Can Virtual Care Support the Outpatient Management of Patients Treated with Chronic Hemodialysis? Lessons from Designing and Testing a Virtual Visit Program in Alberta
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2020-05-25
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Abstract
Many people have difficulty accessing healthcare. Virtual care allows patients and providers to interact using information and communication technologies, which may mitigate inconvenience associated with in-person appointments and potentially barriers to accessing care. Virtual appointments using videoconferencing technology (herein named virtual visits) have become a widely used form of virtual care due to its convenience and accessibility for patients. People with kidney failure receiving dialysis require frequent and ongoing care from multiple healthcare providers and there is a significant potential for virtual visits in this setting. However, the current interest among relevant stakeholders and the optimal delivery processes for outpatient virtual kidney failure management, to our knowledge, are unknown. Our program of study involved: a systematic review of studies exploring the use of virtual care in kidney failure management; interviews with patients and healthcare providers about virtual visit design; and a pilot test of the virtual visit intervention at a kidney clinic to learn about the user experience and identify workflow and resource requirements needed for delivering virtual visits. We hope this research will help inform future decision-making around virtual visit services in our kidney program. Our review found a gap in evidence related to virtual visits for outpatient kidney failure management. Interviews with patients, nurses, and nephrologists confirmed an interest in virtual visits, mainly as they are more convenient for patients and may increase access to care. Further, these stakeholders provided virtual visit recommendations that helped inform the intervention design. Our pilot study found that patients and nephrologists were highly satisfied with the virtual visit intervention. Both groups stated they would use virtual visits again and recommend them to their peers. Most patients used their own devices (computers, tablets, smartphones), but the clinic did not have sufficient hardware for virtual visits. Workflow considerations identified through our study included: using electronic medical records and coordinating with dialysis nurses to collect health information needed for the virtual visit; providing training and technical support to patients; and using a combination of in-person visits and virtual visits as appropriate. Further, clarity around medical-legal matters, platform governance, and future remuneration policies is needed. Overall, our research suggests virtual visits are appropriate for outpatient kidney failure care and warranted by patients, nurses, and nephrologists, given the right circumstances. We identified process and workflow considerations for facilitating virtual visit in outpatient kidney clinics. Lastly, we identified barriers, mainly related to information technology infrastructure and governance, that will need to be addressed to fully capitalize on the benefits of virtual care.
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Lunney, M. (2020). Can Virtual Care Support the Outpatient Management of Patients Treated with Chronic Hemodialysis? Lessons from Designing and Testing a Virtual Visit Program in Alberta (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.