Table 3.
Impact of Virtual Care Integration on Patient and Care Provider Kidney Care Experiences.
| Themes | Selected patient/caregiver comments | Selected health care provider comments |
|---|---|---|
| User experience with virtual tools | “<For in-person visit> you do a lot of sitting and waiting to see each person. You talk to one, and then you go back and sit in the waiting room and wait for the next one. And there’s always quite a few people at clinic. So usually takes a couple of hours that you’re there just to see all the different people, whereas it takes much less time on the phone.”—patient (PP3) “They’ve also changed in the way that you would go in for your care clinic in person prior to pandemic, and you would see all four people bang, bang, bang, bang. With this, it’s a little bit more broken up depending on people’s availability on the phone. So you would maybe talk to one or two people, and then someone else would call you back. Then the nephrologist would usually call several hours after that . . .”—patient (PP5) |
“I’m starting to enjoy my practice again. It’s taken a long time. It’s working in a variety of cases of just staying connected to people. I think there’s going to be some changes in the relationship and potentially some changes in our ability to educate people well.”—nephrologist (HCP10) “How has it affected me as a clinician, I think it’s been difficult, to be honest. I think it’s not so much that any one way of seeing patients is particularly difficult, but I think the fact of doing the visits in so many different modalities, switching between them—often even within one clinic—it is taxing that there’s a certain amount of added—let’s call it—emotional load from just switching and that aspect of it.”—social worker (HCP8) |
| Clinical relationships between patients and care team members | “It’s sometimes hard to understand emotions over the Zoom or the phone.”—patient (PP2) “How do we keep consistent with the same people getting the same information would be really helpful. Like when assigning a patient to a doctor in that clinic, you will always attend that clinic. Because we’ve seen all three [KCC team members], and we’ve got three different sets of answers and three different assessments.”—family caregiver (FP1) |
“Because our relationships are long-term . . . it’s important to be able to build rapport and establish that trusting relationship and [it’s] very, very difficult to do over the phone. First of all, you have no sense of who a person is. What they look like is a big part of building a relationship. So, you’re not able to build that trust.—pharmacist (HCP7) “If we already have a relationship established, then it seems to work okay with these virtual formats. I find that I can still get reasonable information if I’m asking questions in a different way and asking more questions.”—nephrologist (HCP4) |
| Patient access to KCC team members and team member ability to interact with patients | “I’ve only seen a social worker once, and that was the first visit I ever had at the kidney clinic, which is probably six years ago. It wasn’t offered at all, and it’s sort of never been offered since. From time to time I’ve thought . . . especially during the pandemic, everyone’s feeling a little down and a little bewildered by life. It might have been a good idea to talk to a social worker at least once during that period. But it never came up. Once again, in a personal visit I could just say, can I see the social worker? And the person’s right there.”—patient (PP1) | I think what I get worried about is when you do your conversations, especially with patients who either lack the health literacy, or maybe the fact that English is not their first language . . . I think that’s where you kind of get worry of, “Are they providing me the right information?” . . . [When] you’re worried that they have such symptoms, and you ask them, “How is your blood pressure,” and they don’t check it . . . You’re kind of worried, “If this person were to come in, I could’ve checked it . . . Same thing with patients, for example, who, when you ask them if they have edema . . . you can’t assess edema over a telephone . . . So, I think it’s also not knowing what the patient has at home to provide the accurate information that we would’ve received or we would’ve obtained in the in-person appointments.—nurse (HCP1) |
| Other key priorities identified | “I don’t live far from the hospital but to get up, go there, find parking, go in, sit and wait . . . it’s definitely a lot handier just to fire up my computer and get it over and done with.”—patient (PP2) | “I like the flexibility (of being) able to work from home a few days a week, (and) save the transportation times. Also, some patients, they don’t answer calls unless we call them in the evening time—like, 7:00—and then I think working from home, I do have a flexibility for patients.”—nurse (HCP2) |
Note. Numbers in parentheses indicate participants. PP = patient participant; HCP = health care provider; KCC = kidney care clinic; FP = family participant.