Partnering on Appropriate Virtual Care

• Health Link – Alberta Health Services (Alberta)

• Indigenous Wellness Core – Alberta Health Services (Alberta)

• Alberta Indigenous Virtual Care Clinic (Edmonton, Alberta)

• Big Country Primary Care Network (Trochu, Alberta)

• East Prairie Metis Settlement (High Prairie, Alberta)

• Horizon Family Medicine (Red Deer, Alberta)

• Digital Emergency Medicine, Department of Emergency Medicine – The University of British Columbia (Vancouver, British Columbia)

• First Nations Health Authority (West Vancouver, British Columbia)

• Fraser Health Authority (Fraser Valley Regional District, British Columbia)

• Island Health (Victoria, British Columbia)

• North Okanagan Hospice Society (Vernon, British Columbia)

• Office of Virtual Health – Provincial Health Services Authority (Vancouver, British Columbia)

• Terra Nova Medical Clinic (Richmond, British Columbia)

• Vancouver Community Palliative Care Program – Vancouver Coastal Health (Vancouver, British Columbia)

• Virtual Health – Vancouver Coastal Health (Vancouver, British Columbia)

• C.W. Wiebe Medical Centre (Winkler, Manitoba)

• Manitoba Inuit Association (Winnipeg, Manitoba)

• Morning Breeze HealthCare Inc. (Winnipeg, Manitoba)

• Remote Patient Monitoring – Virtual Care, Eastern Health (St. John’s, Newfoundland and Labrador)

• Western Health (Norris Point, Newfoundland and Labrador)

• Halifax Pediatric Associates (Halifax, Nova Scotia)

• Baycrest Hospital and VHA Home HealthCare (Toronto, Ontario)

• CarePartners (Kitchener, Ontario)

• Children’s Hospital of Eastern Ontario (Ottawa, Ontario)

• Mount Sinai Academic Family Health Team (Toronto, Ontario)

• North York Family Health Team (North York, Ontario)

• Petawawa Centennial Family Health Centre (Petawawa, Ontario)

• Scarborough Ontario Health Team (Scarborough, Ontario)

• Six Nations Family Health Team (Ohsweken, Ontario)

• VON Canada (Ottawa, Ontario)

• Western University, PIECES Canada and WeRPN – Registered Practical Nurses Association of Ontario (London, Ontario)

• Keep Breathing Respiratory Exercise Program (Belleville, Ontario)

Home Care Program – Health PEI (Charlottetown, Prince Edward Island)

Department of Acute and Long-Term Care – Health PEI (Charlottetown, Prince Edward Island)

• Centre intégré de santé et services sociaux de Chaudière-Appalaches (Sainte-Marie, Quebec)

• Centre intégré de santé et services sociaux des Laurentides (Saint-Jérôme, Quebec)

• Centre intégré de santé et services sociaux de la Montérégie-Ouest - Équipe de suivi-virtuel (Châteauguay, Quebec)

• BridgePoint Center for Eating Disorder Recovery (Milden, Saskatchewan)

• Saskatoon Community Clinic, Saskatoon Sexual Health and Saskatoon Abortion Support Network (Saskatoon, Saskatchewan)

The Alberta Indigenous Virtual Care Clinic provides essential virtual primary care services to individuals and families that self-identify as First Nations, Inuit and Métis. To enhance the patient and provider experience, the team has revamped existing workflows to optimize triaging and support for patients and healthcare professionals, resulting in nearly 9,000 patients receiving virtual care in a year. This initiative has involved all clinical staff, leading to a more consistent patient experience, improved provider satisfaction and standardized processes.

Objective and purpose of the promising practice

The primary goal of this initiative was to address inconsistent communication and triaging between patients and medical office assistants, which led to varied patient experiences and an unstandardized approach to meeting patient and provider needs. The project focused on refining the booking process to ensure patients were matched with the most appropriate physicians within the clinic or directing patients to the most appropriate external service, thereby improving the overall effectiveness of care through revised triaging workflows.

Approach

Engagement

The project team engaged extensively with diverse clinic staff to co-design new workflows. Through meetings, presentations, reports and weekly check-ins, project deliverables were collaboratively developed and piloted. Key partners included medical leads, clinical nurses, the clinic manager, medical office assistants and a patient navigator. Patient feedback was also collected through surveys and interviews to inform workflow design.

