This mixed-method study aimed to assess the experiences of Renfrew County residents with VTAC, and to identify factors that influence their satisfaction with the program. Survey data analysis revealed that participants expressed overwhelmingly high satisfaction with all visit modalities (virtual physician, hybrid, in-person paramedic). Importantly, visit-related factors, such as issue resolution, played a significantly greater role in determining patient satisfaction than demographic factors such as age, gender, economic status or digital literacy. Qualitative interviews revealed four key themes (“Healthcare in Renfrew County”, “Accessing VTAC”, “VTAC Clinical Care” and “Improving VTAC”), underscoring a widespread perceived access-to-care crisis, affecting both unattached residents and some attached residents in Renfrew County. The findings also suggest that residents value VTAC's accessibility, care quality, and effectiveness in meeting regional healthcare needs, while also identifying areas for improvement.
VTAC also includes an attachment arm, known as the Integrated Virtual Care, which enrolls patients to a named family physician predominantly working off-site. These IVC family physicians are embedded within existing local family health teams. Patients receive comprehensive, team-based primary care, through a blend of in-person, at-home, and virtual care options tailored to their individual needs and preferences. Virtual care options include secure messaging, telephone and video encounters from the patient’s home, as well as enhanced telemedicine options at the local clinic. Enhanced telemedicine involves an allied health professional being present in-person with the patient, providing real-time assistance to the physician delivering virtual care. Partnership with the existing community paramedicine program enables a range of at-home care options for vulnerable, home-bound patients. Furthermore, other physicians, nurse practitioners, and allied health professionals within each local group offer additional in-clinic care options for IVC patients. The named IVC family physician retains overall responsibility for their patients’ primary care (30, 43). Although the IVC is a part of VTAC, it was not the focus of this study, as it is currently undergoing its own independent evaluation.
Rural healthcare challenges are well documented in Ontario (12, 15, 16). During our study, we identified a significant access-to-care crisis within Renfrew County. On the one hand, the county has a significant number of unattached residents (23), and the region lacks the required resources and infrastructure, such as walk-in clinics, to address the acute and episodic healthcare needs of this unattached population. On the other hand, residents with a family doctor also encounter significant barriers to accessing care. Their providers may be distant (often outside the county) and overburdened, especially in more rural regions. This indicates that the access crisis extends to many residents who are formally attached to a provider.
Previous work suggests that longer travel distance contributes to “distance decay”, leading to worse health outcomes (14). In our study, only one-third of survey respondents reported living within 5 kilometers of the nearest hospital, with distance also being a recurring complaint during study interviews. Our findings show, however, that virtual care represents an excellent tool in response to the aforementioned challenge, especially considering Renfrew County's widespread broadband internet access (11). This context, coupled with the high levels of satisfaction reported in our surveys and interviews, suggests that VTAC’s mode of care delivery is a well-suited complement to the existing care delivery options in Renfrew County.
Concerns frequently arise regarding virtual care's impact on health equity, stemming from the notion that residents with lower levels of digital or healthcare literacy may struggle to adapt to new technologies, potentially hindering their access (44). Our study challenges these perceived apprehensions. On rare occasions, interviewees mentioned the possibility that digital, or healthcare literacy could pose challenges. However, survey data reveal that satisfaction with VTAC is not strongly linked to demographic factors such as age or digital literacy. Rather, satisfaction was more closely associated with visit-related factors, including the quality of care and the successful resolution of health concerns. These findings are consistent with previous research on patient experiences with virtual care (33, 45). Furthermore, a recent Canadian systematic review of mixed-methods studies by Ilali et al. suggests that older adults adapt well to telemedicine in a primary care setting (46).
Recommendations
Since its establishment in 2020, VTAC has made significant progress, but there is still room for improvement. Patient feedback suggests a desire for VTAC to expand its in-person healthcare options. This expansion could build on the proven effectiveness and cost-efficiency of paramedic-led home visits and assessment centres (47, 48), or establish new partnerships with other providers such as community pharmacists. Moreover, VTAC's triaging system could be made more transparent and flexible by offering patients options for consultation modes—phone, video, or in-person—since currently, they have little to no involvement in this decision-making process. Although VTAC has undertaken significant campaigns to raise awareness (23), there is a need to continue and strengthen these efforts, particularly by clarifying VTAC's scope of practice, as many residents still perceive VTAC as solely an alternative to a 911 line or a COVID-19 clinic, despite its broader capabilities. Throughout the interviews, many residents raised issues with VTAC's booking system, indicating a need for improvement. Revamping the booking system, perhaps by incorporating an online scheduling tool or reevaluating the policy on same-day appointments, could improve the patient experience.
Limitations
Our patient-centered design, involving partners from the community, coupled with the utilization of a mixed-methods approach employing multiple methods, ensures that the study aligns with community needs and provides a fuller understanding of patient experiences with VTAC. However, the findings from the survey should be approached with caution due to inherent biases common in online surveys (49), a low response rate of 13%, and a participant demographic that does not fully represent the entire VTAC population. For example, survey respondents were older (58% over 55 years old vs. 54% in the VTAC population), predominantly female (70% vs. 63% in the VTAC population), and less likely to be unattached to a provider (58% unattached vs. 73% in the VTAC population) (19). Consequently, some communities and patient groups were not well represented in our study sample. Moreover, the interview participants consisted only of residents who engaged in virtual appointments with physicians and in-person appointments with community paramedics. While these two modalities account for the majority (92%) of VTAC appointments (19), we did not interview participants who had experienced hybrid appointments or other rare visit types, suggesting that our study did not cover all appointment modalities. Finally, VTAC operates within Renfrew County, and our results may not directly apply to other primary care programs across Canada or internationally.