Bibliographic record
Abstract
The COVID-19 pandemic accelerated the adoption of virtual care in primary care, revealing its potential as a key tool in healthcare delivery. As systems look to sustain and expand virtual care, understanding the factors that support long-term integration is essential. This study addresses that gap by identifying key drivers of sustainability in primary care through the lens of the Dynamic Sustainability Framework (DSF), which views ustainability as the interaction between an innovation and its internal and external contexts over time. Three research questions guide this study: What is known in the literature about the sustainability of virtual care in health service delivery? What are the future implications of continued virtual care use in primary care? What factors should be considered in assessing the sustainment and sustainability of virtual care in primary care? A multi-method qualitative approach was used, including a scoping review, key informant interviews, and a comparative case study. Scoping Review (RQ1): The review developed a conceptual framework and identified factors influencing sustainability. It highlighted the importance of fidelity (maintaining core functions) and adaptability (evolving with context), both essential for long-term success. Key Informant Interviews (RQ2): Interviews with Ontario healthcare providers, administrators, and policymakers explored the perceived impacts and future use of virtual care. Findings emphasized the importance of resource availability, technological alignment with workflows, and the perceived appropriateness of virtual care. Virtual care is seen not just as a pandemic solution but a viable long-term option, especially for addressing access issues. Case Study (RQ3): This examined sustainability factors in three community-based primary care settings. Key themes included the fit between technology and patient-provider goals, and significant variation across use cases (e.g., asynchronous messaging, 1:1 care, group programs). Sustainability was influenced by patient, provider, and organizational factors. This study provides both a theoretical and practical foundation for virtual care sustainability, offering guidance to stakeholders and informing future research and policy.
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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 | 0.028 | 0.054 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.004 | 0.008 |
| Scholarly communication | 0.018 | 0.022 |
| Open science | 0.002 | 0.009 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.005 |
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".