Real-Time Virtual Support Program

With the COVID-19 pandemic rapidly escalating throughout BC in early 2020, the Joint Standing Committee on Rural Issues, led by the BC Ministry of Health and Doctors of BC, asked RCCbc to take swift action in facilitating the development and implementation of the RTVS Program to support rural providers and patients. RCCbc drew upon its long-standing relationships with multiple partners, including First Nations Health Authority, Providence Health Care, Provincial Health Services Authority, University of British Columbia’s (UBC) Department of Emergency Medicine, UBC Continuing Professional Development, BC Emergency Medicine Network, and HealthLink BC to expedite the Program’s infrastructure and rollout.

In spring 2020, RTVS partners stood up two peer-to-peer pathways for healthcare providers, RUDi (emergency) and ROSe (critical care), and two patient-facing pathways, the First Nations Virtual Doctor of the Day and HEIDi (through HealthLink BC). In the summer months, CHARLiE (pediatrics) and MaBAL (maternity and newborn) were added for healthcare providers, followed throughout the year by UBC Dermatology Rural and Remote Service, myoLIVE (myofascial pain), RheumVision (rheumatology), Clinical Hematology, and Thrombosis Medicine. The First Nations Virtual Substance Use and Psychiatry Service, which complements services provided through the First Nations Virtual Doctor of the Day, was also added as the year progressed.

In addition to facilitating the recruitment and training of “virtual providers” for the four original pathways, RCCbc coordinated the information technology infrastructure needed to run the pathways, including the allocation of Zoom accounts and telephone lines. It also trained numerous healthcare providers in rural, remote, and Indigenous communities to get started using the RTVS pathways.

The positive impact of the RTVS pathways became clear almost immediately. Throughout the year, peer-to-peer pathways offered 28,776 hours of support for 2,250 cases of varying complexity to rural health providers in 86 unique BC communities. Meanwhile, since April 2020, the First Nations Doctor of the Day and the First Nations Virtual Substance Use and Psychiatry Service recorded 5,201 and 901 encounters, respectively, with over 95 percent of their clients reporting that they would recommend their services to family and friends. Meanwhile, virtual physicians on the HEiDi pathway, provided through HealthLink BC, recorded 30,013 encounters since April 2020, advising almost 75 percent of patients away from in-person emergency or clinic assessment, and 17 percent of patients to seek emergency department care.

The RTVS team has recognized that rigorous evaluation of the Program is mandatory for its success and for the sustainability of services beyond COVID-19. RCCbc was pleased to contribute to both a 90-day and six-month evaluation by the RTVS Learning Health System and Evaluation team. A one-year evaluation will be finalized and released in May 2021.

Qualitative feedback from rural, remote, and Indigenous health practitioners and patients has demonstrated the acceptance, need, and continued desire for RTVS pathways:

“RTVS is a fantastic service that has been a long time coming and really needs to stay. RTVS will improve recruitment and retention of rural doctors, which will benefit many patients; good to have peace of mind to be able to call a non-judgmental colleague for support.”

—Rural general practitioner who accessed RUDi and ROSe

“I can’t express enough how grateful I am as a relatively new-to-practice physician in rural BC to have RUDi, ROSe, CHARLiE, and all the lines and tools that have been rolled out. Very quickly, these supports have been integrated into how I practice in the clinic and Emergency Department. Access to these services in the nick of time has changed outcomes.”

—Rural general practitioner

“A virtual physician appointment is an excellent idea and I hope it continues beyond COVID. I wasn’t able to see my family doctor in a timely manner and needed to better understand how to handle my concussion moving forward. Speaking with [the doctor] was a discussion rather than a one-sided delivery of information. He helped me figure out a move forward plan for my specific circumstances, the activities I participate in on a regular basis. I was impressed with the manner in which he dealt with my situation and am very pleased that 811 is now linked to physicians.”

—HEiDi client

“Everything was perfect, right from the receptionist making the appointments to the doctor talking with me. Very efficient and one of the best doctor appointments I have had.”

—First Nations Virtual Doctor of the Day client

In the coming year, the RTVS Program will onboard new pathways that allow for additional specialized supports for both providers and patients across rural and remote BC. It will also use findings from RTVS Learning Health System Evaluation to understand how RTVS initiatives can be improved from both a user perspective and an implementation-process perspective. RTVS partners will also grow their community outreach and program dissemination across areas of BC to providers and patients who have not yet heard about it. The team will implement awareness-raising and partnership initiatives, such as meeting with health authorities, delivering presentations, and creating a strategy to work with UBC’s Department of Family Practice. It will also participate in academic grand rounds and hold other educational sessions for residents and medical students to engage them in RTVS.