Background

There is growing emphasis on the role of digital solutions in supporting chronic disease management. This has the potential to increase the burden patients experience in managing their health by offloading care from the health system to patients. This paper explores the effects of virtual visits on patient burden using an explicit framework measuring both the work patients do to care for their health and the challenges they experience that exacerbate burden.

Methods

This mixed methods study evaluates a large pilot implementation of virtual visits (video, audio, and asynchronous messaging with providers) in primary care in Ontario, Canada. Participants were recruited using convenience sampling from patients using a virtual visit platform to complete a semi-structured interview or a survey including a free-text response. We conducted 17 interviews and reviewed 427 free text responses related to explore patients' perceived value and burden of these visits. We used qualitative analyses to map patients’ feedback on their experience to the framework on patient burden.

Main findings

Virtual visits appear to reduce the work patients must do to manage their care by 1) improving access, convenience, and time needed for medical appointments, and 2) making it easier to access information and support for chronic disease management. Virtual visits also alleviate patients' perceived burden by improving continuity of care, experience of care, and providing some cost savings.

Conclusions

Virtual visits reduced overall patient burden of treatment by decreasing the required patient effort of managing medical appointments and monitoring their health, and by minimizing challenges experienced when accessing care. For regions that want to improve patient experience of care, virtual visits are likely to be of benefit. There is need for further research on the generalizability of the findings herein, particularly for high-needs populations under-represented such as those of low socioeconomic status and those in rural and remote locations.

中文翻译：

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探索虚拟初级保健就诊如何影响患者的治疗负担。

背景

人们越来越重视数字解决方案在支持慢性病管理中的作用。通过将医疗保健系统中的护理工作转移给患者，这有可能增加患者管理健康的负担。本文使用一个明确的框架来探讨虚拟就诊对患者负担的影响，该框架可衡量患者为维护健康所做的工作以及他们所承受的加剧负担的挑战。

方法

这项混合方法研究评估了加拿大安大略省初级保健中虚拟访问（视频，音频和与提供者的异步消息传递）的大规模试点实施。使用方便的样本从患者中招募了参与者，这些患者使用虚拟访问平台来完成半结构化访谈或包括自由文本回复的调查。我们进行了17次访谈，并回顾了427篇自由文本回复，以探讨患者对这些访问的感知价值和负担。我们使用定性分析将患者对他们经验的反馈映射到患者负担框架。

主要发现

虚拟拜访似乎可以减少患者管理护理所需的工作，方法是：1）改善就诊所需的通道，便利性和时间，以及2）使其更易于访问信息和支持慢性病管理。虚拟访问还可以通过改善护理的连续性，护理经验并节省一些成本来减轻患者的负担。

结论

虚拟拜访减少了患者管理医疗约会和监测健康状况所需的工作量，并最大程度地减少了就医时遇到的挑战，从而减轻了患者的总体治疗负担。对于希望改善患者护理体验的地区，虚拟访问可能会有所帮助。需要对本文发现的一般性进行进一步研究，特别是对于代表性不足的高需求人群，例如社会经济地位低下的人群以及农村和偏远地区的人群。