Outcomes

Between 1 February 2023 and 31 January 2024, the implementation of revised workflows has directly benefited almost 9,000 patients and involved all 46 clinic staff members. Notably, 73 percent of clinic patients reported not having a family doctor or nurse practitioner, and although the clinic does not provide family medicine, it has provided increased access to care for these patients until they are under the care of a local family doctor. Creation and sharing of the patient handbook allows the patients to have an understanding of services available and clearer expectations of the clinic. The standardized clinician workflow has resulted in improved communication between staff.

Impacts and learnings

Key takeaways

• Assumptions that all clinics followed the same process led to varied patient experiences, underscoring the need for collective efforts with medical office assistants to regularly review and improve processes.

• External support and services should be utilized when necessary.

• Dedicated planning time is critical for successful improvements.

• Open communication and a clear implementation process are essential.

Facilitators

• The success of the project was driven by the evaluation team, the engagement of primary care physicians and medical office assistants and the support of project leads, the clinic manager, clinic coordinator and nurse.

Barriers

• Staff and provider experience varied.

• Availability of the team to meet was limited.

• Levels of change readiness among team members differed.

• Competing demands and priorities required significant time management.

The Alberta Indigenous Virtual Care Clinic’s initiative showcases the power of collaborative workflow redesign in enhancing access to care and standardizing patient experiences, ultimately leading to better outcomes for Indigenous communities.

With a shortage of rehabilitation providers in rural and remote communities across Alberta, Health Link 811 implemented virtual care innovations to triage, assess and treat patients in need of occupational therapy (OT) and physical therapy (PT) support appropriate for virtual care. This promising practice aimed to adapt an existing virtual care framework from other communities to enhance access, ensure equitable care and to deliver safe and effective services through a collaborative partnership between virtual providers and local healthcare teams. By leveraging virtual solutions, the Health Link 811 Rehabilitation Advice Line team was able to serve more patients, alleviate the workload on contracted OT services and local providers, and address urgent referrals efficiently.

Objective and purpose of the promising practice

Rural communities, including High Level, La Crete and Fort Vermillion, face a critical shortage of rehabilitation services due to prolonged vacancies of key positions. Long waitlists for OT (n=30+) and PT (n=500+) services are exacerbated by broader clinician shortages in Alberta. Health Link’s 811 virtual care solutions aimed to support community rehabilitation patients by providing OT and PT services remotely.

This initiative’s goal was to utilize virtual technology to triage, assess and treat eligible patients and leverage therapy assistant in-person support within the patient’s home community, thereby reducing waitlists and improving health outcomes.

Approach

Engagement

Health Link’s 811 Rehabilitation and Advice Line staff engaged with patients early through shared decision-making, providing information about virtual rehabilitation services and offering options for virtual appointments. This early introduction allowed for conversations with patients to determine the feasibility and appropriateness of virtual care for each patient.

Additionally, engaging therapy assistants in pilot cases in rural and remote communities proved essential. These assistants offered critical support services virtually, ensuring safety of the patient, reducing the burden on teams and enhancing patient satisfaction.

Outcomes

At the time of project implementation at the beginning of April 2023, there were over 30 people on the OT waitlist and over 500 people on the PT waitlist. As of January 2024, 308 of these patients were reached. The virtual rehabilitation services led to the elimination of the OT waitlist by October 2023, with all new referrals assessed and managed within the acceptable time frame of 1-2 weeks. The PT waitlist was reduced by over 50 percent, with 227 referrals remaining by January 15, 2024, and a goal to address the remaining waitlist in the coming year.

Patient feedback was gathered through 112 completed Telehealth Usability Questionnaire (TUQ) surveys which indicated the following:

• 84% felt virtual health (e.g. Zoom, telephone care) provided for their healthcare needs (n=94).

• 87% felt virtual health (e.g. Zoom, telephone care) improved access to healthcare services (n=97)

• 86% felt it was simple to use Virtual health (e.g. Zoom, telephone care) (n=96)

• 91% felt they can easily talk to the clinician using virtual health (e.g. Zoom, telephone care) (n=102)

• 92% felt they were satisfied overall with virtual health (e.g. Zoom, telephone care) (n=103)

While not an initial objective, an unexpected outcome was improved workplace culture. Existing relationships and positive outcomes contributed to the project’s success.

