Patient experiences of virtual care across specialist neuroscience and psychiatry clinics related to the second wave of the COVID-19 pandemic in Calgary, Alberta.

Purpose: The emergence of the COVID-19 (SARS-CoV-2) pandemic has led to public health restrictions and a shift towards virtual care and telehealth. The aim of this study was to explore barriers and facilitators of virtual care from the perspective of neurological and psychiatric patients. Methods: One-on-one interviews were conducted remotely using telephone and online video teleconferencing. There was a total of 57 participants, and a thematic content analysis was conducted using NVivo software. Results: The two main themes were (1) virtual health service delivery and (2) virtual physician/patient interaction, with subthemes around how virtual care improved accessibility of care for patients and improved patient-centered care; how privacy and technical issues impact patients using virtual care; and the need for relationality and connection between health care providers and patients while using virtual care. Conclusions: This study showed that virtual care can increase accessibility and efficiency for patients and providers, indicating its potential for ongoing use in the delivery of clinical care. Virtual care was found to be an acceptable mode of healthcare delivery from the perspective of patients; however, there is a continued need for relationship-building between care providers and patients.

Understanding virtual primary healthcare with Indigenous populations: a rapid evidence review.

BACKGROUND: Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. METHODS: We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? RESULTS: We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. DISCUSSION: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. CONCLUSION: These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.

The impact of delaying surgery during the COVID-19 pandemic in Alberta: a qualitative study.

BACKGROUND: The COVID-19 pandemic overwhelmed health care systems, leading many jurisdictions to reduce surgeries to create capacity (beds and staff) to care for the surge of patients with COVID-19; little is known about the impact of this on patients whose surgery was delayed. The objective of this study was to understand the patient and family/caregiver perspective of having a surgery delayed during the COVID-19 pandemic. METHODS: Using an interpretative descriptive approach, we conducted interviews between Sept. 20 and Oct. 8, 2021. Adult patients who had their surgery delayed or cancelled during the COVID-19 pandemic in Alberta, Canada, and their family/caregivers were eligible to participate. Trained interviewers conducted semistructured interviews, which were iteratively analyzed by 2 independent reviewers using an inductive approach to thematic content analysis. RESULTS: We conducted 16 interviews with 15 patients and 1 family member/caregiver, ranging from 27 to 75 years of age, with a variety of surgical procedures delayed. We identified 4 interconnected themes: individual-level impacts on physical and mental health, family and friends, work and quality of life; system-level factors related to health care resources, communication and perceived accountability within the system; unique issues related to COVID-19 (maintaining health and isolation); and uncertainty about health and timing of surgery. INTERPRETATION: Although the decision to delay nonurgent surgeries was made to manage the strain on health care systems, our study illustrates the consequences of these decisions, which were diffuse and consequential. The findings of this study highlight the need to develop and adopt strategies to mitigate the burden of waiting for surgery during and after the COVID-19 pandemic.

Access, relationships, quality and safety (ARQS): a qualitative study to develop an Indigenous-centred understanding of virtual care quality.

BACKGROUND: Among Indigenous peoples in Canada, access to high-quality healthcare remains an important determinant of health. The shift to virtual and remote-based approaches, expedited during the COVID-19 pandemic, influenced the ways in which individuals accessed care and the quality of care received. This study sought to determine which elements are required for effective and sustainable virtual care approaches for delivery of primary care to Indigenous patients and develop quality indicators grounded in Indigenous community and experience. We share a conceptual framework to understand how Indigenous patients access and define high-quality virtual care, grounded in Indigenous patient experiences and worldviews. METHODS: Using principles of patient-oriented research, we grounded this work in social justice and participatory action research. We sought to gain an in-depth understanding of the Indigenous experiences of virtual care and specifically of primary care. This was developed through semistructured interviews with Indigenous patients and Indigenous virtual primary care providers. RESULTS: Thirteen participants were interviewed between 5 August 2021 and 25 October 2021. Using Framework Analysis, we constructed four domains including access, relationships, quality and safety as being primary facets of defining high-quality Indigenous virtual primary care. DISCUSSION: The results presented here indicate that the shift to virtual care, largely seen in response to the COVID-19 pandemic, does not compromise quality of care, nor does it lead to negative patient experiences. Optimal care is possible in virtual settings for some care needs and types of appointments and has the potential to decrease barriers to access and improve patient experiences of safety and quality while facilitating patient/provider relationships. CONCLUSION: In summary, high-quality Indigenous virtual care benefits from attention to patients' experiences of access, relationships, safety and quality with their service providers and healthcare teams.

