A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada)

Abstract

The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information; (2) professional and organizational issues; (3) quality of services and patient satisfaction; (4) cost, remuneration, and funding; (5) technology and infrastructure; (6) the emergence of private telehealth platforms in a public HSSS; (7) digital divide and equity; and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges.

Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients

“…At the onset of the COVID-19 crisis, virtual care was widely adopted to provide health care services to the population in many health systems [ 10 , 45 , 46 , 47 ]. In some cases, the “digital-first” model was privileged for scheduling appointments or for the first clinical consultation (e.g., total virtual triage) [ 48 , 49 ].…”

“…During the COVID-19 pandemic, access to health care was restricted due to physical distancing requirements, leading to increased use of virtual care [ 10 , 11 , 12 ]. The latter refers to patient–clinician (e.g., physician, nurse, allied care professionals) “interactions related to diagnosis, evaluation, and management conducted remotely using some combination of text, audio, and video either synchronously or asynchronously” [ 13 ].…”

“…The latter refers to patient–clinician (e.g., physician, nurse, allied care professionals) “interactions related to diagnosis, evaluation, and management conducted remotely using some combination of text, audio, and video either synchronously or asynchronously” [ 13 ]. Virtual care has been a key channel for health care services provision in many health systems [ 10 , 11 , 12 , 14 , 15 ] ( Box 1 ). This rapid deployment of virtual care, whether publicly reimbursed or sold by commercial platforms, has raised concerns regarding equity and the exacerbation of systemic and structural inequalities in accessing and using health care services [ 10 , 16 ].…”

“…Virtual care has been a key channel for health care services provision in many health systems [ 10 , 11 , 12 , 14 , 15 ] ( Box 1 ). This rapid deployment of virtual care, whether publicly reimbursed or sold by commercial platforms, has raised concerns regarding equity and the exacerbation of systemic and structural inequalities in accessing and using health care services [ 10 , 16 ]. According to the World Health Organization (WHO), equity is defined as: “the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification” [ 17 ].…”

“…In North America, the political and media space was dominated, at least at the beginning, by an optimistic and enthusiastic discourse on virtual care “that will transform/revolutionize healthcare delivery” [ 10 , 11 , 22 , 23 , 24 , 25 ].…”