Findings from a new study support a growing body of evidence that the Real-Time Virtual Support program strengthens healthcare in First Nations, rural and remote communities.
The new study is titled Healthcare Providers’ Experiences Accessing Real-Time Virtual Support: Informing More Equitable and Inclusive Healthcare Access in British Columbia’s Rural, Remote, First Nations, and Other Indigenous Peoples and Communities.
The study was published in the Healthcare Management Forum in February and set out to understand rural and remote health care providers’ experiences with RTVS virtual peer pathways for improving access to care.
The main author of the research, Hollis Owens, said: “RTVS is integrated in the fabric of rural, remote, First Nations and other Indigenous communities where health care providers rely on being able to ‘phone a friend’ to provide culturally safe and high-quality care for patients.”
The study concluded three main things:
- Providing timely virtual support is an essential service for health care providers working in rural, remote First Nations and other Indigenous communities
- It is important to maintain technological infrastructure in communities in order to ensure access to care
- Sustained funding for RTVS is needed
The RTVS peer program, administered by the Rural Coordination Centre of BC, connects on-the-ground rural clinicians with RTVS physicians over Zoom or phone. The RTVS instant access pathways are staffed by friendly, compassionate physicians who can offer focused support in Emergency Medicine, Pediatrics, Maternity, Critical Care and Internal Medicine.
The care combines virtual and in-person services to ensure a patient receives integrated, team-based care. This type of care has been identified as a solution for some of the challenges that rural providers face.
A Learning Health System team from UBC Digital Emergency Medicine carries out evaluation of RTVS and this research stems from their work.
A total of 20 users of RTVS participated in the study, including 12 physicians, seven nurses, and one midwife.
Among the themes outlined in the study were the benefits of accessing RTVS peer supports and the outcomes of increasing equitable access to healthcare in First Nations, rural and remote communities.
Timeliness
End-users of RTVS peer support were very appreciative of how quickly they could reach help. They often compared their experience with what it was like before they had the service.
““What used to happen is we would have to call…a very busy Emergency Department…. get put in the queue, we might have to wait an hour, two hours, three hours, depending on the acuity of the situation. When they did end up calling you back…they did not have a lot of time for you. It’s all understandable. This is just the services that they have… now I feel like I have the time to consult for a lot of things that I would never have called for before. So, it’s not just the timing issue, there’s also a quality of care that has significantly improved.””
Cultural Safety
End-users of RTVS consistently described their interactions with RTVS providers as culturally safe for their context and patients.
Most of the providers who took part in the study discussed that a main strength of RTVS was the respectful and collegial support provided by RTVS physicians, including their coaching skills and understanding of the rural practice setting and resources available.
Nursing frequently noted that RTVS providers were also respectful and knowledgeable of the remote nursing scope of work and were respectful in interactions with First Nations communities.
A stated aim of the RTVS program is that providers meet or exceed the College of Physicians and Surgeons of BC’s cultural safety, cultural humility and anti-racism practice standard. They are offered regular cultural safety and humility workshops, presentations, faculty development, and rural community outreach opportunities to ensure progress on their cultural safety and humility journey.
End-users have noticed, with one nurse saying that RTVS providers “have a good understanding of the communities that we’re working for and … [are] very open to exploring alternative treatments and things like that that maybe fit better with a lifestyle plan.”
Transport Help
A substantial benefit of RTVS drawn from the data was its ability to support rural and remote providers when patient transport was needed, including coordinating with the Patient Transport Network (PTN) or avoiding transport when not needed.
“One of the things that I find really helpful from RTVS in my experience is the kind of co-management piece, where sometimes if we need to call PTN or arrange a transfer for a patient, they can actually make those calls for us or help us with those calls while we’re dealing with the actively sick patient. It keeps us hands-on [with] the patient more, and improves care that way,” said one participant in the study.
Recruitment and Retention
Accessing RTVS peer support to speak with an experienced colleague helped rural providers feel more confident to practice and reduced isolation and anxiety. This ultimately improved provider and patient satisfaction, with providers feeling like it helped with recruitment and retention.
“They [RTVS]…have filled a gap… they’ve increased accessibility to higher level of care knowledge,” one participant noted. They continued: “By doing that they contribute to the retention and recruitment to rural areas… So having RTVS I think allows people to take away a little bit of that anxiety and might allow people to be more willing to come out.”
Feeling supported and safe was key to providers’ willingness to stay in rural areas.
““I feel like if I didn’t have CHARLiE [the pediatric pathway for RTVS] available I would really consider whether I want to practice in a rural community or not because I would probably feel unsafe in some situations, or like I don’t have the resources I need and that’s not safe for me professionally or for my patients."”
Challenges
The study also noted some challenges related to the administration and implementation of RTVS included longer wait times when RTVS is busy. This highlights the importance participants place on sustaining RTVS; for these rural providers, RTVS has become embedded in their practice.
Another challenge raised by a few participants was the need for integration of RTVS support into the health system for continuity of care for patients.
RCCbc team members Erika Pritchard and Anne Lesack contributed to the study.
Anne said: “We frequently hear from end-users about the importance of RTVS to their daily practice. It’s wonderful to be able to share this study as it offers a more comprehensive look at their experiences and highlights the critical role qualitative data and stories play in fully understanding the program’s impact.”
Erika added: “RTVS users appreciate how timely, rurally relevant and culturally safe the service is and this study supports that.”
