A mixed-methods evaluation of the implementation and use of an asynchronous virtual care delivery platform (Preprint)
Authors: Marshall Emily Gard , Sadler Laura , Buote Richard , Moritz Lauren R. , Zed Joanna , Donahue Michael 
Published: May 2023

BACKGROUND

Prior to the COVID-19 pandemic, primary care in Canada lagged behind other countries in the use of virtual care modalities. The COVID-19 pandemic incited widespread acceptance and uptake of virtual care in Canada. The use of synchronous virtual care (e.g., telephone or video modalities) was widespread and has been a valuable tool in primary care. While patients and providers have shown interest in using asynchronous modalities (e.g., messaging or email), the use of these modalities was limited compared to synchronous modalities.

OBJECTIVE

To evaluate the implementation and use of an asynchronous virtual care platform at two academic family medicine clinics in Nova Scotia, Canada, in 2021.

METHODS

This mixed-methods study utilized qualitative interview data with family physicians, family practice nurses, and administrative staff from two family medicine clinics; and administrative data, including indicators of the platform’s uptake and use. Critical incident narratives were elicited through semi-structured interviews, and these data were thematically analyzed. Descriptive analyses of administrative data from January to September 2021 were conducted to describe asynchronous care platform utilization over time and by patient characteristics.

RESULTS

The results of this evaluation were organized using a logic model. Interviewees identified inputs, such as technical support and training, and the importance of appropriate funding models to support the use of asynchronous care modalities, which was notably absent. Identified outputs included registration and use of the platform. Various invitation modes were used, but the most successful were individual invitations sent following conversations between the patient and provider. Most of the platform users were women and people over the age of 50, aligning with the characteristics of the highest primary care users. Most interactions on the platform were resolved within a day, but almost a quarter were resolved within 15 minutes. Short-term outcomes of using the asynchronous virtual care platform were considered across the Quadruple Aim Framework. The platform has the potential to improve population health outcomes, improve care and patient experience, improve provider satisfaction, and lower costs.

CONCLUSIONS

The use of virtual care has increased during the COVID-19 pandemic, and patients and providers have expressed a desire for virtual care access to remain beyond the pandemic. This evaluation identifies the necessary inputs to support the implementation of an asynchronous virtual care platform and, if well supported, asynchronous virtual care platforms have the potential to address the four quadrants of the Quadruple Aim, thereby improving the delivery of primary healthcare for patients and providers. This evaluation is formative, and the findings may be used to inform the continued uptake of asynchronous virtual care platforms within primary healthcare settings.