001), a change that was at least partly contributed to by reductions in visits to allied health professionals (e.g. dentists and physiotherapists). Overall healthcare utilization decreased by 27 % in mothers and birthing parents seeking treatment for elevated levels of PPD symptoms during the COVID-19 pandemic in Ontario, Canada – despite higher levels of PPD symptoms – highlighting the need to support and address barriers to postpartum care.

Factors Affecting Family Caregivers' Satisfaction During Virtual Care Visits.

There are 18 million caregivers in the US who are essential in the care process for patients to facilitate scheduling appointments, administer medication, and assist with care coordination. The objective of this study was to examine the facilitators and barriers to a positive virtual care experience for caregivers. examined the satisfaction levels among caregivers using a virtual care service at a Southeastern Medical Center in the U.S. We analyzed 231 virtual care visits completed by caregivers. We found that insurance status and medication prescription played a significant role in caregivers' ratings of their virtual care experience. Caregivers reported that virtual care can improve their quality of life, while mixed opinions were reported with regard to the use of virtual care, and the quality of care provided.

Clinical Experiences of Working with Patient-Generated Health Data in Primary Care.

This research aims to provide insight into the GP experience with patient-generated health data (PGHD) in a virtual care visit. Despite the prevalence of wearables, including smartwatches, the acceptability of generated data in primary care is understudied. The result of this study from mixed-method analysis showed the basic capabilities of PGHD to enhance clinical decision-making and positive impact on collaboration with the patient. The impact of PGHD on clinician satisfaction was not determined, highlighting the importance of rigorous methodology in future research.

Virtual Cancer Care Beyond the COVID-19 Pandemic: Patient and Staff Perspectives and Recommendations.

COVID-19 catalyzed rapid implementation of virtual cancer care (VC); however, work is needed to inform long-term adoption. We evaluated patient and staff experiences with VC at a large urban, tertiary cancer center to inform recommendations for postpandemic sustainment. All physicians who had provided VC during the pandemic and all patients who had a valid e-mail address on file and at least one visit to the Princess Margaret Cancer Centre in Toronto, Canada, in the preceding year were invited to complete a survey. Interviews and focus groups with patients and staff across the cancer center were analyzed using qualitative descriptive analysis and triangulated with survey findings. Response rates for patients and physicians were 15% (2,343 of 15,169) and 41% (100 of 246), respectively. A greater proportion of patients than physicians were satisfied with VC (80.1 v 53.4%; P < .01). In addition, fewer patients than physicians felt that virtual visits were worse than those conducted in person (28.0 v 43.4%; P < .01) and that telephone and video visits negatively affected the human interaction that they valued (59.8% v 82.0%; P < .01). Major barriers to VC for patients were respect for care preferences and personal boundaries, accessibility, and equitable access. For staff, major barriers included a lack of role clarity, dedicated resources (space and technology), integration of nursing and allied health, support (administrative, clinical, and technical), and guidance on appropriateness of use. Patient and staff perceptions and barriers to virtual care are different. Moving forward, we need to pay attention to both staff and patient experiences with virtual care since this will have major implications for long-term adoption into clinical practice.

P952 Why do patients with Inflammatory Bowel Disease Take Part in Pharmaceutical Clinical Trials? A qualitative study of Clinical Trial Participants

Abstract Background Recruitment rates to clinical trials in inflammatory bowel disease (IBD) continue to decline. A better understanding of motivations to participate as well as recommendations to reduce barriers to enrolment from a patient perspective may assist in design of future clinical trials. Methods We developed a 32-item electronic questionnaire to explore motivations, experiences and recommendations of patients with IBD, who have participated in pharmaceutical clinical trials in a tertiary centre in Canada. Results We distributed a total of 82 emails with surveys based on the patient details available to the study team. Using the DillMan Total Design Survey method, participants were followed up one week after the initial email with a reminder phone-call and we received 46 responses (56.1% response rate). Participants were mostly, male (58.7%), non-Hispanic white (93.5%), with a mean age of 45.5 years (SD 10.9). Most participants decided to participate in a clinical trial to benefit future patients with IBD (63.0%). Self-reported knowledge of the possibility of being assigned to placebo on a scale from 0 (no knowledge) to 100 (extremely knowledgeable) was a median of 100 (IQR 100-100) (Table 1). Half of participants (50.0%) reported they were worried about the possibility of receiving placebo, although the majority (63.0%) understood they could improve on placebo. The most challenging aspect reported was the number and length of questionnaires (32.6%), as well of the number of colonoscopies (30.4%). Strategies to increase enrolment recommended by participants were reduction in the chance of receiving placebo (43.5%), facilitating inclusion of patients who have failed multiple therapies (43.5%), allowing virtual visits (39.1%), including subtypes of disease that have traditionally been excluded in clinical trials (e.g., ostomies, fistula) (34.8%), and improving outreach to underrepresented populations (28.3%) (Figure 1). The vast majority (80.4%) reported their experience of participation to be better than expected and would recommend taking part in a clinical trial to other patients with IBD (97.8%). Conclusion Patients with IBD who took part in pharmaceutical trials reported a high level of satisfaction overall. The top three recommendations from patients to improve clinical trial design were reducing the chance of receiving placebo, allowing inclusion of patients who have failed multiple therapies and allowing for virtual visits to reduce travel burden to the clinical trial site. These results should help inform the design of patient centric clinical trials in IBD.