Impacts and learnings

Key takeaways

• Initially piloted in 2021, existing relationships facilitated managers’ openness to virtual rehabilitation.

• Patients were generally indifferent between virtual and in-person care, provided their needs were met.

• Insights from patients highlighted that virtual care may not be suitable for everyone, such as those with specific rehabilitation needs.

• Patients adapted quickly to new approaches, making follow-ups simpler.

• Virtual care complements rather than replaces in-person care, serving as a method of delivering care in certain communities.

• Virtual care’s process-heavy nature requires workflow adjustments to improve efficiency.

• Real-time improvements enabled better wait-list management and reduced staff stress levels.

Facilitators

• Access to experienced rehabilitation staff and open communications between in-person teams.

• Willingness and open-mindedness of all teams to support the project.

• Strong administrative support in communities, aiding early workflow development.

Barriers

• Significant orientation was required due to numerous electronic records systems.

• Unexpected staff absences left gaps in managing referrals.

• Administrative burdens included policy reviews, training for new hires and refining the triage process.

The implementation of virtual care innovations by Health Link 811 has reduced waitlists and enhanced access to rehabilitation services in rural and remote communities across Alberta. By addressing clinician shortages and long waitlists, this initiative demonstrated the potential of virtual care to deliver equitable, safe and effective therapy services.

In response to the need for more accessible home care services for Francophone clients, Health PEI launched an initiative to enhance access through virtual visits. By adopting virtual care delivery, for some clients the travel time for in-person visits was eliminated, enabling the bilingual care coordinator to manage an additional caseload and assist with other functions within home-based care. Surveys from patients, caregivers and providers indicated high levels of satisfaction and confidence in the virtual care provided.

Objective and purpose of the promising practice

The promising practice aimed to serve home care clients in Prince County whose preferred language was French. This project aimed to optimize the bilingual care coordinator’s time and to develop resources to promote the appropriate use of virtual care in interactions with linguistically diverse communities.

Approach

Engagement

The project team engaged with the Francophone community through focus groups, workshops, satisfaction surveys and presentations at local French community events. Leadership and front-line staff were also members of the working group, which developed a framework, process and monthly updates for the leadership team.

Outcomes

The project’s target was to increase the bilingual care coordinator’s case load by 25% by January 2024. Prior to the implementation of the project, the care coordinator’s case load was 32 clients. Although the project was only implemented on January 29, 2024, 8 clients were added by the beginning of March, meeting the 25% target. The plan is to spread within more home-based care programs. By optimizing healthcare resources and managing non-urgent cases remotely, the project reduced the burden on in-person facilities and allowed providers to focus on critical cases. Through client surveys, five patients report feeling more connected and valued, with easier access to healthcare teams for timely answers and engagement in managing their health using this approach.

Home care staff also reported increased confidence in using technology, as a result of the training and support provided. Most staff felt the virtual care approach was worthwhile and appropriate. Initial internet connectivity issues impacting the bilingual care coordinator were resolved, ensuring smoother virtual visits.

The project demonstrated increased satisfaction of clients, increased access for patients facing geographical barriers, and more efficient use of time and healthcare services, and the team plans to expand the initiative by sharing their insights through presentations and learning exchanges.

Impacts and learnings

Key takeaways

• Patients and caregivers shared practical challenges such as time constraints, financial barriers and technological issues, highlighting the need for equipment such as electronic devices and SIM cards.

• Feedback on user interface difficulties led to improvements to the usability of the platform.

• Transparency on data privacy and security helped to build trust in the virtual care platform.

• Engaging with clinicians in creating a dedicated workflow and involving legal and compliance teams ensured seamless integration of virtual care into existing processes and regulatory compliance.

Facilitators

• Clear project objectives guided implementation.

• Specific measurement goals were set.

• Active engagement of stakeholders, including clinicians, staff, clients and caregivers was maintained.

• Regular communication ensured all perspectives were considered.

• The virtual care solution was designed for scalability, fostering future growth and improvement.

Barriers

• Inadequate access to high-speed internet, smartphones and computers.

• Unreliable internet access in rural areas.