The impact of the COVID-19 pandemic on the well-being of individuals with persistent postconcussive symptoms: A qualitative study.

BACKGROUND: In response to the COVID-19 pandemic, public health measures were implemented that closed essential businesses, mandated social distancing, and imposed substantial changes to the routine care experienced by patients with mild traumatic brain injury (mTBI) and persistent postconcussive symptoms (PPCS). Patients with PPCS often rely on a comprehensive care team, requiring in-person treatments and consistent care. Little information exists regarding how access to these services have been affected by public health measures and what outcome the measures have had on the recovery of patients with PPCS. OBJECTIVE: To explore the impact of the restriction of in-person treatments, shifts to virtual care, and global public health measures on the recovery and psychological well-being of patients with PPCS. DESIGN: Qualitative interviews were recorded, transcribed, and analyzed using a reflexive thematic analysis approach to identify the main impacts of the public health measures on participants with PPCS. SETTING: Participant interviews were completed remotely via telephone or video-calling software during province-wide shutdowns. PARTICIPANTS: 20 individuals with PPCS who attended the institution's Brain Injury Program consented to participate. INTERVENTIONS: Not applicable. RESULTS: The impacts of the public health measures emerged most prominently in three main categories: (1) day-to-day lived experiences, (2) personal health status, and (3) health service experiences and barriers. CONCLUSIONS: This in-depth investigation of the lived experiences of patients with PPCS outlines how the COVID-19 public health measures negatively affected their care and well-being. The analysis identified that through increasing social support systems, providing better access to standard or remote treatment, and developing more effective telehealth strategies, this population could be better supported in the event of future public health measures.

Propelled by the Pandemic: Responses and Shifts in Primary Healthcare Models for Indigenous Peoples.

The COVID-19 pandemic posed a significant risk to the health and well-being of First Nations and Métis communities in Alberta. Communities' self-determined and integrated responses with embedded cultural supports - in collaboration with governments, organizations and providers - were key to minimizing morbidity and mortality. Maintaining and building these relationships in the continued pandemic response, broadening approaches to healthcare delivery and continuing to include culture will support attainment of the Indigenous primary healthcare model while addressing logistical challenges in transforming and sustaining healthcare systems in the background of ongoing inequities in the social determinants of health.

Propelled by the Pandemic: Responses and Shifts in Primary Healthcare Models for Indigenous Peoples Propulsé par la pandémie: réponses et changements dans les modèles de soins de santé primaires pour les peuples autochtones

The COVID-19 pandemic posed a significant risk to the health and well-being of First Nations and Métis communities in Alberta. Communities' self-determined and integrated responses with embedded cultural supports – in collaboration with governments, organizations and providers – were key to minimizing morbidity and mortality. Maintaining and building these relationships in the continued pandemic response, broadening approaches to healthcare delivery and continuing to include culture will support attainment of the Indigenous primary healthcare model while addressing logistical challenges in transforming and sustaining healthcare systems in the background of ongoing inequities in the social determinants of health.

