Published on 13.06.22 in Vol 5, No 2 (2022): Apr-Jun
Preprints (earlier versions) of this paper are available at http://preprints.jmir.org/preprint/34115, first published Oct 07, 2021.
Original Paper
Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study
ABSTRACT
Background: Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace.
Objective: This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption.
Methods: This study took place at the Children’s Hospital at London Health Sciences Centre, a children’s hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses.
Results: Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses.
Conclusions: Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care.
JMIR Pediatr Parent 2022;5(2):e34115
doi:10.2196/34115
KEYWORDS
Introduction
Web-based care has been defined as any interaction between patients or members of their circle of care, occurring remotely, using any forms of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care [
]. Though Canadian physicians have been using technologies for delivery of web-based care as early as the 1970’s [ ], prior to the COVID-19 pandemic, there remained significant barriers to widespread delivery of web-based care across the country [ ]. Although web-based care has demonstrated utility in several pediatric subspecialties [ ], before March 2020, the standard of care for pediatricians affiliated with our center was in-clinic visits, with web-based visits limited to the Ontario Telemedicine Network for select patients in remote locations. Additionally, given the sparse uptake of web-based care across pediatric subspecialties at our center, little was known about local web-based care practice patterns before the pandemic.With the onset of the COVID-19 pandemic, web-based care was adopted at an unprecedented scale and pace to mitigate and manage the risk of spread of the disease [
]. Regardless of previous experience with web-based care, physicians of nearly all specialties and disciplines were required to adopt some proportion of digital practice as a means of maintaining a continuum of patient care [ ]. Despite initial positive feedback, the sudden rush to web-based systems carried the risk of diminishing quality of clinical care [ ]. At the time of our study, little was known of the impact of this shift for providers, particularly pediatricians. Therefore, this descriptive study sought to qualify the web-based care experiences of local pediatricians during the early stages of the COVID-19 pandemic (March to September 2020), with the intention of implementing web-based care clinical practice changes at the department level.Methods
Study Design
The Donabedian model for health care quality improvement was used to guide questions within the survey on the Qualtrics platform (
). This survey was then used to evaluate the web-based care experience of staff pediatric physicians and surgeons through their responses. In this survey, web-based care was defined as any interaction between patients or members of their circle of care, occurring remotely, using any forms of communication or information technologies [ ]. Within the Donabedian model, “structure” refers to assessment of health care settings, qualifications of providers, and administrative systems through which care is provided. In our survey, this was assessed with demographic questions, web-based care settings, start-up costs, and platforms used. “Process” refers to the elements of care delivered within clinician-technical and clinician-interpersonal relationships. This was addressed in our survey with questions about percentage of care provided virtually, as well as free text responses related to patient care. Finally, “outcome” refers to achievement of goals of care, with indicators such as satisfaction, safety, and good use of resources. In our survey, our primary outcome was physician experience with web-based care, measured by positive experience with web-based care, negative experience with web-based care, and willingness to continue to provide web-based care in the future. Phrasing of survey questions was balanced to include positive and negative options to avoid leading questions, and the survey was pilot tested by a non-London Health Sciences Centre (LHSC)–affiliated pediatrician for readability and content.Ethics Approval
Research ethics exemption was granted by the Office of Human Research Ethics on behalf of Western University’s Research Ethics Board. As this study is a part of a larger quality improvement initiative, this was granted under the Quality Assurance/Quality Improvement/Program Evaluation classification.
Study Setting
This study took place at LHSC, a children’s hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. This survey was introduced to the Department of Paediatrics in September 2020 to assess web-based practice patterns from March 2020 to September 2020.
Recruitment and Data Collection
Recruitment for the study occurred via email in September 2020 to all LHSC-affiliated pediatric physicians and surgeons within the department’s listserv email database. The Department of Paediatrics email listserv comprises 121 staff physicians, including generalists, subspecialists, pediatric surgeons, as well as academic and community physicians. A follow-up email was sent through the same listserv 2, 4, and 6 weeks after the initial email to prompt further response, with a deadline of 6 weeks total to complete the survey.
Data Analysis
The web-based survey was analyzed through the QualitricsXM platform and Microsoft Excel (version 16.16.5). The results were collated, and descriptive statistics for numerical data were calculated. Partially completed responses to the survey were excluded from analysis, noted as “no response” in
-5. Free text responses were reviewed by the research team to identify themes and provide further support to numerical data ( ).Results
Survey Response
Of the 121 pediatric physicians, 63 (52.1%) responded. Demographic information of the respondents may be viewed in
. The respondents were primarily subspecialists working at an academic institution. This is consistent with the demographics of the total listserv database, which comprises 19 (15.7%) community generalists and 102 (84.3%) academic subspecialists in both pediatric surgery and medicine.