Barriers to Virtual Healthcare Access

By: Julia (Jules) Ferguson

What is Virtual Care?

Virtual care is a term used for healthcare services that are not provided in person. They may use conference calls, phone calls, messaging and emailing to connect physicians to patients who are unable to come into the doctor's office.

COVID-19 has made the use of virtual healthcare widespread, as it reduces the spread of the novel coronavirus through direct contact. While telemedicine will not be replacing in-person healthcare, its use is expected to continue after the pandemic. Though digital care has benefits such as increasing access to specialists and shorter wait times, there are significant shortcomings for vulnerable populations. If practitioners and healthcare systems recognize barriers and proactively work towards treating all patients equally, virtual care can be a beneficial staple in the healthcare system after the COVID-19 pandemic.

What are the benefits of virtual care?

• 50% of Canadians have accessed care over the phone, even though in-person care is still the most common. 91% of these patients were satisfied with the care they received.

• 38% of people would prefer to have the first point of contact with a care provider to be virtual after the pandemic.

• Patients may receive routine care, specialized care, and test results sooner.

• Cost, time commitment, and transportation are a few of the barriers faced by patients living in remote regions, and all of these are exacerbated when there are few practitioners or specialists in the area. Virtual care may be more accessible to these communities.

• Many people expect long wait times when they go to a doctor's office, but virtual healthcare may allow a patient to proceed with their daily activities while they wait for a phone call or an asynchronous message. Patients can sign up for virtual time slots, so they can attend a virtual appointment during a break at work, rather than taking time off to get to a clinic. Delays in care can be communicated more easily through virtual care.

• Many people experience anxiety in a doctor's office, and virtual care can decrease the frustration and uncertainty felt while in a waiting room.

• Virtual healthcare can reduce patient's and doctor's exposure to pathogens, as they will not have to be in proximity of other patients. This was one of the most significant motivations for moving healthcare services online during the COVID-19 pandemic. This not only protects healthcare workers but patients as well, as they are less likely to infect each other through close contact. This shift is especially beneficial for people with compromised immune systems, allergies, or privacy concerns.

What are the shortcomings of virtual care?

Access to technology

Most Canadians have access to telephones, making phone visits the most accessible version of digital healthcare. Video conferencing presents its own set of challenges. Video conferencing requires the patient to have access to a device with video, audio and strong internet connections. Access to these devices is limited by cost and availability (especially in remote regions).

6% of Canadian households do not have internet connections mainly because of cost and availability.

29% of seniors with permanent addresses reported not having access to the internet.

These restrictions may leave rural, low-income and senior populations vulnerable to inadequate healthcare.

Digital Literacy

Digital literacy is the ability to use technology to communicate effectively. People accessing this form of care may not have the digital literacy to be able to navigate new technology like zoom calls, which leaves certain populations vulnerable. Seniors, low-income individuals, indigenous people, those who did not complete high school, disabled people, remote communities, immigrants and language minority groups are at the highest risk for having poor digital literacy. Those who struggle to communicate through technology may be left at a significant disadvantage as virtual healthcare becomes more frequent.

Privacy

In order for virtual healthcare to be an effective form of treatment, the patient must feel comfortable discussing personal topics with their provider. If the patient does not have access to a safe and private space for their virtual visit, they may not disclose intimate information that is critical to their health. With virtual care, the patient is responsible for finding a safe space for their visit, rather than their healthcare providers. This presents challenges for those without permanent addresses or stable housing situations, where they may not have access to technology in a private space.

12-26% of Canadians experience housing insecurity, and specific demographics are more vulnerable than others.

People who are indigenous, have low incomes, or live with chronic illness/disabilities are more likely to experience housing insecurity. Additionally, those who suffer from mental health and addiction are at a higher risk of being unhoused.

For those living with others, a lack of privacy may mean that those suffering from domestic violence may not be able to safely discuss concerns with their doctor or receive the treatment they require. Young people living with their guardians may face restrictions when accessing sexual healthcare if they are unable to find a space for a candid conversation with their physician.

Who is most affected?

These inequalities are exacerbated in specific communities such as people with low incomes, seniors, unhoused people, and those living in rural/remote regions. In Canada, remote regions frequently have unusable internet connections, and this is most common in areas with large indigenous populations.

Unhoused people will often not have access to the internet or phone services, and many rely on libraries for internet access, which were closed in most of Canada during the COVID-19 pandemic. Additionally, most libraries do not have private spaces for patrons to use technology, which may compromise their privacy during a visit.

Digital literacy and accessibility barriers affect senior populations, those with low incomes, and those without high school diplomas most frequently.

Through virtual healthcare, patients have now taken on responsibilities that were previously held by healthcare providers. Because there is no universal method to supply virtual healthcare in Canada, each provider is responsible for their implementation method. Not all providers may consider these inequities, and many patients are at risk of being let down by their healthcare system

Call to action: Practical considerations for healthcare providers.

Physical exams are an important piece in diagnosing a patient. Virtual exams may result in greater diagnostic uncertainty, which may slow the patient's ability to receive treatment and increase strain on the healthcare system. Healthcare providers must seriously consider when it is most beneficial to have a patient attend an appointment in person and when a virtual visit will be adequate. When in doubt, ask the patient what works best for them.

Additionally, because most physicians will recommend a platform or method for a virtual visit, they must consider how this can affect the privacy of their patients and the security of their information.

While virtual visits may be more efficient for doctors, they can lead to a decrease in rapport and connection with patients. It is critical for primary care providers to maintain a relationship with their patients in order to assess their health in the context of the patient's lifestyle and social determinants (i.e. Socioeconomic status, living conditions).

Within the national healthcare system, addressing these inequalities through developing a universal guideline for providing virtual care can help lessen these inequalities and ensure that providers are considering barriers their patients may be facing. Implementing programs to promote access to technology, improving cellular service, and improving internet speeds in rural regions could significantly increase the public's ability to access their own healthcare system.

Sources

Title: “Doctor Zoom will see you now”: an equity-focused perspective on virtual care in the era of COVID-19

Authors: Evan Tang (RN, BScN1), Ming K. Li, (BHSc1) Eric R. Mauti, (BHSc1), Ralph Masi, (MD), Robert Goldberg, (MD, MScCH)

Year: 2021

Journal: University of Toronto Medical Journal

Title: “Exploring the adoption of telemedicine and virtual software for care of outpatients during and after COVID-19 pandemic”

Authors: Anthony Jnr. Bokolo (PhD)

Year: 2021

Journal: Irish Journal of Medical Science

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