The era of virtual care: Perspectives of youth on virtual appointments in COVID-19 and beyond

Abstract

In response to COVID-19, paediatric providers have shifted to providing outpatient health care appointments through telehealth. Youth perspectives on changes to health care access during the pandemic are important to consider when optimizing care for paediatric patients. Youth who contributed to this commentary reported that major benefits of virtual care included time savings, ease of access, continuity of care, and ability to participate in health appointments from the comfort of one’s own home without a risk of COVID-19 exposure. These youth also recognized limitations to virtual care, including the inability to complete laboratory or imaging tests, and the lack of physical examination capabilities. Additionally, they stressed the importance of visual components of virtual appointments and health care providers needing to consider privacy restrictions youth may have. Overall, our cohort of youth feel positive about virtual care and hope care providers can work with youth individually to determine the best solution for them.

Graphical Abstract

Graphical Abstract.

The COVID-19 pandemic has drastically changed health care systems worldwide, including in Canada. In an attempt to reduce the number of people coming into health care facilities and to facilitate patient and provider safety, many health care providers have rapidly shifted to providing patient appointments virtually, including paediatrics (1,2). To adapt to this rapid shift to virtual care, articles and guidelines have been published providing advice for patients and providers alike on this method of care delivery (3–5). However, when considering the use of virtual care in the paediatric setting, we noticed that at least one important perspective was missing—that of youth partaking in virtual appointments (3).

While research has been published previously on this topic, we felt it important to add current Canadian youth perspectives to the mix, specifically on changes due to COVID-19. KidsCan is a pan-Canadian initiative of youth with various health conditions, aged 13 to 19 years, who advise on paediatric research projects. It operates under the Maternal, Infant, Child and Youth Research Network (MICYRN) (6). Two semi-structured discussions were held on virtual care in June and October 2020 with our youth members, which allowed us to glean their unique opinions regarding virtual care in the midst of a pandemic. The following commentary is a compilation of opinions of 10 youth who participated in those discussions, ranging in age from 13 to 17 years and with a variety of health care experiences, geographic representation, and demographic characteristics. All youth had the opportunity to review and edit this manuscript for accuracy. It should be noted that these youth are already engaged in the health care system, and their perspectives are not meant to be entirely representative of all youth in Canada.

BENEFITS OF VIRTUAL CARE

Our cohort of youth feel that it is beneficial to check in with their doctors and other health care providers during the pandemic. This maintains continuity of care, allows them to ask questions regarding management of their health conditions, and mitigates health-related stress. Youth who have participated in virtual appointments value the opportunity to continue to receive care from their providers during this time and note that many appointments, such as medical follow-ups and therapy sessions, would not have been possible during this time if not for virtual care options.

There are a number of benefits of virtual care when compared with traditional in-person visits for youth. Some such benefits noted by participants include ease of accessibility and time saved. Many youth rely on caregivers to drive them to appointments. Therefore, time saved coordinating school schedules with working parents is appreciated and the elimination of clinic waiting time prior to appointments is appealing (7). In line with ease of accessibility and time saved, youth also appreciate the ability to participate in virtual care appointments from the comfort of their own home. During the time of COVID-19 with social distancing and ‘stay home’ orders and recommendations in place, many youth in our cohort were stressed about leaving their house unnecessarily, especially those with chronic health conditions. Aside from decreasing transmission risks, attending virtual appointments decreases anxiety around health care appointments and can be helpful for youth who have fears of going to clinics or the hospital.

DRAWBACKS OF VIRTUAL CARE

There are, however, some drawbacks with virtual care that require consideration and alternate solutions. Privacy limitations are a major concern for many youth in our group. Most youth do not have a space within their home to participate in a virtual appointment without parents or family members overhearing or interrupting. Concerns about privacy and confidentiality were especially important for mental health services. Some youth in our group report hesitancy in their ability to accurately describe symptoms and signs to the same degree a doctor might be able to observe in person. Youth were also concerned that certain aspects of care, such as laboratory blood work or X-rays, are not possible virtually and may impact the quality of their care.