• Lower digital literacy levels among some seniors.

• Resistance to change among some staff members.

Health PEI's initiative demonstrates a successful model for leveraging virtual care to support Francophone patients and caregivers, enhancing access and optimizing healthcare delivery.

Island Health, responsible for delivering health and care services to a large population across Vancouver Island in British Columbia, has introduced a groundbreaking initiative with its Hospital at Home (H@H) program. This program brings hospital-level care to patients in the comfort of their homes. The average age of H@H patients is 80, with some admitted patients being as old as 110 years. Many of these elderly patients are home alone, without a caregiver.

By leveraging technology, particularly video visits, Island Health aims to enhance the quality of care from admission through discharge. The Zoom for Healthcare (Z4HC) program enables virtual visits, increasing staff efficiency and reducing costs by replacing traditional home visits and telephone check-ins. Continuous care is maintained without adding operational costs or inefficiencies.

Objective and purpose of the promising practice

The primary goal of this initiative is to improve therapeutic connections, visual assessments and discharge planning for patients. Eligible patients admitted to Victoria General and Royal Jubilee Hospital through the H@H program receive a single-use iPad to facilitate daily virtual appointments with physicians and nightly virtual check-ins with the responsible nurse.

Approach

Engagement

Patient partners have tested new equipment and evaluated quick reference guides and resources to ensure a patient-centric approach. Personal feedback opportunities and patient surveys were employed for continuous improvement.

Monthly project progress reports are emailed to staff with printed copies posted in communal workspaces. Weekly virtual care updates and animated videos highlight staff achievements. Success stories are shared during morning team reporting sessions.

Outcomes

The introduction of virtual video check-ins has significantly enhanced patient care by enabling nightly check-ins, ensuring more consistent and personalized attention. A patient who is deemed appropriate for a virtual check-in (no cognitive impairment, sufficient dexterity, and strong enough cellular connection in their home) is added to a roaster for a nightly check-in. Once the nightly check-in is complete, the nurse confirms whether the call was successful.

Eligible patients now receive evening virtual visits, enabling more involvement from allied health team members, including occupational therapists and pharmacists. With virtual check-ins, patients receive evening visits lasting about seven minutes. Increased physician uptake of virtual visits was noted. Occupational therapists and pharmacists are using the iPads for compliance reviews and medication check-ins. The implementation team also found that there was a five percent increase in access to care for H@H patients.

Over a seven-month pilot, an increase in the quality of care provided was noted as a result of the second patient visit being changed from a telephone check-in to a visual virtual check-in.

Visual virtual check-ins provide access to visual cues, environmental context and visual demonstrations to support care providers and patients receiving care in their homes. Care providers can observe patient body language, facial expressions, living conditions and other non-verbal cues. Furthermore, certain assessments may require the individual to demonstrate physical movements or reactions which the care provider can observe and evaluate through video. These visual elements are absent during a telephone check-in.

Impacts and learnings

Key takeaways

• Triaging family and caregivers along with the patient are crucial for navigating new technologies.

• Caregiver burnout is a significant concern that must be addressed.

• Digital literacy varies among staff, requiring additional support.

• Elderly patients can successfully manage technology for virtual visits.

• Engaging staff and supporting new workflows is challenging, but essential.

Facilitators

• A patient advocate helped to improve digital literacy, usability of iPads, and revising the quick reference guide to use language that was more patient friendly.

• Providers and clinicians were provided Zoom for Healthcare accounts to initiate video calls to patients’ iPads using either their desktop workstations or Island Health mobile phones.

• A manager engaged with staff to encourage technology adoption and workflow integration.

• A clinical nurse educator worked with staff to enhance the team’s computer skills for providing patient care.

• The Virtual Care Services team worked to find solutions to uncovered technical issues.

• The Collaborative Lead collected data and operationalized project changes.

Island Health’s H@H program demonstrates a successful integration of technology into patient care, offering enhanced access, efficiency, and continuous support while addressing the challenges of digital literacy and caregiver engagement.

Over the past few years, Newfoundland and Labrador have faced significant challenges with community physician clinic closures, recruitment and retention, and a general shortage of primary care providers. To address these issues, the integration of enhanced virtual care into the existing primary care service delivery model has become essential.