Cardiovascular disease risk management during COVID-19: in-person vs virtual visits.

Limited research has assessed how virtual care (VC) affects cardiovascular disease (CVD) risk management, especially in community clinic settings. Thisstudy assessed change in community clinic patients' CVD risk management during the COVID-19 pandemic and CVD risk factor control among patients who had primarily in-person or primarily VC visits. Retrospective interrupted time-seriesanalysis. Data came from an electronic health record shared by 52 community clinics for index (March 1, 2019, toFebruary 29, 2020) and follow-up (July 1, 2020, to February 28, 2022) periods. Analyses compared follow-up period changes in slope and level of population monthly means of 10-year reversible CVD risk score, blood pressure (BP), andhemoglobin A1c (HbA1c) among patients whose completed follow-up period visits were primarily in person vs primarily VC. Propensity score weighting minimizedconfounding. There were 10,028 in-person and 6593 VC patients in CVD risk analyses, 9874 in-person and 5390 VC patients in BP analyses, and 8221 in-person and 4937 VC patients in HbA1c analyses. The VC group was more commonly younger, female, White, and urban. Mean reversible CVD risk, mean systolic BP, and percentage of BP measurements that were 140/90 mm Hg or higher increased significantly from index to follow-up periods in both groups. Rate of change between these periods was the same for all outcomes in both groups, regardless of care modality. Among community clinic patients with CVD risk, receiving a majority of care in person vs a majority of care via VC was not significantly associated with longitudinal trends in reversible CVD risk score or key CVD risk factors.

Evaluating the Impact of Telehealth on Carbon Footprint During Three Phases of the Pandemic at a Rural Academic Medical Center.

Background: Climate change is primarily driven by greenhouse gases, such as carbon dioxide (CO2). Telehealth visits have been found to mitigate carbon emissions by reducing patient and physician transport. Dartmouth Hitchcock Medical Center (DHMC) is the most rural academic medical center in the country, serving a population where the majority of patients reach the hospital by car. No large study or systematic review has evaluated the impact of telehealth visits on CO2 emissions (CO2e) across multiple specialties in a purely rural setting. Further, no sizable rurally focused study has compared CO2e avoided during the various stages of the pandemic. Methods: We extracted data for all outpatient telehealth visits at DHMC from three periods: prepandemic, early pandemic, and late pandemic. The extracted data included the pandemic stage of the virtual visit, the type of visit (video or telephone), the specialty, and the distance from the patient's home to DHMC. Results: The total CO2e avoided among all three pandemic stages analyzed in this study was 23,658,898 kg (n = 251,832). During period 1, the mean driving distance = 159.0 miles; CO2e avoided per encounter = 128.3 kg; period 2, mean distance = 84.85 miles; average CO2e avoided per encounter = 68.47 CO2e kg; and period 3, mean distance = 112.9 miles; average CO2e avoided per encounter = 91.08 kg. Conclusions: This data supported long distances to the medical center and large savings in CO2e avoided across multiple specialties that spanned all pandemic periods. Further, this level of averted emissions could translate to over $3M in saved fuel costs and the avoidance of six excess deaths. While discussions of the future of telehealth commonly focus on access, use cases, technology, costs, and satisfaction, the impact on carbon footprint is an additional important metric, particularly in largely rural regions.

