Complexity of medical needs and primary care attachment shape patient experiences with episodic virtual primary care: a mixed methods study in two Canadian provinces

Abstract

Abstract Background Episodic virtual care (EVC) offers patients rapid access to virtual primary care services but lacks relational continuity with a primary care clinician or team. We investigated patients’ experiences with EVC and examined differences based on access to a regular primary care clinician and self-reported complexity of medical needs. Methods In this convergent parallel mixed methods study, we conducted a descriptive and exploratory survey of EVC users’ health service access, self-reported medical needs, EVC use, and demographics. Participants included adults (aged ≥ 18) living in Nova Scotia or New Brunswick who self-reported using EVC in the past year. We used descriptive statistics to summarize numeric and ordinal data of patient experience and stratified findings by having a regular primary care clinician and medical complexity. We conducted inductive content analysis of free-text survey responses. We integrated quantitative and qualitative data at the interpretation phase. Results We identified mixed experiences among EVC users, with quantitative data portraying virtual care experiences more favourably than free-text responses. Most users felt EVC met their health needs, although those without a regular primary care clinician and with greater medical complexity tended to rate experiences less favourably. In free-text responses, some participants expressed concerns with the technological aspects of virtual visits and voiced preferences for in-person care. Patients with a regular primary care clinician tended to access EVC for short-term health concerns, whereas those without a regular primary care clinician sought care for ongoing/chronic problems and prescription renewals. Conclusions EVC is helping to address some gaps in access, particularly for patients without a regular primary care clinician, by providing care where there might otherwise be none. However, EVC often falls short of meeting ongoing and more comprehensive care needs, underscoring the importance of improving access to longitudinal primary care.