The NLHS Western Zone team designed a new virtual care framework for primary care, incorporating existing frameworks that focus on person and family-centered care, quality improvement and evaluation. This model has successfully increased access to care, expanded service sites and reduced emergency department visits, with 26,000 virtual appointments completed in one year. Enhanced technology and support have been implemented across most sites in the western zone and a hub and spoke model has been established to support more communities.

Objective and purpose of the promising practice

As Newfoundland and Labrador transition to a single provincial health authority, the province is developing a comprehensive virtual care framework for all zones. In the interim, the Western Zone team created guiding principles featuring an integrated virtual primary care model.

This initiative aims to improve access to primary care and patient experience using virtual care in the Western Zone. The focus is on the appropriate use of virtual care in primary care settings, expanding the Integrated Virtual Primary Care Model to all health neighbourhoods for both attached and unattached patients. This is expected to improve patient outcomes, overall health and wellness, care coordination with team-based shared care and reduce emergency department visits for low acuity issues.

Approach

Engagement

The project team engaged extensively with diverse clinic staff to co-design new workflows. Through meetings, presentations, reports and weekly check-ins, project deliverables were collaboratively developed and piloted. Key partners included medical leads, clinical nurses, the clinic manager, medical office assistants and a patient navigator. Patient feedback was also collected through surveys and interviews to inform workflow design.

Outcomes

The virtual care model has achieved a regional reach beyond their initial sites of focus through a hub and spoke model, implementing virtual care in 25 of 28 sites, 89% of all primary care sites in the region, including rural and remote communities. All staff in the established Family Care Teams are using the integrated Virtual Primary Care Framework, and long-term plans will see integration of virtual care into all sites. From 1 February 2023 to 31 January 2024, there were 82,912 appointments completed using this model, consisting of 49,284 virtual appointments and 33,628 in-person appointments. Additionally, 26,138 of the appointments were diversions from the Emergency Department1 through the RVCC and virtual locum services, which provided support to unattached patients and cross-coverage for hub and spoke sites within the Zone.

From patient experience surveys, 95% of respondents report being satisfied with their virtual visit (n=38/40) and 93% indicated that their health care needs were met (n=76/79). This project has improved access to primary care services, particularly in rural and remote communities, improved patient and provider experience and reduced overall costs.

Plans are in place for sustaining the improvement, with working groups, clinical care coordinators and managers collaborating to streamline processes, engage partners and transition relevant initiatives into their workloads. Regular meetings and engagement with organizational leaders, family physician partners, and cross-Zone counterparts across the province support their plans to spread the promising practices both regionally and provincially.

Impacts and learnings

Facilitators

• Involvement of patient and provider champions in all aspects of the project.

• Additional members added to family care teams enabled a team-based shared care model.

• Information-sharing through newsletters, huddles, memos, hands-on training, videos and follow-up improved implementation and provider experience.

Barriers

• Staff turnover and hiring delays slowed uptake by some primary care providers, resulting in inconsistent virtual care offerings.

• Public perception and awareness of available virtual care options, such as the misconception that virtual care is only by telephone.

Newfoundland and Labrador have faced significant challenges with physician shortages and clinic closures, prompting the need for enhanced virtual care integration. The NLHS Western Zone team's new virtual care framework, incorporating person and family-centered care, quality improvement and evaluation, has successfully increased access to care, expanded service sites and avoided over 26,000 emergency department visits in one year.

The North York Family Health Team utilized Ontario Health’s framework for clinically appropriate virtual care to improve patient satisfaction and provider efficacy in delivering safe and effective care for a broad spectrum of stakeholders, including clinicians, non-clinical staff and patients. The framework was adapted for virtual home care visits, focusing on incorporating the patient voice and addressing equity barriers in the community.

Objective and purpose of the promising practice

The primary goal was to better meet patient needs and provide safe and effective care by increasing the percentage of interprofessional healthcare provider (IHP) visits that met patient preferences by 10 percent. Patient satisfaction was measured through ongoing surveys.

The implementation of a virtual care framework dually aimed to improve patient satisfaction and provider efficacy in delivering safe and effective care.

