Why appropriateness matters in virtual care

November 14, 2022

Why appropriateness matters in virtual care

Virtual care is on the rise as a growing number of providers use technology to deliver healthcare. The pandemic highlighted many benefits of offering patients care in their home or community, from increased efficiency to improved access.

But as more care is delivered via video, telephone, email and secure messaging, there’s an increasing need to ensure it’s done appropriately and safely. Primary care providers require tools and competencies to evaluate when and how virtual care should be used in their unique healthcare settings - and to make these decisions in partnership with the patients they support.

HEC invited care providers working in two different contexts to share their insights on using virtual care, why “appropriateness” matters and ways to address it.

Using virtual care in group rehabilitation programs

Lindsay Hansen and Carolyn MacPhail
Provincial Cardiac and Pulmonary Rehabilitation Programs, Health PEI

On Prince Edward Island, 12-week cardiac and pulmonary rehabilitation group programs are available as a complement to medical therapy, focused on patient education and exercise. During the pandemic, these programs were redesigned to be delivered online, and the clinic now runs them in-person and virtually.

For these programs, one of the biggest benefits of virtual care is improving access. The online option accommodates more participants across a bigger geographical area. It also reduces the time and cost burden to patients, who don’t have to miss as much work or pay for the gas to travel.

“It definitely serves a big purpose for us, as we run a provincial program. We’ve been able to increase reach significantly to our patient population across the island by engaging in this virtual program," said Lindsay Hansen, program lead.

There are barriers to using virtual care too. Some patients aren’t familiar or comfortable with connecting online or lack access to the right technology. The clinic has to invest resources into equipping patients to use virtual care, from offering education to providing cellular-enabled tablets. Some tests such as spirometry can’t be conducted online and it can be difficult for clinicians to offer hands-on guidance like corrections to inhaler techniques over a screen.

That’s why appropriateness is about striking a balance. “It’s all very individual as to who is appropriate for virtual care versus who is appropriate for in-person. It’s difficult for us to come up with an exact algorithm,” Hansen said.

This means providers need to be prepared to evaluate and support the use of virtual care with each individual patient – at the beginning of the care process and often throughout it.

Clinicians need to know how to determine each patient’s comfort and capability and how to have conversations with patients that build their confidence with virtual care over time. While there is no one-size-fits-all approach, having a checklist of the characteristics of patients who typically benefit from virtual care can help prepare clinicians to evaluate appropriateness, according to Carolyn MacPhail, a manager at Health PEI who oversees the program.

Clinicians also need to be able to accurately assess what capacity and resources their clinic or practice has in place to help patients connect remotely in a safe and positive way – and what capacity and resources still need to be developed, given how new virtual care is for providers and patients alike.

Virtual care considerations from a physician

Alex Singer, MB BCh BAO, CCFP
Director, Research and Quality Improvement, Department of Family Medicine at the University of Manitoba
Director, Manitoba Primary Care Research Network (MaPCReN)

Singer is a self-professed “early adopter” who has pioneered and studied the use of technology in primary care delivery for several years. In his view, the pandemic shifted virtual care from being fairly niche to almost routine for many practices within a very short timeframe.

Given where we are today, he points to the need for primary care providers, governments and regulatory bodies to take stock of what’s been learned and embed emerging evidence and best practices into how virtual care is delivered going forward. This is to avoid it being offered reflexively or without systematically evaluating when it is appropriate.

“We have to be able to get our heads around doing something that is new and contextual,” Singer said. “I do not think you can codify appropriateness in a list. It has to be a set of principles that are steeped in evidence-based medicine and acknowledge the many gaps we currently have.”

Evaluating appropriateness is consistent with other overarching principles and competencies related to providing healthcare, such as being able to listen, take an adequate history, and acknowledge patient values and limitations in the available evidence, according to Singer.

That said, determining appropriateness is also complicated because of the many factors that need to be considered. It can also be resource intensive to deliver well and in partnership with patients, which requires dialogue and engagement.

Singer says that’s why primary care providers need better frameworks and guidelines that outline what factors should be considered to determine if virtual care is appropriate. These are more useful than prescriptive rules around when to use technology.

Developing these frameworks is essential for good, shared decision-making among individual clinicians, their teams and their patients, and to help inform policy and regulatory progress.

Make appropriate virtual care choices in your practice

Healthcare Excellence Canada just launched a new initiative that helps primary care providers and patients determine when and how to use virtual care – together.

Participants in the Partnering on Appropriate Virtual Care collaborative will have access to current evidence, a network of coaches and peers, and up to $20,000 in seed funding to create a framework for making virtual care decisions that are appropriate and safe.

Apply before January 15, 2023 to be part of the next cohort!