Comparative Analysis between Virtual Visits and Pedagogical Outings to Heritage Sites: An Application in the Teaching of History

In recent years, the teaching and learning of history have been transformed by the incorporation of active methodologies and digital tools. Virtual reality (VR) is one such tool that is being increasingly used in classrooms. It allows students to visit and experience spaces from other historical periods, even those that have been lost. However, due to its relatively slow adoption in formal educational settings, there is still a paucity of scientific references where this type of experience has been empirically tested to prove its potential benefits. Further research on this issue is therefore needed. This study presents a comparative analysis of the didactic use of historical heritage from the Roman period using two different methodological strategies: an educational visit to a museum and a virtual tour via electronic devices. The main objective is to compare the effectiveness of these two methods in terms of usability, learning outcomes, and emotional responses. The study was conducted with 51 primary school teachers in training. Data were collected using two ad hoc questionnaires, which were based on a previous one. A hybrid analysis methodology was adopted, with SPSS used for interpreting the quantitative data and Atlas Ti for the qualitative information. The results indicate that the two methodologies were perceived by future teachers as valuable resources for learning and teaching history. The emotions they evoked were primarily curiosity, joy, and motivation, with only minor occurrences of frustration, nervousness, or fear. The experience gained from this first application will make it possible to extend the study to other educational levels, to enrich the conclusions obtained and to evaluate the potential scope of using this combination of methods to develop historical competences and improve heritage education.

A population-based analysis of rheumatology care patterns for inflammatory arthritis during COVID-19 in Alberta, Canada

ObjectiveThe aim of the study was to understand the impact of the COVID-19 pandemic on inflammatory arthritis (IA) rheumatology care in Alberta, Canada. MethodsWe used linked provincial health administrative datasets to establish an incident cohort of individuals with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and Ankylosing Spondylitis (AS) seen at least once by a rheumatologist. We examined incidence rates (IR) per 100,000 population, and patterns of follow-up care between 2011 and 2022. In a subset of individuals diagnosed five years prior to the pandemic, we report on those lost to follow-up during the pandemic, and those with virtual care visits followed by in-person visit within 30 days. Multivariable logistic regression was used to examine patient characteristics associated with these patterns of care. ResultsThe IR for RA in 2020 declined compared to previous years (44.6), but not for AS (9.2) or PsA (9.1). In 2021 IRs rose (RA 49.5; AS 11.8; PsA 11.8). Among those diagnosed within 5 years of the pandemic, 632 (6.0 %) were lost to follow-up, with characteristics of those lost to follow-up differing between IA types. 1444 individuals had at least one virtual visit followed within 30 days by an in-person follow-up. This was less common in males (OR 0.69–0.79) and more common for those with a higher frequency of physician visits prior to the pandemic (OR 1.27–1.32). ConclusionImpacts of patterns of care during the pandemic should be further explored for healthcare planning to uphold optimal care access and promote effective use of virtual care.

Clinician Perspectives on Virtual Specialty Palliative Care for Patients With Advanced Illnesses.

Background: Patients with serious illnesses have unmet symptom and psychosocial needs. Specialty palliative care could address many of these needs; however, access varies by geography and health system. Virtual visits and automated referrals could increase access and lead to improved quality of life, health outcomes, and patient-centered care for patients with serious illness. Objectives: We sought to understand referring clinician perspectives on barriers and facilitators to utilizing virtual tools to increase upstream access to palliative care. Design: Participants in this multisite qualitative study included practicing clinicians who commonly place palliative care referrals across multiple specialties, including hematology/oncology, family medicine, cardiology, and geriatrics. All interviews were transcribed and subsequently coded and analyzed by trained research coordinators using Atlas.ti software. Settings/Subjects: This study included 23 clinicians (21 physicians, 2 nonphysicians) across 5 specialties, 4 practice settings, and 7 states in the United States. Results: Respondents felt that community-based specialty palliative services including symptom management, advance care planning, physical therapy, and mental health counseling would benefit their patients. However, they had mixed feelings about automated referrals, with some clinicians feeling hesitant about not being alerted to such referrals. Many respondents were supportive of virtual palliative care, particularly for those who may have difficulty accessing physician offices, but most respondents felt that such care should only be provided after an initial in-person consultation where clinicians can meet face-to-face with patients. Conclusion: Clinicians believe that automated referrals and virtual palliative care could increase access to the benefits of specialty palliative care. However, virtual palliative care models should give attention to iterative communication with primary clinicians and the perceived need for an initial in-person visit.

