Virtual Care: A Look Through the Multi Layered Socioecological Model

Looking at it from an individual perspective, the success of virtual care hinges on the patient's willingness to engage, their ability to understand health information, and their level of "Digital Literacy." This level is the most significant when contemplating virtual care, as it places a strong emphasis on patient-centeredness, active patient involvement, and education. It's essential to recognize that digital literacy poses a significant challenge, particularly for the elder population (Jorgensen et al, 2023). Increased literacy is often linked to frequent internet usage.

The geriatric population has a significantly low usage of internet. Mainly used for banking and email. Furthermore, there's an element of "buy-in" involved, where patients need to believe that virtual care can genuinely enhance their health compared to the conventional in-patient approach. A study of 124 geriatric computer users concluded that only one-third of the study was open to new ways of navigating a computer (Jorgensen et al, 2023).

At the interpersonal level, we examine the patient's connections with their family, friends, and healthcare providers. To kickstart virtual care or telemedicine, physicians must be well-versed in various platforms. Within Kingston Health Sciences Center, three orthopedic surgeons are highly virtual care for their hip and knee patients. These patients can engage with a digital care plan application and receive assistance from a remote monitoring team of nurses. When patients encounter challenges while navigating digital platforms, their family and friends can provide significant support (Jorgensen, 2023). The patient's support network will play a crucial role in supporting the patient when necessary.

Most urban communities have full access to cellular and internet services. However, some rural areas are unable to compensate due to low internet speeds, phone reception and other technology. Alternatively, rural areas have also been shown to have less access to in person specialists, potentially creating the virtual platform as a solution (Buyting et al, 2022). A newly launched remote care program at Toronto Grace Hospital (2023) uses a pendant, similar to a life alert, that a patient wears either as a lanyard or as a wrist strap. The purpose of this pendant is that it can sense falls, speed changes and when patients leave the vicinity. This is a great tool for semi confused patients who live alone. However, this device only works in areas with cellular reception.

Hospitals other health care organizations are essential in providing these virtual platforms. At Kingston Health Sciences Center, there are several different programs used for virtual care. Including telemedicine and multiple digital applications. With the discharge call team at KHSC, we work alongside the privacy team to ensure we are following protocol. This would include protocols on leaving voicemails for patients. For smaller hospitals, they may have to partner with other organizations to license these programs. See video below on Cloud Dx, a vendor commonly used in Ontario Hospitals.

To fund healthcare institutions, agencies responsible for healthcare funding rely on data demonstrating virtual programs' positive impact on patient outcomes. This data is vital for continuous funding, potential expansion, and reimbursements. For instance, a hip and knee virtual program may monitor postoperative ER visits and surgical clinic visits.

To ensure the further success in virtual care, patients will need access to digital literacy training and effective onboarding for personalized digital programs. A registered nurse, who is the active recruiter for the orthopedic programs at KHSC, provides the necessary education to navigate the platform. Patient engagement and advocacy for support are essential. Addressing misconceptions among patients who prefer traditional care is crucial for buy-in.

Collaborative partnerships between healthcare institutions and public agencies are necessary for growth. Supplying these agencies with accurate and relevant data will expand healthcare services to a wider patient base.

Business Television. (2021). Cloud DX (TSX.V: CDX): Pushing the Boundaries of Medical Device Technology. Www.youtube.com. https://www.youtube.com/watch?v=UnJtrqwzVhI

Buyting, R., Melville, S., Chatur, H., White, C. W., Légaré, J.-F., Lutchmedial, S., & Brunt, K. R. (2022). Virtual Care With Digital Technologies for Rural Canadians Living With Cardiovascular Disease. CJC Open, 4(2), 133–147. https://doi.org/10.1016/j.cjco.2021.09.027

Jørgensen, B. B., Gregersen, M., Pallesen, S., & Damsgaard, E. (2023). Computer habits and Digital Literacy in Geriatric Patients: A Survey. Digital Health, 9. https://doi.org/10.1177/20552076231191004

Remote Care Monitoring. (n.d.). Toronto Grace Health Centre. https://www.torontograce.org/programs-services/remote-care-monitoring/