When the COVID-19 pandemic reached Canada in 2020, the regional health authorities that are part of the BC Renal network had to rapidly change the way they delivered care to thousands of non-dialysis patients across the province, shifting from primarily in-person care to primarily virtual care. Now, surveys of both patients and health-care providers reveal which aspects of virtual care they like – and when an in-person visit is preferred. The results are described in a poster and pending publication.
“One of the key takeaways is that virtual care is not a complete replacement for in-person care – it’s just not,” says Dr. Mike Bevilacqua, a nephrologist with Fraser Health and chair of the BC Renal provincial Kidney Care Committee. Bevilacqua helped lead the assessment, alongside other members of the committee and in partnership with the Provincial Health Service Authority’s Office of Virtual Health.
The team conducted a series of surveys and structured interviews with dozens of patients and their family members, as well as dozens of health-care providers, assessing their perspectives on in-person, phone, or video encounters in the months following the start of the pandemic.
The results show while roughly half of respondents reported feeling comfortable using technology for video visits, nearly 40% felt somewhat or very uncomfortable using it. What’s more, almost half of the patient respondents (45.9%) believed their health concerns were addressed more thoroughly with in-person visits, whereas none felt that their health concerns were addressed more thoroughly with virtual visits. Patients especially expressed a desire for in-person visits when they were faced with more complex issues and big decisions -- for example when transitioning to dialysis.
Another key theme that emerged is the importance of established relationships between patients and their care providers. Those with established patient-provider relationships were more comfortable communicating virtually, whereas patients and providers reported difficulties in forming new relationships with each other virtually.
However, the results do point to scenarios when virtual care may be more appropriate. For instance, some patients said a quick phone call is preferable when nothing major needs to be discussed or changed regarding their care.
Bevilacqua emphasizes it’s important not to make assumptions about peoples’ preferences, noting he has interacted with elderly patients who enjoy video conferencing, but has seen middle aged people struggle to use the technology. As well, sometimes people who live far away still prefer in-person visits, despite the travel.
“You think you are sparing them some burden of coming in, but they want to come in,” says Bevilacqua. “You can’t make assumptions based on patient characteristics and demographics. It’s really an individual decision.”
Using these findings, Bevilacqua says his team is working on putting together a decision aid to help patients and providers select “the right visit, for the right patient, at the right time.”