BACKGROUND Virtual care expanded rapidly during the COVID-19 pandemic, and how this shift affected healthcare disparities among subgroups of patients is of concern. Racial and ethnic minorities, older adults, individuals with less education, and lower-income households have lower rates of home broadband, smartphone ownership, and patient portal adoption, which may directly affect access to virtual care. Because primary care is a major access point to healthcare, perspectives of primary care providers are critical to inform the implementation of equitable virtual care. OBJECTIVE The aim of this mixed methods study was to explore primary care physician experiences and perceptions of barriers and facilitators to equitable virtual care. DESIGN We used an explanatory sequential mixed methods design, which consists of first collecting and analyzing quantitative survey data, then using those results to inform a qualitative follow-up phase to explain and expand on results. PARTICIPANTS Primary care physicians in a family medicine department at an academic medical center responded to surveys (n = 38) and participated in interviews (n = 16). APPROACH Participants completed a survey concerning frequency and preferences about video visits, pros and cons of video visits, communication aspects, and sufficiency of the technology. A purposeful sample of participants completed semi-structured interviews about their virtual care experiences with a focus on equity for subpopulations. KEY RESULTS The results indicated that physicians have observed equity issues for unique patient populations. The results add to the understanding of nuanced ways in which virtual care can increase and decrease healthcare access for unique populations. Patients with limited English proficiency were particularly affected by inequity in virtual care access. CONCLUSION Additional research and interventions are needed to improve portal access for those with limited English proficiency. Improvements should focus on health system interventions that expand access without requiring increased patient burden.

中文翻译：

---

虚拟护理的公平性：医生观点的混合方法研究。

背景虚拟护理在 COVID-19 大流行期间迅速扩张，这种转变如何影响患者亚组之间的医疗保健差异值得关注。少数种族和族裔、老年人、受教育程度较低的个人和低收入家庭的家庭宽带、智能手机拥有率和患者门户采用率较低，这可能会直接影响获得虚拟护理的机会。由于初级保健是获得医疗保健的主要途径，因此初级保健提供者的观点对于公平虚拟护理的实施至关重要。目的 这项混合方法研究的目的是探讨初级保健医生的经验以及对公平虚拟护理的障碍和促进因素的看法。设计我们使用了解释性顺序混合方法设计，其中包括首先收集和分析定量调查数据，然后使用这些结果为定性后续阶段提供信息，以解释和扩展结果。参与者 学术医疗中心家庭医学科的初级保健医生回答了调查（n = 38）并参加了访谈（n = 16）。方法 参与者完成了一项调查，内容涉及视频访问的频率和偏好、视频访问的利弊、沟通方面以及技术的充分性。有目的的参与者样本完成了关于他们的虚拟护理体验的半结构化访谈，重点是亚人群的公平性。主要结果 结果表明，医生观察到了独特患者群体的公平问题。结果加深了人们对虚拟护理可以增加和减少特定人群的医疗保健机会的微妙方式的理解。英语水平有限的患者尤其受到虚拟护理获取不平等的影响。结论 需要进行更多的研究和干预措施来改善英语水平有限的人的门户网站访问。改进的重点应放在卫生系统干预措施上，这些干预措施可以在不增加患者负担的情况下扩大服务范围。