Exploring critically ill patients' and their relatives' experiences of intensive care unit during COVID-19: A qualitative study.

Admission to an intensive care unit has physiological and psychological consequences for patients and families, including the family's fear that the patient might die. The COVID-19 pandemic underlined this and furthermore involved visiting restrictions separating patients and families. To explore how patients with confirmed COVID-19 and their relatives experienced an intensive care unit stay and its significance for family dynamics. A qualitative study was performed during the spring of 2020. Five dyadic interviews were conducted with COVID-19 patients admitted to an intensive care unit and their relatives. The analysis was inspired by Hochman's dyadic analysis. The analysis revealed three themes: (1) From ill to critically ill: The trauma of separation and fear of losing loved ones; (2) The relatives' significant role in creating a shared coherent understanding of the admission in ICU due to COVID-19; (3) The nurses' roles as a go-between in maintenance of the family dynamic. Separation challenged family function and destabilized family dynamics. Nurses provided emotional support, information about and contact with the patient and relatives. The patients' distorted perception of reality and lack of memory were reconstructed in new family narratives, which offered relief and stabilization of family dynamics. The nurses entered into a triad with the patient and relatives, which also contributed to maintaining a relational dynamic in the family. Maintaining communication between health professionals, relatives and patients, and usage of virtual visits during intensive care unit stay can support the family relationship. Nurse therapeutic conversations might help families' in redefining their family dynamics after ICU admission.

Evaluating the Implementation of a Relationship-Centered Communication Training for Connecting With Patients in Virtual Visits.

The use of telehealth, specifically virtual visits, has increased and adoption continues. Providers need effective training for how to communicate with patients to develop a connection during virtual visits. This article describes the implementation and evaluation of a course called Mastering Presence in Virtual Visits. Results show that although providers perceive lack of time, technology issues, and lacking experiential knowledge as barriers to enacting course behaviors, the course was feasible and acceptable. Following the course, providers rated key course behaviors as helpful for practice, and 80.7% of providers were likely to recommend the course to a colleague. The course shifted provider perceptions of the purpose, patient experience, and procedures in virtual visits. Prior to the course, providers perceived virtual visits as fundamentally different than in-person visits. However, after the course, they recognized the importance of connection in virtual visits and how to foster that connection. Providers continue to require support in conducting high-quality virtual visits. Online, asynchronous courses, developed in partnership with providers, are feasible and effective for encouraging behavior change. Key findings: When asked on a needs assessment in 2020, communication strategies to connect with patients in virtual visits were a top provider need. Partnering with providers to create online, communication training content is effective for increasing the acceptability of courses about virtual visits. Asynchronous, online courses can meet provider needs for communication strategies to connect with patients in virtual visits.

Rural patients' experiences with anesthesia and surgical consultations in British Columbia: A survey-based comparison between virtual and in-person modalities.

Rural patients face barriers to accessing surgical care and often need to travel long distance for pre- or post-surgical consultations. Although adaptation to the COVID-19 pandemic has demonstrated the efficacy of virtual care, there is minimal data available to evaluate patient satisfaction with this modality and consequent health service utilization if virtual services are not available. An online survey was conducted with participants living in rural British Columbia, Canada who had undergone surgery within 12 months of data collection and had either virtual or face-to-face pre- or post-surgical consultations. It was supplemented by an in-person survey administered in two rural sites to all patients who had a virtual visit prior to undergoing procedural care. A ten-point scale was used to assess satisfaction. Quantitative and qualitative data were collected and analyzed. Findings from the province-wide survey (n = 163) revealed no significant differences in average satisfaction ratings between people with in-person and virtual surgical consultations (8.03 versus 8.38, p = 0.26). However, most participants indicated that virtual appointments saved them time traveling, energy, and money and made them less dependent on others, accruing significant social benefit.In the community-focused sample (n = 71), 38% said they would not have had the procedure without a virtual visit option and 21% said that they would have delayed the procedure. Virtual consultations saved patients an average of 9 h (range 1-90). Participants traveled an average of 427 kilometers round trip to have the procedures. Findings reveal costs and time saved in accessing care due to the introduction of pre- and post-operative virtual care visits, and further investments in virtual care are warranted. This will contribute to promoting equitable access to healthcare for rural residents.