Patients' and families' virtual care experiences for hypercholesterolemia management during the COVID-19 pandemic.

Background: Virtual care (VC) in an ambulatory pediatric lipid clinic was rapidly implemented in response to the COVID-19 pandemic, prompting health evaluation and to inform future care planning.

Objective: To assess the impact of VC by analyzing longitudinal changes in lipid profiles and exploring patients' and parents' experiences through surveys and interviews.

Methods: A descriptive, mixed-methods approach examined lipid biomarkers from patients who attended both in-person and VC appointments at a pediatric hospital in Toronto, Canada from 2020 to 2024. This included a retrospective chart review, postpandemic parent survey, and semi-structured interviews. Generalized estimating equations (GEE) were used to model repeated non-high-density lipoprotein (non-HDL) cholesterol levels over time, examining associations with the number of VC visits. The Six-Pillar Framework for VC guided the interview development and qualitative content analysis.

Results: Among the 150 patients (mean age 11 years, SD = 3; 49% female), the trajectory of non-HDL cholesterol levels over time did not significantly differ between those with >3 VC visits and those with fewer visits. However, suboptimal lifestyle behavior patterns were associated with higher non-HDL cholesterol levels. Qualitative data (9 patients, 10 parents) revealed 4 themes: (1) convenient but less effective; (2) managing physical and psychosocial health, (3) situational acceptance, and 4) participant recommendations.

Conclusions: While VC visit frequency alone was not associated with significant changes in non-HDL cholesterol over time, lifestyle factors remained important predictors of lipid outcomes. Recommendations suggested the importance of considering factors such as families' knowledge, privacy, availability of technology, and internet accessibility when planning VC.