The CC@H program was reported by study participants to have several positive benefits. Percentages include the sum of those participants who reported they agree or strongly agree with the statements. Overall, 94% of respondents reported they would recommend the program to both patients with COVID-19 and other patient populations with a lot of health issues. The majority of respondents reported that the program eased their anxiety (87%); that their needs were being met (81%), the care provided was aligned with their goals and preferences (81%), and their condition was being appropriately treated (81%). Study participants also reported that seeing a healthcare provider was easier following their COVID-19 diagnosis (81%); information provided was useful in managing care and treatment (81%); and they were better able to manage their health and medical needs (81%). The level of care received through the program was reported to be at least equivalent to the care prior for 75% of the study participants. Participants also reported that there were minimal technical difficulties (88%) and the scheduling of remote visits were easy (75%).
To a lesser extent, study participants shared that without this program they would not have gotten the care they needed (69%). Further, respondents reported that the program provided appropriate referrals (69%); sufficient time with care providers (63% with physicians and 57% with other providers – nurses, social workers). 63% of participants shared that the program helped them to decide to go or avoid going to the emergency department.
Themes emerging from the narrative further elucidated the benefits that patients perceived and experienced from receiving care within the PHL-NP CC@H program. Specifically, the following three key themes emerged: 1) easing anxiety by providing emotional support and checking in; 2) providing holistic compassionate care to enable self-management; and 3) viewing virtual care as efficient and convenient. Recommendations for improvement also emerged.
Easing anxiety by providing emotional support and checking in
Similar to the quantitative results, participants shared that the CC@H program helped to alleviate and ease the anxiety they were experiencing associated with contracting COVID-19. Being connected with the PHL-NP provided them with answers to their questions and addressed their concerns, and provided emotional supported normalized their experience and eased their anxiety. Study participants also acknowledged how appreciative they were with the follow up and checking in with them, as one participant described “answering the questions reassured me that I am doing well, I’m glad someone is checking in on me as I am essentially living alone” (Patient 1). Some participants also shared that their anxiety was also alleviated by the physicians associated with the primary care setting the CC@H program was offered in. The following narrative quotes illustrate this theme.
“She (nurse practitioner) provided great emotional support and was phenomenal. I was just so happy that existed during that time for me. She called me up, introduced her role, gave me a number I could call 24/7. She was very personable and down to earth, and provided a lot of reassurance. Definitely provided a lot of emotional support. With the good will and love of the nurse practitioner, I don’t know what I would’ve done without her. She would always check in with my symptoms, she’d always return calls promptly. It was just such a wonderful service offered.” (Patient 3)
“I got a call that day and that really helped, she was mostly just reassuring me and giving me an understanding what to look out for regarding fever, my blood oxygen. That really helped quell the anxiety which probably was the biggest thing at the outset after receiving the diagnosis. I was very pleased, and she kept following up, she spoke to my wife for a little while as well because she had questions. She was following up to make sure I was on the right track, and not get worse and I was very appreciative.” (Patient 2)
“At one point I did call them again because I was panicking a little bit but I just wanted to get some reassurance and somebody from the office called me back a few hours later, so they were pretty good with follow up… I think just the reassurance from the doctors and knowing that somebody was there if you had questions.” (Patient 12)
“She (nurse practitioner) was very reassuring. She made me feel moralized, she said I have 2 cohorts of patients and a lot of my patients this group are feeling very much the same as you or have had these symptoms. I felt like okay, what I’m experiencing is normal. I think the most important thing was I was really worried about the asthma and the breathing. How accessible the nurse practitioner was and being able to get reassurance.” (Patient 4)
Providing holistic compassionate care to enable managing care
Closely aligned with the first theme, the holistic, compassionate care provided by the PCL-NP lead of the CC@H program was viewed as valuable in study participants’ efforts to manage their care and care of their family which, in some situations had become infected, or in isolation to avoid acquiring COVID-19. Study participants described the PCL-NP as “calm”, ‘a rock’, and ‘a life line’ as she helped patients to monitor and manage their symptoms and problem solve by providing information on what to look for and triggers to seek emergency and urgent care services and return home. As one participant shared “she was literally helping me triage my entire family while I’m still going through it myself. She was helpful to me in helping me manage symptoms, dry mouth at the beginning. Helping me problem solve as acute issues arose with each family member at the same time.” (Patient 2) Further quotes that exemplify this theme include:
