Patient and caregiver perspectives on virtual care: a patient-oriented qualitative study

CMAJ open Pub Date : 2022-01-01 DOI:10.9778/cmajo.20210065
Sophy Chan-Nguyen, A. O'Riordan, A. Morin, Lisa McAvoy, Eun-Young Lee, Veronica Lloyd, R. Appireddy
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引用次数: 9

Abstract

Background: Since the onset of the COVID-19 pandemic, virtual care solutions have been rapidly adopted across the country to provide safe, quality care to diverse patient populations. The objective of this qualitative case study was to understand patient and caregiver experiences of virtual care to identify barriers and gather suggestions to address them. Methods: In this patient-oriented project, we sought to understand gaps in virtual care experienced by patients and caregivers, using virtual focus groups. With the assistance of a patient research liaison, we engaged 2 patient partners as full partners; they participated in study conception, data collection, data analysis and knowledge translation. Recruitment was done through email by disseminating the study poster to 30 community organizations and health units in Ontario and British Columbia. We conducted a constructivist, qualitative study guided by grounded theory methodology. One researcher employed in-vivo coding, followed by axial coding with focus group participants, followed by selective coding with the study team. The study took place from November to December 2020. Results: We conducted 6 focus groups with 13 patients and 5 caregivers. The analysis resulted in 6 major themes and 17 minor themes. Key findings showed that barriers related to access to technology and Internet, language and cultural differences were challenges to virtual care. Participants identified special considerations surrounding caregiver and family involvement; privacy, consent and confidentiality; and the patient–physician relationship. Participants suggested that technology and the Internet be universally accessible and that virtual care modalities be integrated (e.g., consolidated patient portal) to improve virtual care. Interpretation: There are multiple patient-identified barriers to accessing virtual care in Canada; patients can provide insights into ways to address these barriers. Future research should include robust patient engagement to explore ways to address these challenges and barriers to ensure that virtual care can be equitable, accessible and safe for all users. Plain language summary: Although virtual care has been rapidly adopted and scaled up in health care institutions across the country, few improvements informed by patient and caregiver experiences have been made. Driven by concerns expressed by patient partners, our study team undertook a patient-partnered qualitative study to understand the barriers of virtual care from the perspectives and experiences of patients and caregivers. Our study team created the interview guide drawing from our previous patient-oriented qualitative studies and designed an orientation package to provide resources related to the focus groups and to introduce participants to the study team. Drawing from local health teams, clinics and patient advisory groups, the study team recruited 13 patients and 5 caregivers to participate in 6 focus group interviews. An analysis based on grounded theory was undertaken, with participation from both the study team and participants. Lack of access to technology or Internet and language barriers were determined to be the primary challenges in virtual care. Special considerations to caregiver and family involvement, privacy and confidentiality, as well as the patient–physician relationship were considered priorities to improving access to virtual care. Participants offered recommendations and potential solutions to address barriers and challenges in virtual care, which can serve to encourage large-scale policy and programmatic changes in patient-centred ways.
虚拟护理的患者和护理者视角:一项以患者为导向的定性研究
背景:自2019冠状病毒病大流行爆发以来,全国迅速采用虚拟医疗解决方案,为不同的患者群体提供安全、优质的医疗服务。本定性案例研究的目的是了解患者和护理人员对虚拟护理的体验,以确定障碍并收集解决这些障碍的建议。方法:在这个以患者为导向的项目中,我们试图通过虚拟焦点小组了解患者和护理人员在虚拟护理方面的差距。在患者研究联络员的协助下,我们聘请了2名患者合作伙伴作为全面合作伙伴;他们参与了研究构思、数据收集、数据分析和知识翻译。招募工作通过电子邮件进行,向安大略省和不列颠哥伦比亚省的30个社区组织和保健单位散发研究海报。我们在扎根理论方法论的指导下进行了建构主义的定性研究。一名研究人员采用体内编码,然后对焦点小组参与者进行轴向编码,然后对研究小组进行选择性编码。该研究于2020年11月至12月进行。结果:我们进行了6个焦点小组,13名患者和5名护理人员。分析得出6个主要主题和17个次要主题。主要研究结果表明,与获取技术和互联网、语言和文化差异相关的障碍是虚拟护理面临的挑战。参与者确定了围绕照顾者和家庭参与的特殊考虑;隐私、同意和保密;以及医患关系。与会者建议普及技术和互联网,并整合虚拟护理模式(例如,合并病人门户),以改善虚拟护理。解释:在加拿大,获得虚拟医疗存在多种患者认定的障碍;患者可以提供解决这些障碍的方法。未来的研究应该包括强有力的患者参与,以探索解决这些挑战和障碍的方法,以确保虚拟护理对所有用户来说都是公平、可获取和安全的。简单的语言总结:尽管虚拟护理已在全国各地的卫生保健机构中迅速采用并扩大规模,但根据患者和护理人员的经验,几乎没有取得任何改进。在患者伴侣表达担忧的驱动下,我们的研究团队进行了一项患者伴侣定性研究,从患者和护理人员的角度和经验来了解虚拟护理的障碍。我们的研究团队根据之前的以患者为导向的定性研究,制作了访谈指南,并设计了一套指导方案,以提供与焦点小组相关的资源,并将参与者介绍给研究团队。研究小组从当地卫生团队、诊所和患者咨询小组中招募了13名患者和5名护理人员参加6次焦点小组访谈。在研究小组和参与者的参与下,进行了基于扎根理论的分析。缺乏技术或互联网和语言障碍被确定为虚拟护理的主要挑战。对照顾者和家庭参与、隐私和保密以及医患关系的特别考虑被认为是改善获得虚拟护理的优先事项。与会者提出了解决虚拟医疗中的障碍和挑战的建议和可能的解决办法,这有助于鼓励以患者为中心的方式进行大规模政策和规划变革。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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