Approach

Engagement

The North York Family Health Team collaborated and consulted with the Patient and Family Advisory Committee (7 members) to design and implement the new virtual care framework. This engagement provided a deeper understanding of patient needs and preferences. For example, they discovered patients were eager to participate in surveys and appreciated the option to select a modality of care. Early and frequent provider engagement facilitated co-design and uptake of the virtual care framework.

Outcomes

Key measures demonstrated significant improvements:

• A reduction of 115 patients seen1 that otherwise would have gone to the emergency department, over the 10-month duration of the project visits.

• 90 percent of patients who responded to a survey following a virtual visit agreed that the care they received was in their preferred format (n=53).

• Although not initially prioritized, the initiative fostered a culture of quality improvement around virtual care within the allied health team.

Impacts and learnings

Key takeaways

• Incremental changes through PDSA (Plan-Do-Study-Act) cycles helped address assumptions and misunderstandings among clinical and non-clinical staff.

• Engagement with patients, clients, families and caregivers revealed preferences, many seniors expressed a preference for in-person or phone visits over video visits; eagerness to provide feedback; and appreciation for flexible care modalities.

• Facilitators

• Guidance from teams with similar experiences was invaluable.'

• Dedicated coaches provided essential support and expertise.

• The most significant contributor was the inclusion of the patient voice in the pathway.

Barriers

• Competing organizational priorities frequently impacted progress.

• Navigating the learning curve around the importance of virtual visits compared to other care modalities.

By leveraging Ontario Health’s framework and prioritizing patient engagement, the North York Family Health Team successfully enhanced virtual home care delivery, improving engagement with patients, staff and patient satisfaction and an emergency department diversions.

The Provincial Health Services Authority (PHSA), in collaboration with Provincial Language Services, has initiated a groundbreaking project to provide safe, high-quality and culturally sensitive virtual care to patients, families and caregivers from linguistically diverse communities. Recognizing the absence of standardized resources to facilitate effective virtual communication between healthcare teams and non-English speaking individuals, the project team engaged diverse stakeholders through working groups, focus groups, interviews and surveys to develop a comprehensive guide for these interactions. This evolving resource aims to empower users in making informed decisions when utilizing virtual care.

Objective and purpose of the promising practice

The primary goal of this promising practice is to create resources that promote the appropriate use of virtual care in healthcare interactions involving linguistically diverse communities. This includes ensuring care that is safe, high-quality, equitable and culturally sensitive.

Approach

Engagement

This project heavily emphasized stakeholder engagement. Patients, families and caregiver partners actively participated in working groups, sharing their needs, preferences, beliefs and suggestions for improvement. This included two Spanish speaking patient partners, a Francophone patient partner, and a patient partner who is Indigenous and Deaf, ensuring a broad representation of linguistically diverse voices.

The virtual health team utilized a patient and community partnership toolkit to guide the co-design and development process. The team adopted a new model of project management, in which a patient partner was empowered to be one of the project co-leads to inform the project approach from inception to sustainment. This set a new standard for inclusive project development.

To engage provider and staff perspectives, the project co-leads also included a PLS staff member, who is Deaf, as well as working group members with expertise in in education, practice, clinical care and project management. Through surveys and focus groups, the project team gathered insight from various internal and external healthcare team members. They held monthly meetings and used Microsoft Teams software for ongoing updates and communication.

Outcomes

The virtual care resource will be launched in November 2024 with planned distribution to patient partners, team members, community partners and providers. Following the launch, a PDSA approach will be used to incorporate feedback from patient partners and clinicians. Intended outcomes include improving the resource prior to launch across the organization, increased use of interpreters during virtual visits with linguistically diverse patients, enhanced translation of documents and improved patient and provider experiences. Evaluation of the resource will follow at various intervals to closely measure the uptake of the resources and opportunities to adjust based on the evaluation objectives.

Collaboration with community members and language interpreters in a unified meeting setting proved transformative, fostering rich discussions and highlighting infrastructure limitations that hinder collaboration. An online translation tool was secured to ensure equitable participation across multiple languages. The translation tool will continue to support future projects.

Impacts and learnings

Key takeaways

• Navigating change management and securing clinical program buy-in posed challenges, necessitating additional support for quality improvement efforts.

• External support and services should be utilized when necessary.

• Early and ongoing engagement was crucial for the project’s success, allowing ample time for meaningful connections with patient partners.

