Associate Director for Value Based Care Boston Children's Hospital Boston Children's Hospital Boston, Massachusetts, United States
Background: Use of telehealth rose steeply during the COVID pandemic, but little is known about parent and provider perceptions of virtual urgent-care visits.
Objective: To describe initial parent and provider experiences with virtual urgent-care visits.
Design/Methods: This mixed-methods study evaluated patient-and-provider virtual urgent-care visits at two academic primary care practices serving 22,000 majority non-white, publicly insured patients, where telehealth was the primary mode for urgent care delivery during the pandemic. Experiences of parents whose children had virtual urgent-care visits were collected through: (1) focus groups, and (2) Press Gainey patient-experience surveys conducted between April-December 2020 following virtual encounters. Provider experiences were examined through focus groups and post-visit surveys regarding appropriateness and efficacy of the virtual visits. We used chi-square testing to compare proportions of parents who gave a top score on Press Gainey surveys regarding virtual (n=230) vs in-person (n=242) urgent-care visits during the same calendar months in the two years prior to this study.
Results: Five parents and six physicians participated in separate focus groups. A shared positive theme was appreciation for the convenience of virtual visits. Both providers and parents were concerned about the safety of virtual urgent-care visits, with parents citing discomfort participating in exam maneuvers (e.g., “I am not a doctor”) and providers expressing concern about distractions and exam limitations that might result in missed diagnoses or overtreatment. Providers also noted limited confidentiality for adolescent patients. Providers felt comfortable with virtual visits as “triage” for almost any case, while some parents preferred that all “sick visits” be done in person (Table 1). Parents rated virtual visits significantly higher than in-person visits with respect to inclusion of parents in decision making, care for parents’ worries or concerns, explanations for treatments and diagnosis, and likelihood to recommend the practice and provider (Figure 1). Providers’ survey response rate was poor (n=49, 20%) but 96% of providers considered virtual visits to be appropriate for the care required, and 78% felt they were able to obtain adequate data to diagnose and treat the presenting condition. Conclusion(s): Providers and parents have been broadly accepting of virtual urgent-care visits, with some aspects of care being rated more highly in virtual format, yet concerns around safety persist.
Table 1: Domains and representative quotes from provider and parent focus groups
Figure 1: Comparison of proportion of parents who gave a top score ("top box") in each category
Authors/Institutions: Eli Sprecher, Boston Children's Hospital, Boston, Massachusetts, United States; Grace W. Chi, Boston Children's Hospital, Boston, Massachusetts, United States; Amy Starmer, Boston Children's Hospital, Boston, Massachusetts, United States; Snehal N. Shah, Boston Children's Hospital, Boston, Massachusetts, United States; Jennifer Krupa, Boston Children's Hospital, Boston, Massachusetts, United States; Kathleen Conroy, Boston Children's Hospital, Boston, Massachusetts, United States
