Optimizing the use of virtual care in primary care

How the guideline was developed

We conducted a literature search to assess resources available on the use of virtual care in primary care. This information was summarized and presented to a patient working group and a staff working group at the Mount Sinai Academic Family Health Team in Toronto, Ont. A semistructured interview guide was used. Minutes of the meetings were taken and analyzed by a qualitative researcher (L.R.). Working groups were brought together to discuss any disagreements or conflicts until consensus was achieved. The tool was presented to a patient representative and the communications committee in the Department of Family and Community Medicine at the University of Toronto for review and feedback. Edits were made accordingly and reviewed with the working groups.

Results from patient working group

According to patient working group participants, appropriate use of virtual care includes the following:

• diagnosis does not require a physical examination;

• the patient is comfortable with a virtual appointment;

• the patient has the necessary resources and ability to attend a virtual appointment (eg, telephone, computer for video appointments, technologic proficiency in joining a video appointment); and

• a relationship between the provider and patient has been established.

Virtual care should not be used when there may be disability, linguistic, or cultural barriers that make virtual care difficult to provide.

Results from staff working groups

Participants in staff working groups indicated virtual care use is appropriate when following up on established medical issues, reviewing test results, providing prescription refills, providing chronic disease management, addressing dermatologic issues (with photo or video), counselling about contraceptives, and providing some forms of mental health care. Also, administrative colleagues added that virtual care would be beneficial in the event of an office shutdown owing to major weather events or a code orange.

Virtual care was not recommended when patients had new medical issues, chest or abdominal pain, or shortness of breath, or if the patient needed chronic disease management requiring physical assessment. It was also not appropriate for those who are socially isolated and would prefer an in-person visit, those with cognitive impairments, or those who faced language, cultural, or technologic barriers.

Measures for assessing effectiveness of the virtual care tool

The guideline was evaluated based on the following:

• ratio of duplicate visits with those booked with an initial virtual care appointment compared with those with an initial in-person appointment (duplicate visit defined as a follow-up visit for the same issue within a 2-week period);

• patient satisfaction with the type of appointment;

• access to care (third next available appointment for both virtual and in-person appointments); and

• administrative team satisfaction with the tool and qualitative feedback.