JMIR Form Res. 2022 Aug 10. doi: 10.2196/38916. Online ahead of print.
BACKGROUND: The COVID-19 pandemic led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDD) have complex health care needs and little is known about the value and appropriateness of virtual care for this patient population.
OBJECTIVE: The aim of this study was to explore the accessibility of virtual primary care for patients with IDD during the pandemic.
METHODS: We conducted semi-structured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDD, 13 family caregivers, 5 IDD support staff and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher level themes. The analysis was informed by the Levesque Patient-Centred Access to Health Care Framework.
RESULTS: We identified themes related to 4 of 5 access to care dimensions that highlighted both benefits and challenges of virtual care for adults with IDD. Benefits included: saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved one to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. Challenges included: lack of access, comfort or skill using technology, lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that that one size does not fit all and the accessibility of virtual care is dependent on the interaction between five categories of factors including patient characteristics, the patient context, caregiver characteristics, the service context, and the reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases it dramatically improved patients’ abilities to access necessary health care.
CONCLUSIONS: This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models.
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