Implementation of Video Visits During COVID-19: Lessons Learned From a Primary Care Practice in New York City

Abstract

Background: During the height of the coronavirus (COVID-19) pandemic, there was an unprecedented demand for "virtual visits," or ambulatory visits conducted via video interface, in order to decrease the risk of transmission. Objective: To describe the implementation and evaluation of a video visit program at a large, academic primary care practice in New York, NY, the epicenter of the COVID-19 pandemic. Design and participants: We included consecutive adults (age > 18) scheduled for video visits from March 16, 2020 to April 17, 2020 for COVID-19 and non-COVID-19 related complaints. Intervention: New processes were established to prepare the practice and patients for video visits. Video visits were conducted by attendings, residents, and nurse practitioners. Main measures: Guided by the RE-AIM Framework, we evaluated the Reach, Effectiveness, Adoption, and Implementation of video visits. Key results: In the 4 weeks prior to the study period, 12 video visits were completed. During the 5-weeks study period, we completed a total of 1,030 video visits for 817 unique patients. Of the video visits completed, 42% were for COVID-19 related symptoms, and the remainder were for other acute or chronic conditions. Video visits were completed more often among younger adults, women, and those with commercial insurance, compared to those who completed in-person visits pre-COVID (all p < 0.0001). Patients who completed video visits reported high satisfaction (mean 4.6 on a 5-point scale [SD: 0.97]); 13.3% reported technical challenges during video visits. Conclusions: Video visits are feasible for the delivery of primary care for patients during the COVID-19 pandemic.

Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners

“…This indicates that more seamless integration of VCs with GPs’ electronic record systems still remains a priority. Despite some technical challenges, the GPs reported that 85% of the patients seemed satisfied with the VCs, in accordance with existing knowledge on patient experience with VCs [ 9 , 37 , 38 ]. In about half the consultations, the GPs in our survey also deemed it realistic to handle a similar issue by VC in a future, normalized situation.…”

“…In our study, GPs experienced technical difficulties in 10% of the consultations, somewhat less than a comparable study performed in New York City in March 2020, where technical problems were reported in 13% of consultations [ 37 ]. This indicates that more seamless integration of VCs with GPs’ electronic record systems still remains a priority.…”

Designing Futuristic Telemedicine Using Artificial Intelligence and Robotics in the COVID-19 Era

“…Such a framework would imbibe resilience, innovationdriven technology, and scaled intelligence to enable systems to evolve and be responsive to local and emergent needs such as during an outbreak. COVID-19 has led to a sharp increase in the demand for telemedicine services (5,34). It also has an impact on telemedicine providers, a sector that is facing unprecedented demand, which by some estimates has grown by 150% or more (66).…”

“…Quarantined doctors can provide these services in medical institutions with remote access or care via telecommunications directly to the consumer, freeing other doctors to provide immediate assistance to more needy patients. Teleconsultations allow doctors to evaluate patients, detect signs of infection, and quickly and easily document patients who might be at higher risk of illness (34). Telemedicine solutions work promptly, filling out insurance documents, which allows doctors to devote more time to treating patients.…”

Full Comprehension of Theories, Models, and Frameworks Improves Application: A Focus on RE-AIM

“…Using program data, surveys, and informal interviews, this model was found to be feasible and acceptable for supporting patients from socioeconomically vulnerable populations during self-isolation and quarantine. In another example, New York City primary care facilities developed processes to guide patients through a video-delivered primary care practice appointment ( 20 ). The team applied RE-AIM and found significant differences in terms of reach and representativeness (i.e., patients were more likely to be younger adults, women, and have commercial insurance).…”