Impacts of the COVID-19 Pandemic on the Healthcare Provision and Lived Experiences of Patients with Hydrocephalus

The emergence of COVID-19 (SARS-CoV-2) led to distancing measures which acutely affected healthcare infrastructure, leading to limited in-person clinical visits and an increased number of virtual appointments. This study aimed to examine the effects this had on adults with hydrocephalus by describing the lived experiences of a cohort of patients at an outpatient hydrocephalus clinic. Between early May and early July of 2020, remote structured interviews were conducted with participants. Interviews were in-depth and open-ended, allowing participants to reflect and expand on the effects of the social distancing mandate on their well-being and quality of care. Three themes emerged: (1) impacts of changes in treatment provision, (2) impacts of changes in mitigating activities, and (3) impacts of changes on personal well-being. The comprehensive understanding of lived experiences may inform the future provision of healthcare services and social policy. Improved approaches to remote care telemedicine have the potential to facilitate high-quality care.

Supporting people living with dementia and care partners throughout the COVID-19 pandemic: Health service directions from the first wave in Calgary, Alberta

Background The emergence of COVID-19 (SARS-CoV-2) as a novel coronavirus in late 2019 necessitated public health measures that have impacted the provision of care for people living with dementia and their families. The rapid shift to virtual care across health and social care sectors meant that providers did not have the opportunity to benefit from an evidence-based understanding about how and which services can safely and effectively be delivered virtually prior to public health measures being implemented. Additionally, isolation resulting from social distancing may be harming well-being for families as formal and informal supports become less accessible. Method To understand lived experiences and necessary changes in models of care delivery for people living with dementia during the COVID-19 pandemic in Canada, we remotely interviewed 20 dyads of people living with dementia and their care partners who normally attend a dementia specialty clinic in Calgary, Alberta, during a period where essential businesses were closed and health care had abruptly transitioned to telemedicine. Participants were 50% female and a majority of clinic patients in the dyad had a diagnosis of Alzheimer?s Disease (75%). A reflexive thematic analysis was used to analyze the interview and field note data. Result Themes regarding virtual service provision emerged through the iterative qualitative data analysis: (1) continuation of community-based services for care partners and families delivered in innovative ways to meet support needs during the pandemic;(2) guidance in adapting to technology to enable accessible and effective treatment in a virtual care environment;(3) adapting the process and structure of virtual appointments to operationalize critical information provision while maintaining dignity for the person living with dementia. Conclusion The rapid move to virtual healthcare has influenced how and when people access health services. Health system innovation in the way we structure service models and care provision can mitigate barriers to maintaining high quality virtual health care for people living with dementia. In-depth understandings of how health systems can provide high-quality care in new virtual settings is key to maintaining quality of life for community-dwelling people living with dementia and care partners in times of public health emergencies.

Effects of the COVID-19 Pandemic on Parkinson's Disease: a Single-Centered Qualitative Study.

BACKGROUND: The public health measure restrictions across the world due to COVID-19 have inadvertently impacted the routines for people with Parkinson's disease (PD) and their care partners not only in terms of compromised neurological clinical care but also drastically changing the way of life to minimize the risk of becoming infected. This study explores initial PD patients' lived experiences to observe how quality of life and health care has been affected at the start of the COVID-19 pandemic and provide insight into the importance of patient engagement and virtual care. METHODS: Twenty-two virtual, in-depth semi-structured interviews with persons diagnosed with PD who usually attend a Movement Disorders specialty clinic in Calgary, Alberta, were completed between April 28 and May 13, 2020, and the care partners that wished to participate. Interviews were recorded and transcribed, after which transcripts were analyzed and coded into relevant themes using NVivo 12. RESULTS: Impacts from the public health measures and COVID-19 results into three main themes: (1) Impacts of COVID-19 on PD Clinical Care; (2) Activities of Daily Living; (3) Attitudes and Perceptions. Participants reported worsening in motor and nonmotor symptoms and had to accommodate to clinical care via virtual means which were associated with limitations and suggestions for improvement of remote care. CONCLUSION: This study provides a unique opportunity for researchers to better understand the lived experiences of PD patients in all aspects of their life suggesting that innovative means are needed for facilitating virtual health care medicine and increased social interaction.

Predictors of attitudes and adherence to COVID-19 public health guidelines in Western countries: a rapid review of the emerging literature.

