A mixed-methods evaluation of the implementation and use of an asynchronous virtual care delivery platform (Preprint)
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.075 | 0.049 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".