Primary Care Evolution: Clinic Staff and Patient Perspectives of the Rapid Upscale of Virtual Primary Care during the COVID‐19 Pandemic
Authors: Kelley Lynette , Ho Michael , Zanetti Cole , McKeever Madeline , Na Sopheap , Showell Shabnam , Fehling Kelty , Kenney Rachael 
Published: September 2021

Research Objective

The Veterans Health Administration (VA) offers virtual care options including telephone and video‐based care to supplement face‐to‐face visits, with the goal of expanding access to care for Veterans. Across the Rocky Mountain Regional (RMR) VA Health Care System, virtual care had been used selectively prior to the COVID‐19 pandemic, but since March 2020, it has been systematically expanded. Perceptions of this rapid implementation from patients, providers and primary care clinic staff, are largely unknown. The objective of this evaluation is to better understand these perspectives.

Study Design

We conducted a rapid exploratory qualitative evaluation to understand perceptions and impact of the swift upscale of virtual care on local primary care clinic staff and patients who received virtual care. Five‐question structured surveys were distributed to clinic staff electronically prior to participation in a semi‐structured focus group. Focus groups were scheduled, facilitated, recorded, transcribed, and analyzed by the research team, utilizing rapid analysis process with modified consensus review. Ten‐question semi‐structured patient interviews were conducted among a cohort of patients who received virtual primary care from four identified clinics. Guides were created by the research team and informed by Practical Robust Implementation and Sustainability Model (PRISM) to focus on clinic staff and patient perspectives of virtual care and the rapid upscale and on contextual factors. Data were analyzed descriptively and thematically.

Population Studied

We studied four primary care clinics delivering virtual care within RMR. Clinical staff included providers, nurse care managers, licensed practical nurses, and medical support assistants. Out of the 47 focus group participants, 45% also participated in electronic surveys. All patients were men aged 33 to 76. 40% self‐identified as “White, not Hispanic or Latino”, 40% declined to identify, and 20% identified as “Black or African American, not Hispanic or Latino”.

Principal Findings

Preliminary survey data from clinic staff suggest expanded virtual care options provide the same or slightly higher quality of care, efficiency and patient‐centeredness when compared to face‐to‐face care (3.1, 3.4, and 3.1 respectively on 1–5 Likert scale). Themes from clinic staff focus groups included (not limited to): unintended consequences of rapid upscale, concerns with workload increase, and uncertainty with patient suitability for virtual care. Data from patient interviews suggest satisfaction with both virtual and face‐to‐face care, with concerns regarding uncertainty of network privacy with virtual care usage and interest in self‐scheduling to improve patient satisfaction.

Conclusions

Primary care clinic staff perceive virtual care as providing the same or higher quality of care, efficiency and patient‐centeredness when compared to face‐to face but remain concerned about potential unintended consequences of the rapid scale up of virtual care implementation. Patients report satisfaction with both virtual and face‐to‐face primary care, with questions regarding network safety and self‐scheduling to improve experience.

Implications for Policy or Practice

Virtual Care is an important option for primary care, however perceptions of utilization during a rapid scale up from patients and clinic staff should be considered in future planning. This study provides insight into the impact of the rapid upscale of virtual care and adds perspectives on usage to further inform future program development with appropriate contextual factor consideration.