“She helped me self-manage, she encouraged me to get an oximeter and get the necessary equipment to manage, what the cut offs are for a low oxygen or high heart rate or when it was truly time to seek medical assistance, and just giving me very black and white clinical advice on when it’s time to act and what more I could for myself and how so just providing appropriate self-management support.” (Patient 3)
“It was the hard facts, the thresholds to be mindful of in terms of myself and my symptoms. In a situation where you can’t just walk into a hospital and get care, that I think helped because I was allowed to self-monitor with confidence. She told me what to look out for and she said if it (e.g. blood oxygen) ever went below, I think it was 91% or something, I should call an ambulance. At only one point did it do that but I retested about 30 seconds after and it bounced right back.” (Patient 2)
“The nurse practitioner was, just amazing. I’ve never seen her, we’ve only spoke on the phone, so if you have the opportunity to pass along from me personally that she was just a lifeline.” (Patient 8)
“I’m here alone - what if I had a really bad accident. When I told her that I’m crying, and she was super calm and she was like okay so this is what we need to do. We need to get a pulse oximeter and you’re going to read it and if it’s below 90, you’re going to call 911 and you’re going to the hospital.” (Patient 4)
Viewing virtual care as efficient and convenient
Similar to survey findings, several of the study participants described the efficiency of home-based virtual care and telehealth. Specifically, they shared that appointments were on time and more efficient than going to a doctor’s office. Further, the time saved by not having to go the primary care setting or emergency services located in a busy downtown area and the convenience, particularly during episodes where they were experiencing symptoms, was also beneficial to study participants, as noted in the following narrative:
“The idea that somebody could talk to you rather than lug your ass down to their office and be sitting in a room where there’s other people that may have other things when you’re already immunocompromised, I’m quite happy to talk to somebody on the phone. I think it’s a really – it’s that kind of care I think we’re going to see because of COVID, more at home care being delivered. There’s a lot you can do by sending photographs or if you’re facetiming, it’s something they can see.” (Patient 7)
“If someone’s checking in on you on a daily basis there’s less of a chance of things going the wrong way quickly. It can let you say okay it’s time to go to the hospital or you’re doing fine at home. It keeps people out of emergency because they’ve got somebody to talk to.” (Patient 10)
“Everything was always on time. If an appointment was booked for a specific time then the calls were always on time. It was very different from waiting at a doctor’s office where it could go on for a little bit later. Everything was always very efficient, it felt like more efficient than going into the doctor’s office.” (Patient 6)
“They were all over the phone, and that was really convenient because we were self–isolating too so we didn’t want to leave the house and we didn’t have to go to the hospital. Everything was over the phone.” (Patient 11)
Study participants also identified a few gaps and areas for improvement including variation in follow ups and check ins from the CC@H program. Variation ranged from consistent while others reported sporadic check ins with some reporting no check ins at all. Further, some participants were confused about whether they were oriented to the program at the beginning, thus causing confusion of their participation within the CC@H program. Finally, expanding the program to include other disciplines (e.g. psychology, social work) was suggested. The following quotes illustrate the suggested areas for improvement:
“Reassurance of maybe access to a counsellor at the time or a social worker at the time. Just to talk about the illness and how it affects people’s everyday life and all that stuff. Just maybe knowledge, offering of extra resources, or reassurance maybe that—I have no idea. Just someone to check in I guess just to see how I was doing, if I was improving or whatever.” (Patient 5)
“It was not as regular as I would’ve liked it to be, people had days off. There also wasn’t as rigid of a pattern that I could rely on so I sometimes wondered what’s happening? Had there been a consistent person checking with me that would’ve been good. There was a nurse practitioner initially and then she was gone for a week, so one of the other doctors in the team took care of it. Then it dissipated rather than ended. I didn’t get a sense of completion of this is over. The one doctor I remember saying ‘I think you’re doing fine.’ But I didn’t get the impression that there wouldn’t be any more calls. I think closure needs to be more intentional or more clear or reasons that you’re now at this degree of wellness and therefore we’re not going to be calling you anymore.” (Patient 1)
“I’m just wondering though for people who didn’t have access as a frontline staff to a psychologist. Because the nurse practitioner had her hands full. If perhaps with COVID, there was a psychologist at home because a lot of times easing your mind can maybe ease how you’re physically feeling to some extent. I think if there was a psychologist working with her in some cases because it’s a real head game, this illness.” (Patient 3)
“I’m not sure exactly what the program was. I mean I did speak with my doctor a couple of times, 2–3 times as I was going through the COVID. She’s the one who had mentioned the relapse. My symptoms weren’t bad enough, I didn’t get any sort of prescription medication from her, I just used Tylenol and that was it and maybe the decongestant. Just over the counter stuff. There was no prescription.” (Patient 13)