• Tailored communication and management approaches maintained high levels of engagement with patient partners.

• Further engagement with Indigenous communities needed to better understand their experiences with virtual care and language accessibility, which will inform further resource development and evaluation.

Facilitators

• Access to language interpreters through the Provincial Language Services team was essential.

• Executive sponsorship and the participation of individuals with lived experience fostered engagement and dialogue.

• Seed funding for interpretation and translation was critical to the project’s initiation.

Barriers

• Low response rates from healthcare team members.

• Variances in digital literacy affected the use of Zoom’s interpretation functionality.

This initiative by the PHSA represents a significant step forward in ensuring equitable and culturally sensitive virtual care for linguistically diverse communities, setting a precedent for future healthcare projects.

The virtual health team at Vancouver Coastal Health (VCH), in collaboration with the VCH Sea to Sky chronic disease management team and the Lil’wat Health and Healing Centre, adapted an existing framework to support chronic disease management services within the Lil’wat Nation community. This initiative aimed to improve access to culturally safe and uniquely tailored education for Lil’wat Nation community members living with diabetes, addressing a previously unmet need.

Objective and purpose of the promising practice

The primary objective of this promising practice was to improve access to culturally safe chronic disease management and care in communities like Lil’wat Nation. The virtual health team prioritized building strong relationships with Lil’wat Nation community partners by conducting engagement sessions, completing cultural safety training, assessing the appropriateness of transitioning to virtual access and developing a culturally sensitive curriculum.

Approach

Engagement

The project involved the VCH Sea to Sky chronic disease management team, community leaders and the virtual health team collaborating with the Lil’wat Health and Healing Centre leadership and clinician team to provide the resources necessary for delivery of care through virtual means as part of their diabetes education series.

Educational seminars, co-led by a Lil’wat Health and Healing Centre clinician and the VCH Sea to Sky chronic disease management team, were tailored to support community members living with chronic diseases, such as diabetes and pre-diabetes. The Lil’wat Health and Healing team guided the development of the curriculum, ensuring that the community’s (community members and health service providers) needs and perspectives were central to the project. Providers and clinicians committed to identifying champions to collaborate in the design and decision-making process. This approach was in line with Vancouver Coastal Health’s commitment to inclusive and community-driven healthcare.

Outcomes

Prior to the development of the diabetes educational program, Lil’wat Nation community members were primarily accessing diabetes support through the phone or on a 1to1 basis with the VCH team. The launch of the educational program has improved access to a hybrid virtual model in which patients access diabetes support both virtually and in-person. This model incorporates culturally-safe and uniquely tailored diabetes support for the Lil’wat Nation community. In addition, the series provides the opportunity for social connection and support within a group setting.

The current diabetes education program is held annually, with a goal to increase to twice a year. The program aims to engage up to 20 new participants in the diabetes education series. Additionally, after completing the series, the program will continue to offer individualized sessions for participants. This project continues to explore future opportunities to expand as relationship-building efforts are sustained and our understanding of community needs deepens. Through the education series we've identified a need to enhance access to lab services, particularly for HbA1c testing. Lil'wat Health and Healing has since launched their HbA1c testing program with several patients on the first run, testing will serve as a valuable complement to the educational sessions.

Impacts and learnings

Key takeaways

• Stakeholder engagement was crucial in designing a program that meets the needs of the Lil’wat Nation community.

• Continuous collaboration between the virtual health team, the VCH Sea to Sky chronic disease management team, and the Lil’wat Health and Healing team led to the integration of sustainable new technologies, stronger relationships between decision-makers across organizations, and a better understanding of their needs and limitations.

• Prioritizing collaboration and relationship building supported a natural evolution of the project and program delivery rather than focus on a timeline-based management approach.

• Support for digital devices and resolving software and hardware issues were essential, especially given the limited staff in rural areas.

• Pre-existing relationships with key leadership members facilitated engagement.

Facilitators

• Strong partnership between the VCH Sea to Sky chronic disease management team and the Lil’wat Health and Healing Centre.

• Access to Zoom virtual meeting platform and an OWL conferencing device for meetings.

• Collaboration between operational teams, including IT staff and management.

Barriers

• Ongoing IT support was needed to address issues with technology during sessions.