BACKGROUND: Physical distancing, wearing face masks and hand hygiene are evidence-based methods to protect the public from coronavirus disease 2019 (COVID-19) infection. There has been a proliferation of research examining characteristics that can be targeted by public health interventions. This rapid review sought to identify predictors of attitudes toward and adherence to COVID-19 public health guidelines, and identify interventions aiming to improve adherence. METHODS: Articles were retrieved from multiple databases (e.g. MEDLINE, CINAHL and medRxiv) on 6 August 2020. Studies were limited to samples collected from Western countries. Studies were classified according to the types of factor (s) examined as independent variables. The consistency of evidence for each factor was scored by two reviewers. RESULTS: In total, 1323 unique articles were identified in the initial search, resulting in 29 studies in the final synthesis. The available evidence suggests individuals who are older, identify as women, trust governments, perceive COVID-19 as threatening and access information through traditional news media are more likely to adhere with COVID-19 public health guidelines. Interventions for improving adherence have not yet been investigated thoroughly, and this review identified only three experimental studies. CONCLUSIONS: This review has identified several characteristics that impact attitudes and adherence to COVID-19 public health guidelines.

Understanding the impact of the COVID-19 pandemic on well-being and virtual care for people living with dementia and care partners living in the community.

The COVID-19 pandemic has necessitated public health measures that have impacted the provision of care for people living with dementia and their families. Additionally, the isolation that results from social distancing may be harming well-being for families as formal and informal supports become less accessible. For those living with dementia and experiencing agitation, social distancing may be even harder to maintain, or social distancing could potentially aggravate dementia-related neuropsychiatric symptoms. To understand the lived experience of social and physical distancing during the COVID-19 pandemic in Canada, we remotely interviewed 21 participants who normally attend a dementia specialty clinic in Calgary, Alberta, during a period where essential businesses were closed and health care had abruptly transitioned to telemedicine. A reflexive thematic analysis was used to analyze the interview and field note data. The impacts of the public health measures in response to the pandemic emerged through iterative analysis in three main categories of experience: (1) personal, (2) health services, and (3) health status (of both persons living with dementia and care partner). Isolation and mental health needs emerged as important impacts to family experiences. This in-depth understanding of the needs and experiences of the pandemic for people living with dementia suggests that innovative means are urgently needed to facilitate provision of remote medicine and also social interaction and integration.

Examining the impacts of the COVID-19 pandemic on the well-being and virtual care of patients with epilepsy.

OBJECTIVE: The emergence of SARS-CoV-2 (COVID-19) as a novel coronavirus resulted in a global pandemic that necessitated the implementation of social distancing measures. These public health measures may have affected the provision of care for patients with epilepsy. Social isolation may have also adversely affected well-being and quality of life due to informal and formal support networks becoming less accessible. The purpose of this qualitative study was to examine the lived experiences of patients with epilepsy and to see how their quality of life and healthcare has been affected by the COVID-19 pandemic. METHODS: From April 27 to May 15, 2020 we performed remote interviews with 18 participants who had virtual appointments with their healthcare providers and were enrolled in the Calgary Comprehensive Epilepsy Program registry. Interviews were recorded and transcribed, after which transcripts were analyzed and coded into relevant themes using NVivo 12. RESULTS: Three broad themes emerged throughout the interviews:1) impact of pandemic on informal and formal support systems; 2) impact of pandemic on healthcare provision; and 3) concerns about the impact of the pandemic on personal situations and society in the future. Participants reported anxiety and stress about decreased social engagement and activity cessations. Although face-to-face appointments were preferred, virtual care was well-received. Common concerns about the future included securing employment and burnout from balancing family responsibilities. Some patients also feared they would be stigmatized as society adapted to the situation. SIGNIFICANCE: This study highlights the need for additional research in anticipation of the implementation of remote medicine in the management and treatment of epilepsy. It also highlights the tenacity of those living with epilepsy during difficult periods despite social and familial pressures. Raising awareness during this time about the lives and experiences of epilepsy patients can help challenge misconceptions and stigma in the workplace and wider society.