Youth also mention other concerns about having appointments virtually. Youth report that it would be easier to have a virtual appointment with doctors they already have established relationships with, but it will be challenging to meet and establish trust with a doctor for the first time virtually (8). Additionally, some youth discussed how they would often connect with friends who have the same medical experiences as them in the waiting rooms when attending in person appointments, but this peer support is missing from virtual appointments. Of note, while none of the youth in our group expressed concerns about technological or internet accessibility challenges (likely biased because KidsCan meets virtually on an ongoing basis), this may be a significant drawback for youth without reliable access to the technology and internet necessary to partake in virtual appointments (9).

FIVE TIPS TO KEEP IN MIND!

Youth expressed their thoughts on the most important things they would want health care providers to know. They are summarized into five tips to keep in mind when providing virtual care appointments for paediatrics patients.

Tip 1: Youth are definitely open to trying virtual care – in fact, many would prefer it right now!

Almost all youth who participated in the virtual care discussion said they would prefer a virtual appointment amidst COVID-19 compared to an in-person one, even after in-person school and other activities had resumed. Youth who had experienced virtual appointments reported being slightly apprehensive before their first virtual appointment but felt the virtual appointments went very well (10). When thinking ahead to after the pandemic, our youth expressed ongoing interest in, and possible preference for, virtual care options for appointments. They noted that virtual appointments would be especially useful for those who live long distances away from the appointment location, for follow-up appointments and for those paediatric patients with frequent appointments.

Tip 2: Whenever possible, try to offer video appointments, rather than audio-only or phone appointments.

All of our youth members expressed a preference for video appointments compared to phone or audio-only appointments, stating the visual component was important to adequately communicate with their health care providers. Youth stated that under current circumstances of the COVID-19 pandemic, they would want a virtual visit compared to visiting clinics or hospitals in person. However, if they could only have a phone appointment, they may opt for the in-person appointment.

Tip 3: Keep in mind the limitations to privacy youth may have at home.

Privacy is an essential aspect of safe and effective health care for youth. Thus it is important to consider limitations to a youth’s privacy at home. Youth who normally see their providers alone mention that there are details they wish only for their providers to hear; at home it may be easier for other household members to overhear or interrupt their appointment. The issue of privacy should be addressed before every virtual appointment, to ensure youth feel comfortable conducting the appointment from home; if not, offer in-person appointments if possible. Our youth also mentioned that it is easier for the health care provider to ask a parent to step away from an appointment to allow the youth to talk alone with the provider, rather than relying on the youth to ask.

Tip 4: Ensure that the same amount of time is spent with the patient as you would for an in-person appointment

Some youth are concerned that the quality of care, such as the amount of time a doctor spends getting to know them or reading their file, may be compromised by virtual care (11). While our youth did not report that this changed their preferences on virtual or in-person appointments, they want to highlight that it is important for the same care quality of care and time to be demonstrated, whenever possible, in virtual appointments.

Tip 5: Work with your youth patient to figure out which appointments might be well-suited to virtual appointments and which would be better to do in-person

One key theme is the variability amongst preferences for certain types of appointments to be held in person versus virtually. For example, some youth feel they would be comfortable with mental health appointments being conducted virtually, while other members expressed a desire to have face-to-face appointments for mental health concerns. Youth and their families are likely to all have different preferences and comfort levels with virtual care, and it is important for health care providers to recognize that and tailor their approach to each patient. Our youth would like to continue to have the option for virtual appointments even when the pandemic has resolved.

CONCLUSIONS

In summary, youth are eager and excited to partake in virtual care appointments, especially during a pandemic, for increased safety, ease of access, and care continuity. Youth recognize that not all types of care can be provided virtually, and there are important considerations such as individual preferences and privacy. As the health care system adapts in response to COVID-19, youth are willing and able to adapt to how they receive health care services. Virtual care options post-COVID should be considered as viable supplements to in-person appointments for youth.