• Limited response and feedback to surveys hindered the understanding of attrition and other issues.

The virtual health team at Vancouver Coastal Health, in partnership with the VCH Sea to Sky chronic disease management team and the Lil’wat Health and Healing Centre, developed a culturally safe and uniquely tailored framework to support delivery of chronic disease management services to Lil’wat Nation community members. This initiative, which includes virtual diabetes education sessions, enhances access to chronic disease care and overall population health.

CISSS des Laurentides has implemented a virtual care initiative to enhance the self-management of chronic obstructive pulmonary disease (COPD) among patients in the Laurentides. Sub-optimal management and unfamiliarity with the signs and symptoms of COPD can cause more frequent episodes of secondary bronchial infections. Repeated secondary infections can seriously harm a patient’s health and increase their number of visits to the emergency department.

This project helps users and caregivers better monitor the illness by providing them with support and education. This helps nurses and doctors provide speedier care when users need it. It has been proven that access to virtual care makes for speedier treatment, increased access to care, reduced isolation and fewer visits to the emergency department. It also improves self-management of COPD and ensures residents of the Laurentides can have high-quality, local care.

Objective and purpose of the promising practice

Access to the virtual care service platform aims to empower COPD patients and caregivers through personalized learning. This makes it possible for the patient or caregiver to detect the signs and symptoms of an exacerbation early on. This allows for a quicker intervention, improving the patient’s quality of life and cutting down on visits to the emergency department.

Nearly 800 patients receive regular treatment at the Saint-Jerome Hospital COPD Clinic and Saint-Eustache Hospital Respiratory Clinic. Many lack the knowledge and resources to manage their illness effectively, resulting in frequent emergency department visits and occasional hospitalizations. Through this project, an additional four patients were introduced to virtual care each week, with the goal of having 40 percent of clinic patients registered and active on the platform.

Approach

Engagement

Resource patient partners also played an important role with platform implementation and ongoing improvement, particularly in designing questionnaires to detect exacerbating signs and symptoms of COPD. Patients and caregivers continue to be engaged for feedback to make the platform easier to use and understand. The project team also collaborated with respiratory therapists, nurses and clinicians at CISSS des Laurentides, collectively developing indicators to monitor project progress after implementation.

Outcomes

Since the project’s implementation, CISSS Laurentides has observed a reduction in emergency department visits and hospitalizations related to COPD exacerbations. The virtual, at-home care platform has enabled quicker personalized interventions and therefore better control over the disease.

Personnel who participate in the project are able to monitor a large number of patients efficiently and intervene when necessary, leading to fewer calls to outpatient respirology clinics and fewer procedures required by pulmonologists. Overall, patients feel like they are better able to manage their illness and have more continual support.

Following the project’s success, Hôpital de Saint-Jérôme’s neurology department took steps to roll out a similar monitoring platform for patients with Parkinson’s disease.

Impacts and learnings

Key takeaways

• Employees who participated in the project discovered that patients using the virtual platform have specific needs that are different than those cared for in outpatient clinics.

• The project team’s professionals collaborated with patients on the design, development and continuous improvement of the platform.

• This same team of professionals had access to IT resources and phone support to help users if needs cropped up later on.

Facilitators

• Creating a step-by-step user guide for the virtual platform.  

• Ensuring the virtual care platform was beneficial for patients was key to successful implementation. 

• Providing accessible IT support for patients and caregivers.

•  Automatically relaunching the platform after periods of inactivity to detect usage problems that the patient might be experiencing. 

• Providing a health library directly in the platform that could be used as a tool for personalized patient learning.

• Leveraging reference resources from other organizations to facilitate rollout of patient support.

Barriers

• Some patients found it challenging to understand and use digital information.

• Issues with internet connectivity.

• Patients uninterested in regular monitoring, despite efforts to engage them.

• Some patients found completing daily questionnaires burdensome.

The virtual care initiative at CISSS Laurentides demonstrates a promising practice in enhancing COPD management. By leveraging technology to improve patient self-management, the project has shown significant benefits:

• Fewer emergency department visits

• Personalized learning tailored to clients

• Improved support and safety for patients and caregivers

• Better disease self-management

• Improved quality of life for patients by reducing isolation, as well as inspiring further innovations in virtual care for chronic conditions