Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study

Simone Shahid; Sophie Hogeveen; Philina Sky; Shivani Chandra; Suman Budhwani; Ryan de Silva; R Sacha Bhatia; Emily Seto; James Shaw

doi:10.1186/s12939-023-01849-y

Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study

Int J Equity Health. 2023 Mar 11;22(1):44. doi: 10.1186/s12939-023-01849-y.

Authors

Simone Shahid¹, Sophie Hogeveen², Philina Sky³, Shivani Chandra⁴, Suman Budhwani⁴, Ryan de Silva⁴, R Sacha Bhatia^{5

6}, Emily Seto^{6

7}, James Shaw^{4

8}

Affiliations

¹ Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada. simone.shahid@wchospital.ca.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
³ Waasegiizhig Nanaandawe'iyewigamig, PO Box 320, Keewatin, ON, P0X 1C0, Canada.
⁴ Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
⁵ Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada.
⁶ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada.
⁷ Centre for Digital Therapeutics, Techna Institute, University Health Network, 90 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
⁸ Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada.

Abstract

Background: Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered.

Methods: We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques.

Results: Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities.

Conclusion: This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system.

Keywords: Access to care; Digital health; Health disparities; Health equity; Structurally marginalized communities; Telemedicine; Virtual care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Delivery of Health Care
Health Equity*
Humans
Ontario
Pandemics