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A mixed-methods exploration of the Real-Time Virtual Support pathway Child Health Advice in Real-Time Electronically
Sean Duke1, Jenna Treissman1, Shannon Freeman2,3
1Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Insights
The Child Health Advice in Real-Time Electronically (CHARLiE) virtual paediatric service improved access to care and reduced paediatrician burnout in Northwestern British Columbia. This innovative model enhanced provider confidence and caregiver trust, promoting health equity for children in rural areas.
Area of Science:
- Pediatric Healthcare Delivery
- Telemedicine Implementation
- Rural Health Equity
Background:
- Implementing a provincial virtual paediatric consulting service, Child Health Advice in Real-Time Electronically (CHARLiE), aimed to integrate with existing paediatric on-call schedules.
- This initiative sought to address healthcare access challenges in Northwestern British Columbia.
Purpose of the Study:
- To explore the implementation and impact of the CHARLiE virtual paediatric consulting service.
- To evaluate healthcare providers' experiences with virtual paediatric consultations in lieu of in-person coverage.
Main Methods:
- A mixed-methods approach was employed, including surveys (n=72) and focus groups (n=35) with healthcare providers.
- Qualitative data from focus groups and key informant interviews (n=4) were analyzed thematically.
- Survey data were analyzed using descriptive statistics.
Main Results:
- 96.1% of users rated CHARLiE as 'good' or 'very good', and 77.6% reported improved access to paediatric care.
- Providers valued timely virtual assessments, collegiality, reduced burnout, and prevention of unnecessary transfers.
- Video support enhanced provider confidence and caregiver trust, though technological barriers and continuity of care were noted areas for improvement.
Conclusions:
- CHARLiE provides valuable 24/7 virtual support, improving access to paediatric care in smaller communities.
- While not replacing on-the-ground specialists, virtual support enhances health equity for children in British Columbia.
- The service positively impacts paediatrician well-being and reduces indirect patient care burdens.
Objectives:
To explore the implementation of a provincial virtual paediatric consulting service, Child Health Advice in Real-Time Electronically (CHARLiE), integrated into the paediatric on-call schedule in Northwestern British Columbia.
Methods:
Healthcare providers in Northwestern British Columbia responded to a survey (n = 72) and participated in focus groups (n = 35) and key informant interviews (n = 4) to share their experiences engaging in a healthcare model that incorporated virtual paediatric consultants in lieu of in-person local paediatrician coverage over a 28-month period. Survey data was analyzed using descriptive statistics. Themes were generated from a qualitative descriptive approach to focus groups and key informant interview transcripts.
Results:
96.1% of survey respondents who had used CHARLiE rated it as 'good' or 'very good' in the provision of overall support, while 77.6% reported that CHARLiE improved access to paediatric care. Focus group and key informant interview participants valued CHARLiE's timely, dedicated virtual bedside assessments of patients; collegiality and professionalism; amelioration of local paediatrician burnout; prevention of unnecessary transfers; and offloading of indirect patient care tasks. Video support improved provider confidence and appeared to improve caregiver trust. Suggested improvements included addressing technological barriers, enhancing providers' knowledge of local resources, and enabling continuity of care. Participants identified that virtual care does not replace on-the-ground specialist care.
Conclusions:
Participants valued CHARLiE's 24/7, timely, and collegial video support. While maintaining a full complement of on-the-ground paediatricians remains the goal for some rural communities, dedicated virtual support provides access to paediatric care in smaller communities, thereby improving health equity for children in British Columbia.
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